Prednisone

Prednisone is a prescription medication used most commonly to treat diseases affecting endocrine, rheumatic, collagen, dermatologic, ophthalmic, respiratory, neoplastic, gastrointestinal diseases, allergic reactions, hematologic disorders, edematous conditions, and disorders of the nervous system.

• Prednisone is available under the following different brand names: Deltasone, Rayos, Prednisone Intensol, Sterapred, and Sterapred DS.

Common side effects of prednisone include:

Allergic reactions:

• serious allergic reaction
• rapid swelling

Cardiovascular:

• slow heart rate, under 60 beats per minute
• cardiac arrest
• cardiac irregular rhythm
• cardiac enlargement
• circulatory collapse
• congestive heart failure
• fat embolism
• high blood pressure
• thickening of heart muscles in the premature infants
• laceration or tear in the walls of the heart after a recent myocardial infarction
• fluid in the lungs
• fainting
• elevated heart rate, over 100 beats per minute
• blood clot
• inflammation in a vein caused by a blood clot
• inflammation of blood vessels

Dermatologic:

• acne
• allergic dermatitis
• cutaneous and subcutaneous wasting of the skin
• dry scalp
• swelling
• facial redness
• excessive pigmentation
• impaired wound healing
• increased sweating
• small spots on the skin caused by broken blood vessels
• discoloration of the skin
• rash
• sterile abscess
• stretch marks
• suppressed reactions to skin tests
• thin fragile skin
• thinning scalp hair
• hives

Endocrine:

• abnormal fat deposits
• decreased carbohydrate tolerance
• development of Cushing's syndrome
• excessive body hair
• manifestations of latent diabetes mellitus
• increased requirements for insulin or oral hypoglycemic agents in diabetics
• menstrual irregularities
• development of a rounded appearance of the face
• 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
• high blood pressure
• the imbalance caused by vomiting, diuretics, and mineralocorticoid excess
• sodium retention

Gastrointestinal:

• bloating (abdominal distention)
• elevation of serum liver enzymes levels (usually reversible upon discontinuance)
• enlarged liver
• hiccups
• feeling unwell (malaise)
• nausea
• pancreatitis
• peptic ulcer with possible perforation and hemorrhage
• inflammation of the esophagus

General:

• increased appetite
• weight gain

Metabolic:

• negative nitrogen balance due to protein catabolism

Musculoskeletal:

• death of bone tissue of femoral and humeral heads
• neurologic pain-causing muscle wasting
• loss of muscle mass
• muscle weakness
• osteoporosis
• pathologic fracture of long bones
• steroid myopathy
• tendon rupture
• vertebral compression fractures

Neurologic:

• pain disorder caused by inflammation of the membrane surrounding the nerves
• convulsions
• depression
• emotional instability
• intense excitement
• headache
• increased intracranial pressure with swelling affecting the optic nerve (pseudotumor cerebri; usually following discontinuance of treatment)
• insomnia
• meningitis
• mood swings
• inflammation of a nerve or group of nerves
• damage or disruption to nerves
• partial paralysis
• abnormal sensation
• personality changes
• sensory disturbances
• spinning sensation (vertigo)

Ophthalmic:

• abnormal protrusion of the eye
• increased pressure within the eye
• the increased pressure of the fluid inside of the eye
• posterior subcapsular cataracts
• temporary visual impairment

Reproductive:

• alteration in motility
• number of spermatozoa

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

Adult and pediatric dosages:

Concentrate

• 5 mg/mL

Oral solution

• 5 mg/5mL

Tablet

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

Administration

• Prednisone should be taken with a meal or snack. High-dose glucocorticoids may cause insomnia, and immediate-release formulation is typically administered in the morning to coincide with circadian rhythm.
• The delayed-release formulation takes about 4 hours to release active substances. With this formulation, the timing of the dose should consider the delayed-release pharmacokinetics and the disease or condition being treated (for example, the medication may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis).

Adult

Glucocorticoid-Responsive Conditions

• 5-60 mg/day orally in a single daily dose or divided every 6 to 12 hours.

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).

• Adult: 40-60 mg/day orally in a single daily dose or divided every 12 hours for 3-10 days
• Children younger than 12 years: 1-2 mg/kg/day orally in a single daily dose or divided every 12 hours for 3-10 days; not to exceed 80 mg/day.
• Children 12 years or older: 40-60 mg/day orally in a single daily dose or divided every 12 hours for 3-10 days

• 40-60 mg orally every day (1-2 years usual duration of treatment).

