Prednisolone

Prednisolone (中文: 潑尼松龍) is a steroid with anti-inflammatory and immunosuppressant effects. It is used to treat a wide range of inflammatory and autoimmune conditions.

Indications include:

• Multiple Sclerosis
• Asthma
• Inflammatory bowel disease
• Dermatitis
• Rheumatoid arthritis

Pronunciation

Prednisolone 5mg

Equivalent anti-inflammatory doses of steroids

Prednisolone 5 mg is equivalent to	Betamethasone 750 micrograms
	dexamethasone 750 micrograms
	hydrocortisone 20 mg
	methylprednisolone 4 mg
	triamcinolone 4 mg

Drug Names

Generic Name	HA Code	Classification
Prednisolone 5mg	PRED02	P1S1S3

Mechanism of Action

Immunosuppression agent,

Steroid replacement agent,

Anti-inflammatory agent

Dosage

Dosages of steroids vary widely in different diseases and in different patients.

When long-term steroid therapy is used in some chronic diseases, the adverse effects of treatment may be great. To minimize side-effects the maintenance dose should be kept as low as possible.

Steroids are used both topically (by rectum or eye) and systemically (by mouth or intravenously).

Whenever possible local treatment with creams, intra-articular injections, inhalations, eye-drops or enemas should be used in preference to systemic treatment.

The suppressive action of a steroid on cortisol secretion is least when it is given as a single dose in the morning.

Oral	initially, up to 10-20 mg daily (severe disease, up to 60 mg daily),
preferably taken in the morning after breakfast; can often be reduced within a few days but may need to be continued for several weeks or months.	Maintenance, usual range: 2.5 – 15 mg daily
Child and infant dose
Usually indicated for mild to moderate acute asthma
1 month to 11 years old	1-2mg/kg once daily, max 40 mg daily
Child 12-17 years old	40-50 mg daily for at least 5 days
By intramuscular injection	prednisolone acetate 25 – 100 mg once or twice weekly	For intra-articular injection, 5 to 25 mg of prednisolone acetate. Prednisolone acetate and prednisolone sodium phosphate are also used in the topical treatment of allergic and inflammatory conditions of the eyes or ears, usually as drops containing 0.5 or 1%. Side Effects Short-term use include nausea and feeling tired. More severe side effects include psychiatric problems including euphoria, nightmares, insomnia, irritability, confusion, suicidal thoughts and behavioral disturbances. This may occur in about 5% of people. Long-term steroid use can lead to Adrenal suppression Steroid-induced diabetes Osteoporosis, muscle wasting and weakness which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae Susceptibility to infection Cushing’s syndrome moon face, striae, and acne Endocrine side effects menstrual irregularities and amenorrhea, hirsutism, weight gain, hyperlipidemia Neuropsychiatric side effects aggravation of schizophrenia, aggravation of epilepsy, insomnia, irritability, mood changes Dermatological effects easy bruising, impaired wound healing, and thinning of skin Ophthalmic effects glaucoma, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease Side-effects can be minimized by using lowest effective dose for minimum period possible. Pharmacokinetics Oral bioavailability Prednisolone is readily absorbed from the gastrointestinal tract. Onset of action Peak plasma concentrations occur 1 or 2 hours after an oral dose. Metabolism Prednisolone is excreted in the urine. Elimination half-life Prednisolone has a usual plasma half-life of 2 to 4 hours. Prednisolone is largely inactivated as it crosses the placenta; small amounts are excreted in breast milk. Drug Management Monitoring Elderly (close supervision required particularly on long-term treatment) Frequent monitoring required if history of tuberculosis (or X-ray changes) Blood sugar level, blood pressure, mood change, Monitoring of the fluid intake and output, and daily weight records may give early warning of fluid retention. Sodium intake may need to be reduced and calcium and potassium supplements may be necessary. Back pain may signify osteoporosis Height should be monitored in children receiving prolonged therapy with inhaled or nasal steroid. Drug interaction Interactions do not generally apply to steroid used for topical action including inhalation, unless specified. Drugs given with steroid Potential adverse drug interactions NSAIDs Increased risk of gastro-intestinal bleeding Rifampicin Accelerate metabolism of steroid so reduce the effects of steroid Antidiabetics Steroid antagonize hypoglycaemic effect. Requirements of antidiabetics may be increased. Antiepileptics: Carbamazepine Phenobarbitone phenytoin Accelerate metabolism of steroid so reduce the effects of steroidd Antifungals: amphotericin Increased risk of hypokalaemia Antivirals: ritonavir Increase plasma concentration of steroid – increased risk of adrenal suppression Digoxin Increased risk of hypokalaemia Diuretics: frusemide hydrochlorothiazide antagonize diuretic effect, increased risk of hypokalaemia Oral contraceptive (oestrogens) Increase plasma concentration of steroid Theophylline Increased risk of hypokalaemia Caution Children and adolescents (growth restriction possibly irreversible) Osteoporosis (post-menopausal women at special risk) Recent myocardial infarction, congestive heart failure Glaucoma (including family history) Ocular herpes simplex – risk of corneal perforation Psychiatric disorders (particularly if history of steroid-induced psychosis) Epilepsy Peptic ulcer Hypothyroidism Ulcerative colitis Diverticulitis Thromboembolic disorders Myasthenia gravis Contraindication acute infections patients with active or doubtfully quiescent tuberculosis concurrent treatment live virus vaccines for at least 3 months afterwards Hepatic impairment When steroids are administered orally or parenterally, the plasma-drug concentration may be increased in patients with hepatic impairment. The patient should be monitored closely. Renal impairment Should be used with caution in patients with renal impairment. Pregnancy Prednisolone should only be used in pregnant women when benefits outweigh the risks. No convincing evidence that systemic steroids increase the incidence of congenital abnormalities such as cleft palate or lip. Prolonged use increases the risk of intra-uterine growth; but no evidence of intra-uterine growth restriction following short-term treatment. Prednisolone appears in small amounts in breast milk but maternal doses of up to 40 mg daily are unlikely to cause systemic effects in the infants; infants should be monitored for adrenal suppression if the mothers are taking a higher dose. Note Prolonged use of steroid Advice to patient Immunosuppression Prolonged use can increase susceptibility to infection Avoid contact with people who have chickenpox, shingles, or measles. Adrenal suppression Steroid suppresses the endogenous secretion of corticotropin by the anterior pituitary, resulting the adrenal cortex becomes atrophied. If given for more than 3 weeks, treatment must not be stopped gradually. Patient must mention the course of steroid when receiving treatment for intercurrent illnesses or trauma such as surgery. FAQ How should I take the tablet? Follow all directions on your prescription label. Use prednisolone exactly as directed on the label. Steroids are associated with a risk of GI irritation. The tablet MUST be with or after food to help reduce side-effects. What should I avoid while taking? Avoid abruptly discontinue the medication. Should not be taken with NSAIDs. What happen if I overdose? Contact your primary care doctor. If emergency situation, call 999 What happen if I miss a dose? Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.