prednisone (Rx)

Brand and Other Names:Deltasone, Rayos, more...Prednisone Intensol, Sterapred, Sterapred DS
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

concentrate

  • 5mg/mL

oral solution

  • 5mg/5mL

tablet

  • 1mg
  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 50mg

tablet, delayed release

  • 1mg
  • 2mg
  • 5mg

Glucocorticoid-Responsive Conditions

5-60 mg/day PO in single daily dose or divided q6-12hr

Dosing considerations

  • When converting from immediate-release to delayed-release formulation, note that delayed-release formulation takes about 4 hours to release active substances
  • Note that exogenous steroids suppress adrenal cortex activity least during maximal natural adrenal cortex activity (between 4:00 and 8:00 AM)

Acute Asthma

40-60 mg/day PO in single daily dose or divided q12hr for 3-10 days

Giant Cell Arteritis

40-60 mg PO qDay (1-2 years usual duration of treatment)

Idiopathic Thrombocytopenic Purpura

1-2 mg/kg/day PO  

Dose Tapering

Day 1: 10 mg PO before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime

Day 2: 5 mg PO before breakfast, after lunch, and after dinner and 10 mg at bedtime

Day 3: 5 mg PO before breakfast, after lunch, after dinner, and at bedtime

Day 4: 5 mg PO before breakfast, after lunch, and at bedtime

Day 5: 5 mg PO before breakfast and at bedtime

Day 6: 5 mg PO before breakfast

Rheumatoid Arthritis

Immediate-release: ≤10 mg/day PO added to disease-modifying antirheumatic drugs (DMARDs)

Delayed-release: 5 mg/day PO initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis

Advanced Pulmonary/Extrapulmonary Tuberculosis

40-60 mg/day PO, tapered over 4-8 weeks

Autoimmune Hepatitis

60 mg PO qDay for 1 week; THEN 40 mg qDay for 1 week; THEN 30 mg qDay for 2 weeks; follow by 20 mg qDay; give half this dose if giving in combination with azathioprine

COVID-19 (Off-label)

NIH guidelines recommend corticosteroids (preferably dexamethasone) to reduce mortality in hospitalized patients with COVID-19 disease who are receiving either invasive mechanical ventilation or oxygen alone, but not among those receiving no respiratory support

If dexamethasone is unavailable, use alternant glucocorticoids (eg, prednisone, methylprednisolone, or hydrocortisone)

Prednisone 40 mg PO qDay for up to 10 days or discharge, whichever comes first; use in addition to standard of care

Consider prednisone use as follows

  • Supplement oxygen, but not requiring oxygen delivery through high-flow device, noninvasive ventilation, invasive mechanical ventilation, or ECMO
  • Requires oxygen delivery through high-glow device or noninvasive ventilation
  • Requires invasive mechanical ventilation or ECMO

Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)

40 mg PO q12hr for 5 days, then 40 mg PO q24hr for 5 days, then 20 mg q24hr for 11 days

Crohn Disease (Off-label)

40-60 mg PO qDay until resolution and resumption of weight gain (7-28 days usual duration)

Dosage Forms & Strengths

oral solution

  • 5mg/5mL

tablet

  • 1mg
  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 50mg

tablet, delayed release

  • 1mg
  • 2mg
  • 5mg

Inflammation

0.5-2 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 80 mg/day  

Acute Asthma

<12 years: 1-2 mg/kg/day PO in single daily dose or divided q12hr for 3-10 days; not to exceed 80 mg/day  

≥12 years: 40-60 mg/day PO in single daily dose or divided q12hr for 3-10 days

Nephrotic Syndrome

2 mg/kg/day PO; not to exceed 80 mg/day  

Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)

<12 years: 1 mg/kg PO q12hr for 5 days, then 0.5-1 mg/kg q12hr for 5 days, then 0.5 mg/kg q24hr for 11-21 days  

>12 years: 40 mg PO q12hr for 5 days, then 40 mg PO q24hr for 5 days, then 20 mg q24hr for 11 days

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Interactions

Interaction Checker

and prednisone

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          Minor

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            Adverse Effects

            Frequency Not Defined

            Allergic: Anaphylaxis, angioedema

            Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in premature infants, myocardial rupture after recent myocardial infarction, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

            Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper- or hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria

