Prednisolone, Indications, Dosage, Side Effect, Interactions, Pregnancy

Prednisolone
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Prednisolone is a synthetic glucocorticoid with anti-inflammatory and immunomodulating properties. After cell surface receptor attachment and cell entry, prednisolone enters the nucleus where it binds to and activates specific nuclear receptors, resulting in an altered gene expression and inhibition of proinflammatory cytokine production. This agent also decreases the number of circulating lymphocytes, induces cell differentiation, and stimulates apoptosis in sensitive tumor cells populations.

Prednisolone is a synthetic glucocorticoid used as the anti-inflammatory or immunosuppressive agent. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states.  Prednisolone is indicated in the treatment of various conditions, including congenital adrenal hyperplasia, psoriatic arthritis, systemic lupus erythematosus.

Mechanism of Action of Prednisolone

Glucocorticoids such as Prednisolone can inhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses. The anti-inflammatory actions of glucocorticoids are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes. Prednisolone reduces inflammatory reaction by limiting the capillary dilatation and permeability of the vascular structures. These compounds restrict the accumulation of polymorphonuclear leukocytes and macrophages and reduce the release of vasoactive kinins. Recent research suggests that corticosteroids may inhibit the release of arachidonic acid from phospholipids, thereby reducing the formation of prostaglandins. Prednisolone is a glucocorticoid receptor agonist. On binding, the corticoreceptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA bound receptor then interacts with basic transcription factors, causing an increase or decrease in expression of specific target genes, including suppression of IL2 (interleukin 2) expression.

Indications of Prednisolone

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Therapeutic Indications Prednisolone

  • For the treatment of primary or secondary adrenocortical insufficiency, such as congenital adrenal hyperplasia, thyroiditis. Also used to treat psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, bursitis, acute gouty arthritis and epicondylitis.
  • Also indicated for treatment of systemic lupus erythematosus, pemphigus and acute rhematic carditis. Can be used in the treatment of leukemias, lymphomas, thrombocytopenia purpura and autoimmune hemolytic anemia. Can be used to treat celiac disease, insulin resistance, ulcerative colitis and liver disorders.
  • Alleviation of inflammatory and clinical parameters associated with recurrent airway obstruction (RAO) in horses, in combination with environmental control.

Contra Indications of Prednisolone

  • Serious infections
  • Herpetic eye infections
  • Hypersensitivity to the Prednisolone
  • HBsAg-positive chronic active hepatitis
  • Two months before and fourteen days after prophylactic vaccination
  • Herpes simplex infection
  • Herpes zoster infection
  • Other viral infections
  • Hypersensitivity to prednisolone or any of the excipients
  • Systemic infections unless specific anti-infective therapy is employed.
  • Ocular herpes simplex because of possible perforation.

Prednisolone may be used only with extra precaution and only after the consultations with your doctor in the following situations:

  • Ulcers in the stomach and duodenum
  • Acute and chronic bacterial infections
  • Fungal infections affecting the skin and internal organs
  • Infections caused by parasites
  • Unstable hypertension
  • Osteoporosis
  • Neuropsychiatric disorders
  • Glaucoma
  • Diverticulitis
  • Cushing’s disease

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Dosage of Prednisolone

Strengths: 5mg/5mL,10mg/5mL, 15mg/5mL, 20mg/5mL ,25mg/5mL suspension

Tablet : 5 mg, 10 mg ,15 mg, 30mg

Rheumatoid Arthritis

  • 5-7.5 mg PO qDay

Multiple Sclerosis

  • 200 mg/day PO for 1 week, then 80 mg PO every other day for 1 month

Acute Exacerbation of COPD 

  • 30-40 mg PO qDay for 10-14 days

Bells Palsy

  • 60 mg PO qDay for 5 days; then taper down by 10 mg daily for 5 days for total duration time of 10 days

Sarcoidosis

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Systemic Lupus Erythematosus

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Ulcerative Colitis 

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses
  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Iritis

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Optic Neuritis

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Gouty Arthritis

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses
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Hemolytic Anemia

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Immunosuppression

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Neoplastic Diseases

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Rheumatic Heart Disease

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Adrenocortical Insufficiency

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Corneal Ulcers

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Keratitis

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Pemphigus

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Synovitis

  • Dosing should be individualized based on disease and patient response:
  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Thrombocythemia

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Serum Sickness

  • Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses

Nephrotic Syndrome

  • Initial episode: 1 mg/kg (up to 80 mg/day) orally once a day or 2 mg/kg (up to 120 mg) orally once every other day
  • Duration of therapy: 4 to 16 weeks

Pediatric 

Inflammation

  • 0.1-2 mg/kg/day PO in single daily dose or divided q6-12hr; not to exceed 80 mg/day 

Asthma

  • 1-2 mg/kg/day in single daily dose or divided q12hr for 3-5 days 

Nephrotic Syndrome

  • First 4 weeks: 60 mg/m²/day or 2 mg/kg/day PO divided q8hr until urine is protein free for 3 consecutive days; not to exceed 28 days; dose not to exceed 80 mg/day 
  • Subsequent 4 weeks: 40 mg/m² or 1-1.5 mg/kg PO every other day; not to exceed 80 mg/day
  • Maintenance in frequent relapses: 0.5-1 mg/kg/dose PO every other day for 3-6 months

Side Effects of Prednisolone

The most common

Common

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Rare

Drug Interactions of Prednisolone

Prednisolone may interact with following drugs, supplements, & may change the efficacy of drugs

The above list is not the sufficient drugs interactions list, please always consult your doctor or pharmacist before taking this drug.

Pregnancy & Lactation of Prednisolone

FDA pregnancy category D

Pregnancy

Very little prednisolone acetate in an eye drop form is absorbed into the body and available to affect an unborn baby. For this reason, prednisolone acetate eye drops are considered safe to use during pregnancy for short periods of time. If you are concerned about using this medication, discuss the benefits and risks of using this medication with your doctor.

Lactation

Corticosteroids pass into breast milk, however in an eye drop form, very little prednisolone acetate is absorbed into the body and available to pass into breast milk. The use of corticosteroid eye drops, including prednisolone acetate, is considered to be safe while breastfeeding.

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