Prednisone

# Prednisone ## Overview - **Classification**: Corticosteroid (Glucocorticoid) - **Mechanism**: Binds to intracellular glucocorticoid receptors, modulating gene expression to produce broad anti-inflammatory and immunosuppressive effects. ## Primary Indications 1. **Inflammatory/Autoimmune Conditions**: Rheumatoid arthritis, lupus, inflammatory bowel disease, sarcoidosis. 2. **Allergic Reactions**: Severe asthma exacerbations, severe allergic dermatitis, anaphylaxis. 3. **Neoplastic Diseases**: Leukemias, lymphomas (part of chemotherapy regimens). 4. **Organ Transplant**: Prevention and treatment of organ rejection. ## Adult Dosing ### Standard Dosing **Inflammatory/Immunosuppressive Conditions** (e.g., RA, Lupus, Sarcoidosis) - **Dose**: **5 mg to 60 mg** - **Frequency**: Once daily or divided **BID-QID** - **Route**: Oral - **Duration**: Highly variable; long-term use requires gradual taper. **Acute Asthma Exacerbation/Allergic Reaction (Short Burst)** - **Dose**: **40 mg to 60 mg** - **Frequency**: Once daily or divided **BID** - **Route**: Oral - **Duration**: **3 to 10 days** (taper generally not needed for short courses). **Multiple Sclerosis Exacerbation** - **Dose**: **60 mg to 1250 mg** (often **60-120 mg/day**) - **Frequency**: Once daily - **Route**: Oral - **Duration**: **3 to 7 days** ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment generally needed. - **Hepatic Impairment**: Monitor for increased effects; dose reduction may be needed in severe liver disease (prednisone is converted to active prednisolone in liver). - **Elderly Patients**: Use lowest effective dose. Increased risk of osteoporosis, cataracts, and metabolic side effects. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **0.5-2 mg/kg/day** - **Frequency**: Once daily or divided **BID** - **Maximum**: Highly dependent on indication; use with extreme caution. - **Special Notes**: Risk of growth retardation and adrenal suppression. Monitor closely for hyperglycemia. ### Infants (1-12 months) - **Dose**: **0.5-2 mg/kg/day** - **Frequency**: Once daily or divided **BID** - **Maximum**: **60 mg/day** for acute conditions (e.g., asthma burst). - **Special Notes**: Monitor growth, blood pressure, and signs of infection. Oral liquid formulations available. ### Children (1-12 years) - **Dose**: **0.5-2 mg/kg/day** - **Frequency**: Once daily or divided **BID** - **Maximum**: **60 mg/day** (or **80 mg/day** for severe acute conditions). - **Special Notes**: For acute asthma, **1-2 mg/kg/day** for 3-5 days is common. Consider alternate-day therapy for long-term use to reduce side effects. ### Adolescents (13-18 years) - **Dose**: Generally follows **adult dosing** guidelines. - **Maximum**: Up to **60-80 mg/day** for acute conditions. - **Special Notes**: Monitor for growth, bone health, and typical adult adverse effects. ## Safety Information ### Contraindications - **Absolute**: Systemic fungal infections (untreated). - **Absolute**: Known hypersensitivity to prednisone. - **Relative**: Administration of live or live attenuated vaccines when on immunosuppressive doses. ### Common Adverse Effects - **Very Common (>10%)**: Fluid retention, increased appetite, weight gain, insomnia, mood changes. - **Common (1-10%)**: Hyperglycemia, hypertension, acne, skin thinning, impaired wound healing, osteoporosis (long-term). - **Serious but Rare**: Adrenal suppression, gastrointestinal ulceration/bleeding, aseptic necrosis, cataracts, glaucoma, serious infections. ### Key Drug Interactions - **CYP3A4 Inducers (e.g., Rifampin, Phenytoin, Phenobarbital)**: May decrease prednisone levels. Increased prednisone dose may be required. - **NSAIDs**: Increased risk of GI ulceration and bleeding. Use with caution or consider gastroprotection. - **Diuretics (Thiazide/Loop)**: Enhanced potassium loss leading to hypokalemia. Monitor serum potassium. - **Warfarin**: May alter anticoagulant effect. Close INR monitoring is essential. - **Live Vaccines**: Avoid concurrent administration due to risk of vaccine-induced infection. ## Monitoring & Follow-up - **Before Treatment**: Baseline weight, blood pressure, serum electrolytes, glucose. Consider bone density scan (DEXA) for long-term use. - **During Treatment**: - **Short-term**: Blood pressure, blood glucose (especially in diabetics), electrolytes. - **Long-term**: Weight, BP, glucose, electrolytes (every 3-6 months). DEXA scan every 1-2 years. Annual ophthalmologic exam. - **Clinical Signs**: Watch for signs of infection, GI discomfort, mood swings, edema, and muscle weakness. ## Clinical Pearls - 💡 **Tip 1**: Always take prednisone with food or milk to minimize gastrointestinal upset. - 💡 **Tip 2**: For prolonged therapy (typically >2 weeks), taper the dose gradually to prevent adrenal insufficiency. - 💡 **Tip 3**: Administer once-daily doses in the morning (before 9 AM) to mimic the body's natural cortisol rhythm and reduce insomnia. - 💡 **Tip 4**: Patients on chronic prednisone should carry a steroid identification card or wear medical alert jewelry. - 💡 **Tip 5**: Counsel patients on bone health (calcium/vitamin D supplementation) and diet to manage weight gain and hyperglycemia. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.