Names and pronunciation
(pred′ni-sone) Rayos
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Drug reference
(pred′ni-sone) Rayos
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Func. class.: Corticosteroid
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Chem. class.: Intermediate-acting glucocorticoid
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Do not confuse: predniSONE/methylPREDNISolone/ prednisoLONE/PriLOSEC
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ACTION: Decreases inflammation by increasing capillary permeability and lysosomal stabilization, minimal mineralocorticoid activity
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USES: Severe inflammation, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders, pulmonary fibrosis, asthma
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Unlabeled uses: Adjunct for refractory seizures, infantile spasms, acute intersti- tial nephritis, amyloidosis, autoimmune hepatitis, Behçet’s syndrome, Bell’s palsy, carpal tunnel syndrome, Churg-Strauss syndrome, dermatomyositis, Duchenne muscular dystrophy, endophthalmitis, Lennox-Gastaut syndrome, lupus nephri- tis, mixed connective-tissue disease, pericarditis, pneumonia, polyarteritis nodosa, polychondritis, polymyositis, rheumatic carditis, temporal arteritis, TB, Wegener’s granulomatosis
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CONTRAINDICATIONS: Fungal infections, hypersensitivity Precautions: Pregnancy, diabetes melli- tus, glaucoma, osteoporosis, seizure dis- orders, ulcerative colitis, HF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, cataracts, coagulopathy, abrupt dis- continuation, children, corticosteroid hypersensitivity, Cushing syndrome, dia- betes mellitus, ulcerative colitis, throm- boembolism, geriatric patients, acute MI
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SIDE EFFECTS CNS: Depression, flushing, sweating, headache, mood changes CV: Hypertension, thrombophlebitis, embolism, tachycardia, fluid retention EENT: Fungal infections, increased intra- ocular pressure, blurred vision GI: Diarrhea, nausea, abdominal disten- tion, GI hemorrhage, increased appetite, pancreatitis INTEG: Acne, poor wound healing, ecchymosis, petechiae META: Hyperglycemia MS: Fractures, osteoporosis, weakness MISC: Decreased immune response
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INTERACTIONS Increase: tendon rupture—quinolones Increase: side effects—alcohol, salicy- lates, NSAIDs, amphotericin B, digoxin, cycloSPORINE, diuretics Increase: predniSONE action—salicylates, estrogens, NSAIDs, oral contraceptives, ketoconazole, macrolide antiinfectives Increase: predniSONE effect—CYP3A4 inhibitors Decrease: predniSONE effect—CYP3A4 inducers Decrease: predniSONE action—chole- styramine, colestipol, barbiturates, rifAMPin, phenytoin, theophylline Decrease: effects of anticoagulants, anti- convulsants, antidiabetics, neostigmine, isoniazid, toxoids, vaccines, anticholines- terases, salicylates, somatrem Drug/Herb Decrease: predniSONE effect—ephedra (ma huang) Drug/Lab Test Increase: cholesterol, sodium, blood glu- cose, uric acid, calcium, urine glucose Decrease: calcium, potassium, T4, T3, thyroid 131I uptake test, urine 17-OHCS, 17-KS, PBI False negative: skin allergy tests
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DOSAGE AND ROUTES Most uses • Adult: PO 5-60 mg/day or divided bid- qid • Child: PO 0.05-2 mg/kg/day divided 1-4×/day Nephrotic syndrome • Child: PO 2 mg/kg/day in divided doses, until urine is protein-free for 3 consecutive days, then 1-1.5 mg/kg/day every other day × 4 wk Multiple sclerosis • Adult: PO 200 mg/day × 1 wk, then 80 mg every other day × 1 mo Asthma • Adult/adolescent: PO 40-80 mg/day in 1-2 divided doses until PEF is 70% of predicted or personal best • Child: PO 1 mg/kg (max 60 mg)/day in 2 divided doses until PEF is 70% of predicted or personal best
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Available forms: Tabs 1, 2.5, 5, 10, 20, 50 mg; oral sol 5 mg/5 mL; del rel tab 1, 2, 5 mg
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Administer: • Regular tabs may be crushed and given with foods or fluids • For long-term use, alternate-day ther- P apy recommended to decrease adverse reactions; give in am to coincide with normal cortisol secretion • Titrated dose; use lowest effective dose • With food or milk to decrease GI symptoms • Oral sol: use calibrated measuring device • Del rel tab: swallow whole; do not break, crush, chew; give once a day
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Assess: • Adrenal insufficiency: nausea, vomit- ing, anorexia, confusion, hypotension, weight loss before or during treatment; HPA suppression may be precipitated by abrupt withdrawal • Potassium, blood glucose, urine glucose while patient receiving long-term therapy; hypokalemia and hyperglycemia; plasma cortisol with long-term therapy, normal: 138-635 nmol/L SI units drawn at 8 am • Weight daily; notify prescriber of weekly gain of >5 lb • B/P, pulse; notify prescriber of chest pain; monitor for crackles, dyspnea if edema is present; hypertension, cardiac symptoms • I&O ratio; be alert for decreasing uri- nary output, increasing edema, rales, crackles; notify provider if present • Infection: increased temperature, WBC, even after withdrawal of medica- tion; product masks infection • Potassium depletion: paresthesias, fa- tigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness • Mental status: affect, mood, behavioral changes, aggression • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; do not breastfeed • Beers: avoid in older adults with a high risk of delirium
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Evaluate: • Therapeutic response: ease of respira- tions, decreased inflammation
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That emergency ID as corticosteroid user should be carried; provide infor- mation about product being taken and condition • To notify prescriber if therapeutic re- sponse decreases; that dosage adjust- ment may be needed • To avoid vaccinations • Not to discontinue abruptly; adrenal crisis can result • To avoid OTC products: salicylates, cough products with alcohol, cold prepa- rations unless directed by prescriber • Cushingoid symptoms: moon face, weight gain; symptoms of adrenal insuf- ficiency: nausea, anorexia, fatigue, dizzi- ness, dyspnea, weakness, joint pain • That product causes immunosuppres- sion; to report any symptoms of infection (fever, sore throat, cough) • To notify provider before surgery • That continuing follow-up and blood work will be needed • That antidiabetic agents may need ad- justment in diabetic patients • Pregnancy: to notify prescriber if pregnancy is planned or suspected; cleft palate, stillbirth, abortion reported
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PHARMACOKINETICS PO: Well absorbed PO, peak 1-2 hr; del rel peak 6-61/2 hr; half-life 31/2-4 hr, crosses placenta, enters breast milk, metabolized by liver after conversion, excreted in urine
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• Adult/adolescent: PO 40-80 mg/day in 1-2 divided doses until PEF is 70% of predicted or personal best
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