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SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS › CORTICOSTEROIDS FOR SYSTEMIC USE › CORTICOSTEROIDS FOR SYSTEMIC USE, PLAIN › Glucocorticoids
prednisolone
H02AB06
Forms & Strengths
- Oral Solution: 5 mg/5 mL, 15 mg/5 mL
- Syrup: 15 mg/5 mL
- Tablet: 5 mg
- Ophthalmic Suspension: 1%
- Ophthalmic Solution: 0.125%, 1%
Adult Dosing
- Initial dosage: 5 mg to 60 mg daily depending on the disease entity being treated
- Maintenance: Titrate to the lowest effective dose
- Multiple sclerosis (acute exacerbation): 200 mg daily for 7 days followed by 80 mg every other day for 1 month
Pediatric Dosing
- Anti-inflammatory or immunosuppressive: 0.14 mg to 2 mg/kg/day in divided doses every 6 to 12 hours
- Acute asthma exacerbation (children > 2 years): 1 to 2 mg/kg/day in single or divided doses for 3 to 5 days
Indications
- Endocrine disorders (primary or secondary adrenocortical insufficiency)
- Rheumatic disorders (rheumatoid arthritis, systemic lupus erythematosus)
- Allergic states (bronchial asthma, severe seasonal rhinitis)
- Dermatologic diseases (pemphigus, severe erythema multiforme)
- Ophthalmic diseases (severe acute and chronic allergic and inflammatory processes)
- Respiratory diseases (symptomatic sarcoidosis, Loeffler's syndrome)
Mechanism of Action
- Synthetic glucocorticoid that crosses cell membranes and binds to specific cytoplasmic glucocorticoid receptors
- Modulates protein synthesis to suppress the immune system by inhibiting leukocyte infiltration at the inflammatory site
- Interferes with mediator release of the immune response and suppresses humoral immune responses
Contraindications
- Systemic fungal infections
- Known hypersensitivity to prednisolone or any component of the formulation
- Administration of live or live-attenuated vaccines in patients receiving immunosuppressive doses
Adverse Reactions
- Fluid retention, hypertension, and electrolyte imbalance (sodium retention, potassium loss)
- Hyperglycemia, masking of infections, and impaired wound healing
- Osteoporosis, vertebral compression fractures, and myopathy
- Cushingoid appearance (moon facies, central obesity), weight gain
- Psychiatric disturbances (mood swings, psychosis, euphoria, depression)
- Increased intraocular pressure, cataracts (with long-term systemic or ophthalmic use)
Drug Interactions
- CYP3A4 inducers (e.g., rifampin, phenobarbital, phenytoin) decrease prednisolone plasma concentrations
- CYP3A4 inhibitors (e.g., ketoconazole, macrolides) increase prednisolone exposure and toxicity
- Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of gastrointestinal ulceration and bleeding
- Antidiabetic agents: Corticosteroids antagonize hypoglycemic effects, requiring dose adjustments
- Coumarin anticoagulants: May enhance or diminish anticoagulant effects; monitor INR closely
- Potassium-depleting agents (e.g., thiazide or loop diuretics) increase the risk of severe hypokalemia
Curated Content: Needs Vetting Before Put to Clinical Use