Prednisolone

# Prednisolone ## Overview - **Classification**: Corticosteroid (intermediate-acting glucocorticoid) - **Mechanism**: Binds to glucocorticoid receptors, inhibiting inflammatory mediators, suppressing immune response, and modulating metabolism. ## Primary Indications 1. **Inflammatory Conditions**: Asthma, allergic reactions, dermatologic diseases, inflammatory bowel disease. 2. **Autoimmune Disorders**: Rheumatoid arthritis, systemic lupus erythematosus. 3. **Neoplastic Diseases**: Leukemias, lymphomas, multiple myeloma. 4. **Adrenal Insufficiency**: Replacement therapy. 5. **Organ Transplant**: Prophylaxis and treatment of rejection. ## Adult Dosing ### Standard Dosing **Acute Asthma Exacerbation / Allergic Reactions (Short Burst)** - **Dose**: **30-60 mg** - **Frequency**: Once daily - **Route**: Oral - **Duration**: **3-10 days**, then discontinue or taper **Anti-inflammatory / Immunosuppressive** - **Dose**: **5-60 mg** (highly individualized) - **Frequency**: Once daily or divided - **Route**: Oral - **Special Considerations**: Tapering often required for prolonged use. **Adrenal Insufficiency (Replacement)** - **Dose**: **2.5-10 mg** - **Frequency**: Once daily - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment generally required. - **Hepatic Impairment**: May require dose reduction in severe liver disease (monitor for increased adverse effects). - **Elderly Patients**: Start at lower end of dosing range; monitor for increased susceptibility to adverse effects (e.g., osteoporosis, hyperglycemia). ## Pediatric Dosing ### Neonates (0-28 days) - **Indication**: Bronchopulmonary Dysplasia (BPD) prevention/treatment (off-label) - **Dose**: **0.5 mg/kg/day** - **Frequency**: Once daily - **Maximum**: Not well established, use lowest effective dose. - **Special Notes**: Closely monitor growth, blood pressure, blood glucose, and signs of adrenal suppression. Use only when benefits clearly outweigh risks. ### Infants (1-12 months) - **Indication**: Anti-inflammatory / Immunosuppressive - **Dose**: **0.1-2 mg/kg/day** - **Frequency**: Once daily or divided Q8-12H - **Maximum**: **60 mg/day** for most acute conditions. - **Special Notes**: For acute asthma exacerbations, **1-2 mg/kg/day** for 3-5 days. ### Children (1-12 years) - **Indication**: Anti-inflammatory / Immunosuppressive - **Dose**: **0.1-2 mg/kg/day** - **Frequency**: Once daily or divided Q8-12H - **Maximum**: **60 mg/day** for most acute indications (e.g., acute asthma, severe allergic reactions). - **Special Notes**: For nephrotic syndrome, initial dose typically **2 mg/kg/day** (max **60 mg/day**) for 4-6 weeks, then taper. ### Adolescents (13-18 years) - **Indication**: Follow adult dosing guidelines. - **Dose**: **5-60 mg** orally once daily, depending on indication. - **Maximum**: **60 mg/day** for acute bursts. Higher doses for specific conditions (e.g., oncology) guided by specialist. ## Safety Information ### Contraindications - **Absolute**: Systemic fungal infections (untreated) - **Absolute**: Live or live-attenuated vaccines during immunosuppressive doses - **Relative**: Known hypersensitivity to prednisolone or components ### Common Adverse Effects - **Very Common (>10%)**: Increased appetite, weight gain, fluid retention, hyperglycemia, mood changes, insomnia, indigestion. - **Common (1-10%)**: Hypertension, headache, muscle weakness, osteoporosis (long-term), skin thinning, delayed wound healing. - **Serious but Rare**: Adrenal suppression, GI perforation, avascular necrosis, severe psychiatric disturbances, cataracts/glaucoma (long-term), severe infections. ### Key Drug Interactions - **CYP3A4 Inducers (e.g., phenobarbital, phenytoin, rifampin)**: Decreased prednisolone levels; may need dose increase. - **CYP3A4 Inhibitors (e.g., ketoconazole, clarithromycin)**: Increased prednisolone levels; monitor for toxicity. - **NSAIDs**: Increased risk of GI ulceration and bleeding; concurrent use with caution. - **Warfarin**: May alter anticoagulant effect; closely monitor INR. - **Potassium-depleting diuretics (e.g., thiazides, loop diuretics)**: Increased risk of hypokalemia. - **Live Vaccines**: Contraindicated during immunosuppressive therapy due to risk of severe infection. ## Monitoring & Follow-up - **Before Treatment**: Baseline blood pressure, glucose, electrolytes. Bone mineral density scan for long-term use. - **During Treatment**: Blood pressure, blood glucose (especially in diabetics), electrolytes (potassium), growth velocity in children. - **Clinical Signs**: Monitor for signs of infection, fluid retention, weight gain, mood changes, persistent abdominal pain. ## Clinical Pearls - 💡 **Tapering is essential**: Do not abruptly stop prednisolone after prolonged use to avoid adrenal crisis. - 💡 **Take with food/milk**: To minimize gastrointestinal irritation and upset stomach. - 💡 **Morning dose preferred**: To mimic natural cortisol rhythm and reduce insomnia. - 💡 **Immunosuppression risk**: Counsel patients on increased susceptibility to infections and reporting fever or signs of illness. - 💡 **Long-term effects**: Discuss risks of osteoporosis, cataracts, glaucoma, and diabetes with long-term use. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.