            Endocrine: Abnormal fat deposits, decreased carbohydrate tolerance, development of cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon facies, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in children

            Fluid and electrolyte disturbances: Fluid retention, potassium loss, hypertension, hypokalemic alkalosis, sodium retention

            Gastrointestinal: Abdominal distention, elevation of serum liver enzymes levels (usually reversible upon discontinuance), hepatomegaly, hiccups, malaise, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis

            General: Increased appetite and weight gain

            Metabolic: Negative nitrogen balance due to protein catabolism

            Musculoskeletal: Osteonecrosis of femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures

            Neurologic: Arachnoiditis, convulsions, depression, emotional instability, euphoria, headache, increased intracranial pressure with papilledema (pseudotumor cerebri; usually following discontinuance of treatment), insomnia, meningitis, mood swings, neuritis, neuropathy, paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo

            Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts, central serous chorioretinopathy

            Reproductive: Alteration in motility and number of spermatozoa

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            Warnings

            Contraindications

            Untreated serious infections

            Documented hypersensitivity

            Varicella

            Administration of live or attenuated live vaccine (Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (<2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages, such as, replacement therapy)

            Cautions

            Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia

            Prolonged use associated with increased risk of infection; monitor

            Use with caution in cirrhosis, ocular herpes simplex, hypertension, diverticulitis, hypothyroidism, myasthenia gravis, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, renal insufficiency, pregnancy, diabetes mellitus, congestive heart failure, thromboembolic disorders, GI disorders

            Long-term treatment associated with increased risk of osteoporosis, myopathy, delayed wound healing

            Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated

            Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)

            Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy

            Methylprednisolone is preferred in hepatic impairment because prednisone must be converted to prednisolone in liver

            Prolonged corticosteroid use may result in elevated intraocular pressure, glaucoma, or cataracts

            May cause impairment of mineralocorticoid secretion; administer mineralocorticoid concomitantly

            May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions

            Monitor for Kaposi sarcoma

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            Pregnancy & Lactation

            Pregnancy

            Based on findings from human and animal studies, therapy can cause fetal harm when administered to a pregnant woman

            Published epidemiological studies suggest a small but inconsistent increased risk of orofacial clefts with use of corticosteroids during first trimester; intrauterine growth restriction and decreased birth weight have also been reported with maternal use of corticosteroids during pregnancy; however, underlying maternal condition may also contribute to these risks

            Infants born to pregnant women who have received corticosteroids should be carefully monitored for signs and symptoms of hypoadrenalism

            Animal data

            • Published animal studies show drug to be teratogenic in rats, rabbits, hamsters, and mice with increased incidence of cleft palate in offspring; advise a pregnant woman about potential harm to a fetus

            Lactation

            Prednisolone has been found to be present in human milk following administration to lactating women; published reports suggest infant daily doses are estimated to be less than 1% of maternal daily dose; no adverse effects in breastfed infant have been reported following maternal exposure of prednisolone during breastfeeding

            There are no available data on effects of drug on milk production; high doses of drug administered to lactating women for long periods could potentially produce problems in breastfed infant including growth and development and interfere with endogenous corticosteroid production

            Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from mother’s underlying condition

            In order to minimize exposure, prescribe lowest dose to lactating women to achieve desired clinical effect.

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level; in physiologic doses, corticosteroids are administered to replace deficient endogenous hormones; in larger (pharmacologic) doses, they decrease inflammation

            Absorption

            Bioavailability: 92%

            Duration: Plasma, 60 min; biologic, 8-36 hr

            Peak plasma time: PO (immediate release), 2 hr; PO (delayed release), 6.0-6.5 hr

            Distribution

            Protein bound: 65-91%

            Metabolism

            Extensively metabolized in liver; hydroxylated to active metabolite; conversion can be impaired in liver disease

            Metabolite: Prednisolone (active)

            Elimination

            Half-life: 2.6-3 hr

            Dialyzable: Hemodialysis, no

            Excretion: Urine (mainly)

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            Administration

            Oral Administration

            Take with meal or snack

            High-dose glucocorticoids may cause insomnia; immediate-release formulation is typically administered in morning to coincide with circadian rhythm

            Delayed-release formulation takes ~4 hr to release active substances; thus, with this formulation, timing of dose should take into account delayed-release pharmacokinetics and disease or condition being treated (eg, may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.