Prednisone; Indications, Dosage, Side Effect, Interactions, Pregnancy

Prednisone
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Prednisone is a synthetic glucocorticoid with anti-inflammatory and immunomodulating properties. After cell surface receptor attachment and cell entry, prednisone 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 cell populations.

Prednisone is only found in individuals that have used or taken this drug. It is a synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [PubChem]Prednisone is a glucocorticoid receptor agonist. It is first metabolized in the liver to its active form, prednisolone.
Prednisolone crosses cell membranes and binds with high affinity to specific cytoplasmic receptors. The result includes inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, suppression of humoral immune responses, and reduction in edema or scar tissue. The anti-inflammatory actions of corticosteroids are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes.

Mechanism of Action of Prednisone

Prednisone is a glucocorticoid receptor agonist. It is first metabolized in the liver to its active form, prednisolone. Prednisolone crosses cell membranes and binds with high affinity to specific cytoplasmic receptors. The result includes inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, suppression of humoral immune responses, and reduction in edema or scar tissue. The anti-inflammatory actions of corticosteroids are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes. Prednisone can stimulate secretion of various components of gastric juice. Suppression of the production of corticotropin may lead to suppression of endogenous corticosteroids. Prednisone has slight mineralocorticoid activity, whereby entry of sodium into cells and loss of intracellular potassium is stimulated. This is particularly evident in the kidney, where rapid ion exchange leads to sodium retention and hypertension.

Or

In physiologic doses, corticosteroids are administered to replace deficient endogenous hormones. In larger (pharmacologic) doses, glucocorticoids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation; and possibly by other mechanisms as yet unknown. The drugs suppress the immune response by reducing activity and volume of the lymphatic system, producing lymphocytopenia, decreasing immunoglobulin and complement concentrations, decreasing passage of immune complexes through basement membranes, and possibly by the depressing reactivity of tissue to antigen-antibody interactions. Glucocorticoids stimulate erythroid cells of bone marrow, prolong survival time of erythrocytes and platelets, and produce neutrophilia and eosinopenia. Glucocorticoids promote gluconeogenesis, redistribution of fat from peripheral to central areas of the body, and protein catabolism, which results in negative nitrogen balance. They reduce intestinal absorption and increase renal excretion of calcium.

Indications of Prednisone

Most common or FDA approved uses are listed.

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It also is used the treatment of

  • Leukemias
  • Lymphomas
  • Idiopathic thrombocytopenic purpura
  • Autoimmune hemolytic anemia
  • Bronchitis

FDA Approval: Indications of Prednisone

  • Prednisone is approved to be used to reduce inflammation and suppress (lower) the body’s immune response. It is used with other drugs to treat the following types of cancer: Acute lymphoblastic leukemia.
  • Chronic lymphocytic leukemia.
  • Hodgkin lymphoma.
  • Mycosis fungoides.
  • Non-Hodgkin lymphoma.
  • Prednisone is also used alone or with other drugs to prevent or treat the following conditions related to cancer: Anemia.
  • Drug hypersensitivity (allergic reactions).
  • Hypercalcemia (high blood levels of calcium).
  • Thrombocytopenia (low platelet levels).
  • Prednisone is also used alone or with other drugs to treat many other diseases and conditions. The drug continues to be studied in the treatment of many types of cancer and other conditions.

