Dosing & Uses
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
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
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

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
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
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.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)
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
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