• 1-2 mg/kg/day orally.
• Dose Tapering
• Day 1: 10 mg orally before breakfast, 5 mg after lunch and after dinner, and 10 mg at bedtime
• Day 2: 5 mg orally before breakfast, after lunch, and after dinner, and 10 mg at bedtime
• Day 3: 5 mg orally before breakfast, after lunch, after dinner, and at bedtime
• Day 4: 5 mg orally before breakfast, after lunch, and at bedtime
• Day 5: 5 mg orally before breakfast and at bedtime
• Day 6: 5 mg orally before breakfast

• Immediate-release: Greater than or equal to 10 mg/day orally added to disease-modifying anti-rheumatic drugs.
• Delayed-release: 5 mg/day orally initially; maintenance: lowest dosage that maintains clinical response; may be taken at bedtime to decrease morning stiffness with rheumatoid arthritis.

• 40-60 mg/day orally, tapered over 4-8 weeks
• Pneumocystis (carinii) jiroveci Pneumonia in Patients With AIDS (Off-label)
• Adult: 40 mg orally every 12 hours for 5 days, then 40 mg orally every 24 hours for 5 days, then 20 mg every 24 hours for 11 days.
• Children younger than 12 years: 1 mg/kg orally every 12 hours for 5 days, then 0.5-1 mg/kg orally every 12 hours for 5 days, then 0.5 mg/kg orally every 24 hours for 11-21 days.
• Children 12 years or older: 40 mg orally every 12 hours for 5 days, then 40 mg orally every 24 hours for 5 days, then 20 mg orally every 24 hours for 11 days.

• 40-60 mg orally every day until resolution and resumption of weight gain (7-28 days usual duration).

• 60 mg orally once a day for 1 week; then 40 mg orally once a day for 1 week; then 30 mg once a day for 2 weeks; followed by 20 mg orally once a day; give half this dose if given in combination with azathioprine.

• 0.5-2 mg/kg/day orally in a single daily dose or divided every 12 hours; not to exceed 80 mg/day.

• 2 mg/kg/day orally; not to exceed 80 mg/day

If your doctor has directed you to use this medication for diabetes, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe Interactions of Prednisone include:
  • mifepristone
• Prednisone has serious interactions with at least 76 different drugs.
• Prednisone has moderate interactions with at least 240 different drugs.
• Prednisone has mild interactions with at least 129 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains prednisone. Do not take Deltasone, Rayos, Prednisone Intensol, Sterapred, or Sterapred DS, if you are allergic to prednisone or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Avoid use if there are untreated serious infections, documented hypersensitivity, or chickenpox.
• 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 (less than 2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in the maintenance of physiologic dosages, such as replacement therapy.

Effects of Drug Abuse

• No information was provided.

Short-Term Effects

• See "What Are Side Effects Associated with Using Prednisone?"

Long-Term Effects

• Prolonged use associated with the increased risk of osteoporosis, myopathy, delayed wound healing of infection; monitor. may result in elevated intraocular pressure, glaucoma, or cataracts.
• See also "What Are Side Effects Associated with Using Prednisone?"

Cautions

• Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia.
• Prolonged use is associated with an increased risk of infection.
• Use with caution in liver disease, herpes infection of the eye, high blood pressure, diverticulitis, hypothyroidism, abnormal muscle weakness, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, kidney insufficiency, pregnancy, diabetes mellitus, congestive heart failure, clotting disorders of the blood and GI disorders.
• Long-term treatment is associated with an increased risk of osteoporosis, disease of muscle tissue, and delayed wound healing.
• Patients receiving corticosteroids should avoid chickenpox or measles-infected persons, if unvaccinated.
• Latent tuberculosis may be reactivated (patients with positive tuberculin tests should be monitored).
• Some suggestions (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 the liver.
• Prolonged corticosteroid use may result in elevated pressure in the eye, glaucoma, or cataracts.
• May cause impairment of mineralocorticoid secretion; administer mineralocorticoid simultaneously.
• May cause psychiatric disturbances; monitor for behavioral and mood changes; may exacerbate pre-existing psychiatric conditions.
• Monitor for Kaposi sarcoma, cancer that develops from cells that line lymph or blood vessels.

Pregnancy and Lactation

• Use prednisone with caution in pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies are done. Use prednisone only in LIFE-THREATENING emergencies in pregnancy, when no safer drug is available. There is positive evidence of human fetal risk.
• Some suggestions (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy.
• Breastfeeding: 5-25% of maternal serum metabolites are found in breast milk; prednisone is not recommended when lactating or breastfeeding, or if the benefit outweighs the risk, use the lowest dose.