Prednisolone

General

• Type: Corticosteroid
• Dosage Forms: 5; 5,15,25/5 mL
• Common Trade Names: Flo-Pred, Millipred, Oraped, Pedipred, Prelone, Veripred 20

Adult Dosing

Corticosteroid-responsive conditions

• 5-60mg/day PO divided qd-qid

Asthma, acute

• ED/hospital: 40-80mg/day PO divided qd-bid, cont. until peak flow = 70% predicted
• Outpatient burst treatment: 40-60mg/day PO divided qd-bid x 3-10 days

Asthma, severe persistent

• 7.5-60mg PO qd-qod

Adrenal insufficiency

• 4-5mg/m² PO qd

Multiple sclerosis, acute exacerbation

• 200mg PO qd x 1 wk, then 80mg PO qod x 1 mo

Alcoholic hepatitis, acute

• 40mg PO qd

Pediatric Dosing

Corticosteroid-responsive conditions

• 0.14-2mg/kg/day PO divided qd-qid

Asthma, acute

• ED/hospital: 1-2mg/kg/day PO divided qd-bid
• Max: 60mg/day, cont. until peak flow = 70% predicted
• Outpatient burst treatment: 1-2mg/kg/day PO divided qd-bid x 3-10 days
• Max: 60mg/day

Asthma, severe persistent

• 0.25-2mg/kg PO qd-qod
• Max 60mg/day

Adrenal insufficiency

• 4-5mg/m^2 PO qd

Nephrotic syndrome

• 60mg/m^2/day PO divided tid x 4 wk, then 40mg/m^2 PO qod x 4 wk

Special Populations

• Pregnancy Rating: C
• Lactation: Probably Safe
• Renal Dosing
  • Adult: no adjustment
  • Pediatric: no adjustment
• Hepatic Dosing
  • Adult: not defined
  • Pediatric: not defined

Contraindications

• Allergy to class/drug
• systemic fungal infection
• active or recent varicella infection
• active or recent measles infection
• avoid abrupt withdrawal (high dose or long-term use)
• caution if active infection
• caution if TB infection
• caution if ocular HSV
• caution if immunosuppressed
• caution if hypertension
• caution if CHF
• caution if diabetes mellitus
• caution if seizure disorder
• caution if PUD
• caution if ulcerative colitis
• caution if diverticulitis
• caution if recent intestinal anastomosis
• caution if psychiatric disorder
• caution if hypothyroidism
• caution if osteoporosis
• caution if myasthenia gravis
• caution if renal impairment, severe
• caution if hepatic impairment, severe
• caution if thromboembolic disorder
• caution if coagulation disorder
• caution in elderly patients

Adverse Reactions

Serious

• adrenal insufficiency
• Cushing syndrome
• immunosuppression
• infection
• hypertension
• CHF
• diabetes mellitus
• steroid psychosis
• GI perforation/ulcer
• osteopenia/osteoporosis
• hypokalemic alkalosis
• steroid myopathy
• tendon rupture
• pseudotumor cerebri
• ICP increase
• seizures
• glaucoma
• cataracts
• pancreatitis
• growth suppression (long-term use, pediatric patients)
• exophthalmos
• anaphylaxis
• withdrawal symptoms if abrupt discontinuation (high dose or long-term use)

Common

• sodium and fluid retention
• diaphoresis
• headache
• vertigo
• insomnia
• nervousness
• mood swings
• edema
• muscle weakness
• BP elevation
• glucose intolerance
• petechiae/ecchymosis
• facial erythema
• menstrual irregularities
• hypokalemia
• IOP increase
• impaired wound healing (long-term use)
• Cushing syndrome
• skin pigmentation abnormality
• hirsutism
• urticaria

Pharmacology

• Half-life: 18-36h
• Metabolism: liver, CYP450: 3A4 substrate
• Excretion: urine
• Mechanism of Action: exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects

References

Authors

Tasha Fernando, Ross Donaldson, Neil Young, Claire, Daniel Ostermayer