What is prednisolone, and how does it work (mechanism of action)?
Prednisolone is a synthetic adrenal corticosteroid
(cortisone). Corticosteroids are natural substances produced by the adrenal
glands located adjacent to the kidneys. Corticosteroids have potent
anti-inflammatory properties, and are used in a wide variety of inflammatory
conditions such as
arthritis, colitis,
asthma,
bronchitis,
certain skin rashes,
and allergic or inflammatory conditions of the nose and eyes. There are numerous
preparations of corticosteroids including tablets, capsules, liquids, topical
creams and gels, inhalers, eye drops, as well as injectable and intravenous
solutions. The FDA approved prednisolone in June 1955.
What brand names are available for prednisolone?
Flo-Pred, Pediapred, Orapred, Orapred ODT
Is prednisolone available as a generic drug?
Yes
Do I need a prescription for prednisolone?
Yes
What are the side effects of prednisolone?
Prednisolone side effects depend on the dose, the duration and
the frequency of administration. Short courses of prednisolone – days to a week
or two – are usually well tolerated with few and mild side effects. Long-term,
high doses of prednisolone will usually produce predictable and potentially
serious side effects. Whenever possible, the lowest effective doses of
prednisolone should be used for the shortest length of time to minimize side
effects. Alternate day dosing can also help reduce side effects.
Side effects of prednisolone and other corticosteroids range from mild
annoyances to serious irreversible damage. Side effects include
- fluid retention,
- weight gain,
- potassium loss,
- headache,
- muscle weakness,
- puffiness of and hair growth on the face,
- thinning and
easy bruising
of the skin, - glaucoma,
- cataracts,
- peptic
ulceration, - worsening of
diabetes, - irregular menses,
- growth retardation in children,
- convulsions, and
- psychic
disturbances. (Psychic disturbances can include
depression,
euphoria,
insomnia,
mood swings, personality changes, and even psychotic behavior.)
Prolonged use of prednisolone can depress the ability of body's adrenal
glands to produce corticosteroids. Abruptly stopping prednisolone can cause
symptoms of corticosteroid insufficiency, with accompanying
nausea/a>,
vomiting,
and even shock.
Therefore, withdrawal of prednisolone is usually accomplished by gradual
tapering. Gradually tapering prednisolone not only minimizes the symptoms of
corticosteroid insufficiency, but it also reduces the risk of an abrupt flare of
the disease under treatment.
Prednisolone and other corticosteroids can mask signs of infection and impair
the body's natural immune response to infection. Patients on corticosteroids are
more susceptible to infections and can develop more serious infections than
healthy individuals. For instance,
chickenpox
and measles
viruses can produce serious and even fatal illnesses in patients on high doses
of prednisolone. Live virus vaccines, such as smallpox vaccine, should be
avoided in patients taking high doses of prednisolone, since even vaccine
viruses may cause disease in patients taking prednisolone. Some infectious
organisms, such as
tuberculosis (TB) and
malaria, can
remain dormant in a patient for years. Prednisolone and other corticosteroids
can reactivate dormant infections in these patients and cause serious illnesses.
Patients with
dormant
TB may require anti-TB medications while undergoing prolonged corticosteroid
treatment.
By interfering with the patient's immune response, prednisolone can impede
the effectiveness of
vaccinations. Prednisolone can also interfere with the
tuberculin skin test and cause false negative results in patients with
tuberculosis infection.
Prednisolone impairs calcium absorption and new bone formation. Patients on
prolonged treatment with prednisolone and other corticosteroids can develop
thinning of bone (osteoporosis)
and an increased risk of
bone fractures. Supplemental calcium and vitamin D are
encouraged to slow this process of bone thinning. In some patients, medications
used to treat osteoporosis may be prescribed. In rare individuals, destruction
of large joints (osteonecrosis) can occur while undergoing treatment with
prednisolone or other corticosteroids. These patients experience severe pain in
the involved joints, and can require replacement of joints. The reason behind
such destruction is not clear.
What is the dosage for prednisolone?
Dosage requirements of corticosteroids vary among individuals and the
diseases being treated. The usual starting dose range is 5 mg to 60 mg daily
depending on the disease being treated. Doses are adjusted based on patient
response. In general, the lowest possible effective dose is used.
Corticosteroids given in multiple doses throughout the day are more effective,
but also more toxic than alternate-day therapy where twice the daily dose is
administered every other morning. Prednisolone should be taken with food to
reduce irritation of the stomach and intestines.
Which drugs or supplements interact with prednisolone?
Rifampin decreases blood levels of prednisolone by
increasing its breakdown in the liver. The dose of prednisolone may need to be
increased in order to avoid therapeutic failure.
Corticosteroids have variable effects of
warfarin
(Coumadin) therapy. Coagulation levels should be monitored more closely when
anticoagulants are combined with corticosteroids.
Estrogens may increase the levels of prednisolone by decreasing its
breakdown. When estrogens are used with prednisolone, side effects of
prednisolone should be monitored.
Steroids increase blood sugar (glucose) levels and, therefore, reduce the
effect of
drugs used for treating diabetes.
Activity of cyclosporine and corticosteroids increase when both drugs are
combined. Seizures have been reported.
Combining aspirin or other
nonsteroidal anti-inflammatory
drugs (NSAIDs) and corticosteroids increases the risk of gastrointestinal side effects.
Combining corticosteroids with potassium-depleting agents (for example, diuretics) increases the risk of low blood potassium (hypokalemia).
Vaccines are less effective in patients on prolonged corticosteroid treatment because corticosteroids suppress the immune system. Corticosteroids may also allow organisms contained in live attenuated vaccines to replicate.
What else should I know about prednisolone?
What preparations of prednisolone are available?
- Tablets: 5 mg.
- Tablets
(Disintegrating): 10, 15, 30 mg - Syrup or Suspension: 5, 10, 15, 20 or
25 mg/5 ml (teaspoon).
How should I keep prednisolone stored?
Store at room temperature, 15 C to 30 C (59 F to 86 F). Do not
refrigerate.