Therapeutic Indications of Prednisone

  • Prednisone is usually considered the oral glucocorticoid of choice for anti-inflammatory or immunosuppressant effects. Because it has only minimal mineralocorticoid properties, the drug is inadequate alone for the management of adrenocortical insufficiency. If prednisone is used in the treatment of this condition, concomitant therapy with a mineralocorticoid is also required.
  • Prednisone tablets and solutions are indicated in the following conditions: Endocrine Disorders: Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the first choice: synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance); congenital adrenal hyperplasia; hypercalcemia associated with cancer; nonsuppurative thyroiditis.
  • Prednisone tablets and solutions are indicated in the following conditions: Rheumatic Disorders: As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy), ankylosing spondylitis, acute and subacute bursitis, acute nonspecific tenosynovitis, acute gouty arthritis, post-traumatic osteoarthritis, synovitis of osteoarthritis, epicondylitis.
  • Prednisone tablets and solutions are indicated in the following conditions: Collagen Diseases: During an exacerbation or as maintenance therapy in selected cases of systemic lupus erythematosus, systemic dermatomyositis (polymyositis), acute rheumatic carditis.
  • Prednisone tablets and solutions are indicated in the following conditions: Dermatologic Diseases: Pemphigus; bullous dermatitis herpetiformis; severe erythema multiforme (Stevens-Johnson syndrome); exfoliative dermatitis; mycosis fungoides; severe psoriasis; severe seborrheic dermatitis.
  • Prednisone tablets and solutions are indicated in the following conditions: Allergic States: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: seasonal or perennial allergic rhinitis; bronchial asthma; contact dermatitis; atopic dermatitis; serum sickness; drug hypersensitivity reactions.
  • Prednisone tablets and solutions are indicated in the following conditions: Ophthalmic Diseases: Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: allergic corneal marginal ulcers, herpes zoster ophthalmicus, anterior segment inflammation, diffuse posterior uveitis and choroiditis, sympathetic ophthalmia, allergic conjunctivitis, keratitis, chorioretinitis, optic neuritis, iritis and iridocyclitis.
  • Prednisone tablets and solutions are indicated in the following conditions: Respiratory Diseases: Symptomatic sarcoidosis; Loeffler’s syndrome not manageable by other means; berylliosis; fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy; aspiration pneumonitis.
  • Prednisone tablets and solutions are indicated in the following conditions: Hematologic Disorders: Idiopathic thrombocytopenic purpura in adults; secondary thrombocytopenia in adults; acquired (autoimmune) hemolytic anemia; erythroblastopenia (RBC anemia); congenital (erythroid) hypoplastic anemia.
  • Prednisone tablets and solutions are indicated in the following conditions: Neoplastic Diseases: For palliative management of leukemias and lymphomas in adults, acute leukemia of childhood.
  • Prednisone tablets and solutions are indicated in the following conditions: Edematous States: To induce a diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.
  • Prednisone tablets and solutions are indicated in the following conditions: Gastrointestinal Diseases: To tide the patient over a critical period of the disease in ulcerative colitis.
  • Prednisone tablets and solutions are indicated in the following conditions: Tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy; trichinosis with neurologic or myocardial involvement.
  • Systemic glucocorticoids have been used to reduce the pain, fever, and inflammation of pericarditis, including that associated with myocardial infarction.
  • Systemic conventional glucocorticoids (e.g., prednisone ) have been used in pediatric patients with mild esophageal or gastroduodenal Crohn’s disease. In addition, glucocorticoids (e.g., prednisone or methylprednisolone ) are recommended for the management of moderately to severely active Crohn’s disease, in children.
  • Glucocorticoids (e.g., prednisone) are used in the management of myasthenia gravis, usually in patients who have had an inadequate response to anticholinesterase therapy.
  • Glucocorticoid therapy has been used as an adjunct to anti-infective therapy in the treatment of anthrax in an attempt to ameliorate toxin-mediated effects associated with Bacillus anthracis infections. Some experts suggest that glucocorticoids may be indicated in the treatment of cutaneous anthrax if there are signs of systemic involvement or extensive edema involving the neck and thoracic region. Glucocorticoid therapy also has been used as an adjunct in the treatment of anthrax meningitis.
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Contra-Indications of Prednisone

Depending on the indication and the general situation, peptic ulcers, osteoporosis, psychoses, infections, diabetes, and hypertension can represent contraindications.

  • Serious infections
  • Herpetic eye infections
  • Hypersensitivity to the Prednisone
  • HBsAg-positive chronic active hepatitis
  • Two months before and fourteen days after prophylactic vaccination
  • Herpes simplex infection
  • Herpes zoster infection
  • Other viral infections
  • 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

Dosage of Prednisone

Strengths: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg

Rheumatoid Arthritis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Gouty Arthritis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Psoriatic Arthritis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Ankylosing Spondylitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Osteoarthritis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Psoriasis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Asthma 

  • Short-course “burst” therapy: 40 to 80 mg orally once a day or in 2 divided doses until peak expiratory flow (PEF) reaches 70% of predicted or personal best
  • For OUTPATIENT “burst” therapy: 40 to 60 mg orally once a day or in 2 divided doses for a total of 5 to 10 days

Aspiration Pneumonia

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained

Hemolytic Anemia

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Rheumatic Heart Disease

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Immunosuppression

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained

Ulcerative Colitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained

Adrenocortical Insufficiencyency

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained

 Iritis

  • Initial dose: 5 to 60 mg orally per day

Allergic Reaction

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Bursitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Synovitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Dermatitis Herpetiformis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained.

Hypercalcemia of Malignancy

  • Initial dose: 5 to 60 mg orally per day

Thrombocytopenic Purpura

  • Initial dose: 5 to 60 mg orally per day

Pediatric 

Ankylosing Spondylitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Pediatric Aspiration Pneumonia

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Bursitis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained;

Hypercalcemia of Malignancy

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Osteoarthritis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained
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Psoriasis

  • Initial dose: 5 to 60 mg orally per day
  • Maintenance dose: Adjust or maintain the initial dose until a satisfactory response is obtained;

Side Effects of Prednisone

The most common

Common

Rare

Drug Interactions of Prednisone

Prednisone 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 and Lactation of Prednisone

FDA pregnancy category: D 

Prednisone can cause intrauterine growth retardation and cleft palate, and its use during pregnancy is recommended only in situations where the benefits to the mother outweigh the risks to the fetus. Cases of hypoadrenalism (reduced levels of adrenaline in the blood) in newborns have been reported, but symptoms quickly go away without any complications. Cases of cataracts in newborns whose mothers took this drug during pregnancy have been reported.

Lactation and Breastmilk

Published information on the effects of prednisone on serum prolactin or on lactation in nursing mothers was not found as of the revision date. However, medium to large doses of depot corticosteroids injected into joints has been reported to cause temporary reduction of lactation.

  1. https://www.drugs.com/prednisone.html
  2. https://www.webmd.com/drugs/2/drug-6007-9383/prednisone-oral/prednisone-oral/details/list-contraindications
  3. https://pubchem.ncbi.nlm.nih.gov

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