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Prednisolone is a synthetic glucocorticoid drug. It has anti-inflammatory, anti-allergic, immunosuppressive, antioxidative and antipruritic effects. The immunosuppressive effect is associated with inhibition of cytokines release from lymphocytes and macrophages. Other effects are caused by the stabilization of cell membranes, decreased capillary permeability, and improved microcirculation.

Prednisolone has a catabolic effect, increases the level of glucose in the blood, and causes the redistribution of adipose tissue. The drug inhibits the synthesis and secretion of adrenocorticotrophic hormone and, secondly, adrenal corticosteroids.

With the external and local applications, the therapeutic activity of prednisone is achieved due to anti-inflammatory, anti-allergic and antioxidative effects.

Indications

Endocrine disorders:

  • primary and secondary adrenal insufficiency;
  • congenital adrenal hyperplasia;
  • subacute thyroiditis;
  • hypoglycemic conditions.

Systemic diseases of the connective tissue:

  • rheumatoid arthritis;
  • systemic lupus erythematosus;
  • dermatomyositis;
  • scleroderma;
  • periarteritis nodosa;
  • acute rheumatism, acute carditis, small chorea.

Acute and chronic inflammatory joint diseases:

  • humeroscapular periarthritis;
  • ankylosing spondylitis;
  • gout and psoriatic arthritis;
  • osteoarthritis (including post-traumatic);
  • polyarthritis;
  • juvenile arthritis;
  • Still-Chauffard syndrome in adults;
  • bursitis;
  • nonspecific tendosynovitis;
  • synovitis;
  • epicondylitis.

Acute and chronic allergic diseases:

  • allergic reactions to drugs and foods;
  • drug exanthema;
  • serum sickness;
  • hives;
  • hay fever;
  • angioedema;
  • allergic rhinitis;
  • bronchial asthma, asthmatic status.

Diseases of the blood and hematopoietic system:

  • autoimmune hemolytic anemia;
  • acute lymph and myeloid leukemia;
  • lymphogranulomatosis, thrombocytopenic purpura;
  • agranulocytosis;
  • panmyelopathy;
  • secondary thrombocytopenia in adults;
  • erythroblastopenia (erythrocyte anemia);
  • congenital (erythroid) hypoplastic anemia.

Skin diseases:

  • pemphigus;
  • eczema;
  • psoriasis;
  • exfoliative dermatitis;
  • atopic dermatitis;
  • diffuse neurodermatitis;
  • contact dermatitis (with damage to a large surface of the skin);
  • taxidermy;
  • seborrheic dermatitis;
  • toxic epidermal necrolysis (Lyell’s syndrome);
  • bullous herpetiform dermatitis;
  • malignant exudative erythema (Stevens-Johnson syndrome).

Allergic and inflammatory eye diseases:

  • allergic corneal ulcers;
  • allergic forms of conjunctivitis;
  • sympathetic ophthalmia;
  • anterior and posterior uveitis;
  • optic neuritis.

Gastrointestinal disorders:

  • ulcerative colitis, Crohn’s disease;
  • hepatitis;
  • local enteritis;
  • Lung cancer (in combination with cytostatic drugs);
  • Myeloma.

Lung diseases:

  • acute alveolitis;
  • pulmonary fibrosis;
  • sarcoidosis of the II-III stage.

Dosage and mode of application

The dose and duration of treatment are selected by the doctor individually, depending on the indications and severity of the disease.

Typically, the daily dose is taken once or taken as a double dose every other day, in the morning, in the interval from 6 to 8 hours in the morning.

A high daily dose can be divided into 2-4 doses, while a large dose should be taken in the morning.

Tablets should be taken during or immediately after a meal with a small amount of liquid.

In acute conditions and as replacement therapy, adults have prescribed an initial dose of 20-30 mg/day, the maintenance dose is 5-10 mg/day. In some diseases (nephrotic syndrome, some rheumatic diseases), higher doses are prescribed. Treatment is stopped slowly, gradually reducing the dose. If there is a history of psychosis, high doses are prescribed under strict physician supervision.

Doses for children: the initial dose is 1-2 mg/kg/day in 4-6 doses, the maintenance dose is 0.3-0.6 mg/kg/day.

Contraindications

For short-term use for health reasons, contraindications include:

  • hypersensitivity to prednisone or drug’s components;
  • lactase deficiency, lactose intolerance, sucrose/isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption;
  • children’s age up to 3 years.

