Prednisone

A to Z Drug Facts

(PRED-nih-sone)

Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M, Prednisone Intensol Concentrate, Sterapred, Sterapred DS,  Alti-Prednisone, Apo-Prednisone, Deltasone, Jaa Prednisone, Novo-Prednisone, Winpred

Class: Corticosteroid

 Action Intermediate-acting glucocorticoid that depresses formation, release and activity of endogenous mediators of inflammation, including prostaglandins, kinins, histamine, liposomal enzymes and complement system. Also modifies body's immune response.

 Indications Endocrine disorders; rheumatic disorders; collagen diseases; dermatologic diseases; allergic states; allergic and inflammatory ophthalmic processes; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states (because of nephrotic syndrome); GI diseases; multiple sclerosis; tuberculous meningitis; trichinosis with neurologic or myocardial involvement. Unlabeled use(s): COPD; Duchenne's muscular dystrophy; Graves ophthalmopathy.

 Contraindications Systemic fungal infections; administration of live virus vaccines.

 Route/Dosage

ADULTS: PO 5 to 60 mg/day.

COPD

ADULTS: PO 30 to 60 mg/day for 1 to 2 wk, then taper.

Duchenne's Muscular Dystrophy

ADULTS: PO 0.75 to 1.5 mg/kg/day.

Graves Ophthalmopathy

ADULTS: PO 60 mg/day; taper to 20 mg/day.

 Interactions

Anticholinesterases: Antagonizes anticholinesterase effects in myasthenia gravis. Anticoagulants, oral: Alters anticoagulant dose requirements. Barbiturates, hydantoins (eg, phenytoin), rifampin: Decreased pharmacologic effect of prednisone. Cyclosporine: Enhanced cyclosporine toxicity. Estrogens, ketoconazole, oral contraceptives: Decreased clearance of prednisone. Nondepolarizing muscle relaxants: May potentiate, counteract, or have no effect on neuromuscular blocking action. Salicylates: Reduced serum levels and efficacy of salicylates. Somatrem: Inhibition of growth-promoting effects of somatrem. Theophylline: Alterations in pharmacologic activity of either agent.

 Lab Test Interferences May increase serum cholesterol; decrease serum levels of T₃ and T₄; decrease uptake of thyroid I¹³¹; and cause false-negative result on nitroblue-tetrazolium test for systemic bacterial infection and suppression of skin test reactions.

 Adverse Reactions

CV: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture; CHF. CNS: Convulsions; pseudotumor cerebri (increased intracranial pressure with papilledema); vertigo; headache; neuritis/paresthesias; psychosis. DERM: Impaired wound healing; thin fragile skin; petechiae and ecchymoses; erythema; lupus erythematosus–like lesions; subcutaneous fat atrophy; purpura; striae; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation. EENT: Posterior subcapsular cataracts; increased intra-ocular pressure; glaucoma; exophthalmos. GI: Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer with perforation and hemorrhage; small and large bowel perforation. GU: Increased or decreased motility and number of spermatozoa. HEMA: Leukocytosis. META: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; hypocalcemia. OTHER: Musculoskeletal effects (muscle weakness, steroid myopathy, muscle mass loss, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures, including vertebral compression fractures and pathologic fracture of long bones); endocrine abnormalities (menstrual irregularities, cushingoid state, growth suppression in children secondary to adrenocortical and pituitary unresponsiveness, increased sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements in diabetics, negative nitrogen balance because of protein catabolism, hirsutism); anaphylactoid/hypersensitivity reactions; aggravation or masking of infections; malaise; fatigue; insomnia.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Observe growth and development of infants and children on prolonged therapy. Elderly: May require lower doses. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Cardiovascular effects: Use drug with great caution in patients who have suffered recent MI. Hepatitis: Drug may be harmful in patients with chronic active hepatitis positive for hepatitis B surface antigen. Hypersensitivity: May occur, including anaphylaxis. Immunosuppression: Do not administer live virus vaccines during treatment. Infections: May mask signs of infection. May decrease host-defense mechanisms to prevent dissemination of infection. Ocular effects: Use systemic drug cautiously in ocular herpes simplex because of possible corneal perforation. Ophthalmic use: Prolonged use may result in glaucoma, cataracts, or other complications. Peptic ulcer: May contribute to peptic ulceration, especially with large doses. Renal impairment: Use with caution; monitor renal function. Stress: Increased dosage of rapidly acting corticosteroid may be needed before, during and after stressful situations. Withdrawal: Abrupt discontinuation may result in adrenal insufficiency.

 Administration/Storage

• Administer with meal or snack.
• Give single daily dose before 9 AM; space multiple doses evenly throughout day.
• Do not administer to patients who have received live virus vaccine within last month.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note MI, diabetes, renal impairment, hepatitis, tuberculosis, peptic ulcer disease, ocular herpes simplex, or current infections.
• Ensure that baseline laboratory tests have been obtained before beginning therapy, and monitor for possible hyperglycemia, hypokalemia, and hypocalcemia during treatment.
• Be aware that drug may mask signs of infection and that resistance to infection may be diminished.
• Observe for possible delayed wound healing.
• Monitor blood glucose of diabetic patient carefully.
• If menstrual irregularities, muscle wasting or weakness, rounded moon facies, fluid retention, GI bleeding or mental status changes occur, notify physician.
• Assess for signs of adrenal insufficiency (eg, fever, myalgia, arthralgia, malaise, anorexia, nausea, orthostatic hypotension, dizziness, fainting). Notify physician immediately if this condition is suspected.

 Patient/Family Education

• Advise patient to take single daily doses or alternate day doses in morning (before 9 AM) and to take multiple doses at evenly spaced intervals throughout day.
• Instruct patient to take medication with meals or snack to avoid GI irritation.
• Caution patient not to discontinue drug suddenly, to avoid withdrawal syndrome. Explain that dosage will be tapered slowly (until £ 5 mg/day) before stopping.
• Warn patient to avoid people with known viral infections, particularly chickenpox or measles, and to inform physician if exposure occurs.
• Explain that patient should not receive live virus vaccinations.
• Instruct diabetic patients to monitor blood glucose closely.
• Advise patient to notify health care providers of drug regimen before any surgical procedure, emergency treatment, immunization, or skin test.
• Tell patient to carry medical identification card at all times describing medication being taken.
• Tell patient about symptoms of adrenal insufficiency (eg, fever, myalgia, malaise, anorexia, nausea, orthostatic hypotension, dizziness, fainting) and need to report these symptoms to physician immediately.
• Instruct patient to report the folowing symptoms to physician: Black tarry stools, vomiting of blood, menstrual irregularities, unusual weight gain, swelling of lower extremities, puffy face, muscle weakness, prolonged sore throat, fever, or cold.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts