Prednisone

Oral
Anti-inflammatory or immunosuppressive

Oral
Acute exacerbations in multiple sclerosis

Should be taken with food.

Systemic fungal infections. Concomitant administration with live or live attenuated vaccines (particularly immunosuppressive doses).

Patient with systemic sclerosis; gastrointestinal disease (e.g. active or latent peptic ulcer, non-specific ulcerative colitis, diverticulitis, fresh intestinal anastomoses), hypertension, CHF, myasthenia gravis, history of seizure disorders, psychiatric disorders, diabetes mellitus, thyroid disease, osteoporosis or at risk of osteoporosis (e.g. postmenopausal women), glaucoma, acute viral infections (e.g. chickenpox, measles), history of ocular herpes simplex, Strongyloides infestation, tuberculosis (fulminating or disseminated cases), cirrhosis. Patient subjected to stressful conditions (e.g. trauma, critical illness, surgery). May mask signs of infection. Avoid abrupt withdrawal. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.

Significant: Adrenal suppression (e.g. hypercortisolism, hypothalamic-pituitary-adrenal [HPA] axis suppression), Cushing's syndrome, scleroderma renal crisis, transient exacerbation of myasthenia gravis; glucocorticoid-induced ocular effects (e.g. glaucoma, subcapsular posterior cataract, increased IOP), corneal perforation; CV effects (e.g. hypertension, dyslipidaemia, fluid retention, electrolyte disturbances, arrhythmias); growth suppression in children, Kaposi sarcoma, acute myopathy, immunosuppression, convulsions, psychiatric disturbances (e.g. insomnia, euphoria, mood swings, personality changes, severe depression, frank psychotic manifestations); gastrointestinal effects (e.g. peptic ulcer, dyspepsia, gastritis, abdominal distention, ulcerative oesophagitis, gastrointestinal perforation); new-onset hyperglycaemia, exacerbation of diabetes mellitus; infection (e.g. Pneumocystis jirovecii pneumonia, herpes zoster, tuberculosis, secondary ocular infection); neuromuscular and skeletal effects (e.g. osteoporosis, vertebral compression fracture, myopathy, osteonecrosis). Rarely, acute steroid myopathy.
Blood and lymphatic system disorders: Leucocytosis.
Ear and labyrinth disorders: Vertigo.
Gastrointestinal disorders: Nausea, dyspepsia, diarrhoea, constipation, abdominal distension, gastric irritation, oesophageal ulceration, pancreatitis, peptic ulceration with perforation and haemorrhage.
General disorders and administration site conditions: Fatigue.
Investigations: Weight gain.
Metabolism and nutrition disorders: Increased appetite, muscle atrophy.
Musculoskeletal and connective tissue disorders: Myalgia, proximal, myopathy.
Nervous system disorders: Headache.
Reproductive system and breast disorders: Menstrual disorders.
Skin and subcutaneous tissue disorders: Hirsutism, acne, pruritus, urticaria, increased sweating, rash, bruising, wound healing impairment, skin atrophy.

PO: C, D (for delayed-release tab)

Avoid exposure to chickenpox or measles; if exposed, seek immediate medical advice.

Monitor blood pressure, creatine kinase, serum glucose, Hb, electrolytes, occult blood loss, intraocular pressure (>6 weeks therapy), bone mineral density, weight; growth and development in children. Perform eye examination periodically during treatment; chest x-ray at regular intervals (prolonged use). Assess for signs and symptoms of HPA axis suppression, infection, or ocular changes.

Symptoms: Mental symptoms, moon face, abnormal fat deposits, fluid retention, excessive appetite, weight gain, hypertrichosis, acne, striae, ecchymosis, increased sweating, pigmentation, dry scaly skin, thinning scalp hair, increased blood pressure, tachycardia, thrombophlebitis, decreased resistance to infection, negative nitrogen balance with delayed bone and wound healing, headache, weakness, menstrual disorders, accentuated menopausal symptoms, neuropathy, fractures, osteoporosis, peptic ulcer, decreased glucose tolerance, hypokalaemia, adrenal insufficiency. Management: Symptomatic and supportive treatment. Perform immediate gastric lavage or induce emesis for acute overdosage. Decrease prednisone dose temporarily or administer as alternate day treatment for chronic dosage.

May result in loss of corticosteroid-induced adrenal suppression with aminoglutethimide. May increase the anticoagulant effect of vitamin K antagonist (e.g. warfarin). May decrease the plasma concentrations of isoniazid. Decreased plasma concentrations with CYP3A4 inducers (e.g. barbiturates, phenytoin, carbamazepine, rifampicin). Increased plasma concentrations with CYP3A4 inhibitors (e.g. ketoconazole, macrolide antibiotics). May increase the plasma concentration with estrogen including oral contraceptives. Concurrent use with colestyramine may increase the clearance of prednisone. May decrease effect with mifepristone and antacids. Increased risk of gastrointestinal adverse effects with NSAIDs and aspirin. Increased risk of hypokalaemia with K-depleting agents (e.g. diuretics, amphotericin B). May increase the risk of seizures with ciclosporin.
Potentially Fatal: May diminish the serum antibody response to live or live attenuated vaccines.

Metabolism may be inhibited by liquorice. Increased risk of gastrointestinal ulceration or haemorrhage with alcohol.

May suppress skin test reactions.

Description:
Mechanism of Action: Prednisone, a biologically inert corticosteroid, is converted hepatically into the glucocorticoid corticosteroid prednisolone. It decreases inflammation by the reversal of increased capillary permeability and suppression of polymorphonuclear leucocytes migration. Additionally, it suppresses the immune system by the reduction of lymphatic system activity and volume.
Pharmacokinetics:
Absorption: Readily absorbed from the gastrointestinal tract. Time to peak plasma concentration: 2 hours (immediate-release tab); 6-6.5 hours (delayed-release tab).
Distribution: Distributed to all body tissues. Crosses the placenta, enters breast milk (small amount). Plasma protein binding: <50%.
Metabolism: Metabolised in the liver into prednisolone (active metabolite).
Excretion: Via urine (as conjugates). Elimination half-life: 2-3 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5865, Prednisone. https://pubchem.ncbi.nlm.nih.gov/compound/Prednisone. Accessed Nov. 23, 2023.

Store between 15-30°C. Protect from light and moisture.

Corticosteroid Hormones

A07EA03 - prednisone ; Belongs to the class of corticosteroids acting locally. Used in the treatment of intestinal inflammation.
H02AB07 - prednisone ; Belongs to the class of glucocorticoids. Used in systemic corticosteroid preparations.

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Anon. Prednisone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/03/2023.

Buckingham R (ed). Prednisone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/02/2023.

Clinect NZ Pty Limited. Prednisone 1 mg, 2.5 mg, 5 mg, and 20 mg Tablets data sheet 07 September 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 10/02/2023.

Prednisone Tablet and Solution; Prednisone Intesol Solution, Concentrate (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/02/2023.

Prolix 10 mg/5 mL Suspension (Lloyd Laboratories Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 10/02/2023.

Prolix 20 mg Tablet (Lloyd Laboratories Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 10/02/2023.

Rayos Tablet, Delayed Release (Horizon Therapeutics USA, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/02/2023.