The drug should be used with caution in the following diseases and conditions:

  • gastrointestinal tract diseases – gastric and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, recently created intestinal anastomosis, ulcerative colitis, diverticulitis;
  • parasitic and infectious diseases of a viral, fungal or bacterial nature (ongoing or recently transferred, including recent contact with the patient) – herpes simplex, herpes zoster (viremic phase), chickenpox, measles; amoebiasis, strongyloidiasis; systemic mycosis;
  • active and latent tuberculosis.
  • the use in severe infectious diseases is permissible only on the background of specific therapy;
  • pre- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination;
  • immunodeficiency conditions (including AIDS or HIV infection);
  • diseases of the cardiovascular system, including decompensated chronic heart failure, arterial hypertension, hyperlipidemia;
  • endocrine diseases – diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing’s disease, obesity;
  • severe chronic renal and/or liver failure, nephrolithiasis;
  • hypoalbuminemia and conditions predisposing to its occurrence (cirrhosis of the liver, nephrotic syndrome);
  • systemic osteoporosis, myasthenia gravis, acute psychosis, polio (except for the form of bulbar encephalitis), open- and angle-closure glaucoma;
  • pregnancy.

Side effects

  • Endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, inhibition of adrenal function, Itsenko-Cushing’s syndrome (pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle striae), delayed sexual development in children.
  • Digestive system: nausea, vomiting, pancreatitis, “steroid” ulcer of the stomach and duodenum, erosive esophagitis, gastrointestinal bleeding and perforation of the gastrointestinal wall, increased or decreased appetite, digestion, flatulence, hiccups, increased liver function, and alkaline phosphatase.
  • Cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of heart failure, ECG changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis.
  • Nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor, cerebellum, headache, convulsions.
  • Sensory organs: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral infections of the eyes, trophic changes in the cornea, exophthalmos.
  • Metabolism: increased excretion of calcium ions, hypocalcemia, increased body weight, negative nitrogen balance (increased protein breakdown), increased sweating, hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).
  • Musculoskeletal system: growth retardation and ossification processes in children, osteoporosis, rupture of muscles’ tendons, “steroid” myopathy, decreased muscle mass (atrophy).
  • Skin and mucous membranes: delayed healing of wounds, petechiae, ecchymosis, skin thinning, hyper- or hypopigmentation, acne, striae, a tendency to develop pyoderma and candidiasis.
  • Allergic reactions: skin rash, itching, anaphylactic shock.
  • Other: the development or exacerbation of infections (the appearance of this side effect is facilitated by the jointly-used immunosuppressants and vaccination), leukocyturia, “withdrawal” syndrome, frequent nighttime urination, urolithiasis.

Pregnancy and lactation

During pregnancy, the use of prednisone is possible if the intended benefit to the mother outweighs the potential risk to the fetus.

In the first trimester of pregnancy, prednisone is used only for health reasons.

With prolonged therapy during pregnancy, the possibility of impaired fetal growth is not ruled out. If used in the third trimester of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

Since corticosteroids penetrate into breast milk, if it is necessary to use the drug during breastfeeding, breastfeeding is recommended to be arrested.

Interactions

Tell your doctor if you are taking, have recently taken, or intend to take any other drugs. This applies to any herbal preparations or preparations that you bought without a prescription.

Some drugs can be used with Prednisone, while others can cause unwanted reactions when combined. It is very important to inform your healthcare provider if you are using the medications listed below:

  • blood pressure-lowering drugs or diuretics;
  • drug for epilepsy treatment – carbamazepine, phenobarbital, barbiturates, phenytoin, primidone, phenylbutazone;
  • antidiabetic drugs including insulin;
  • drugs for infectious diseases’ treatment, such as rifabutin, rifampicin, tetracycline, amphotericin, ketoconazole;
  • etoposide – a drug for cancer treatment;
  • methotrexate in the treatment of arthritis, Crohn’s disease, psoriasis;
  • contraceptives;
  • growth hormone non-steroidal anti-inflammatory drugs or aspirin;
  • sympathomimetics (bambuterol, fenoterol, formoterol, ritodrine, salbutamol, salmeterol, and terbutaline);
  • aminoglutethimide, acetazolamide;
  • antacids (with digestive upset);
  • carbimazole (for hyperthyroidism);
  • antidepressants fluoxetine or nefazodone;
  • theophylline (for asthma).