prednisone

(pred' ni sone)
Apo-Prednisone (CAN), Liquid Pred, Meticorten, Novo-Prednisone (CAN),
Orasone, Panasol-S, Prednicen-M, Prednisone Intensol Concentrate,
Sterapred DS, Winpred (CAN)

Pregnancy Category C

Drug classes
Corticosteroid (intermediate acting)
Glucocorticoid
Hormone

Therapeutic actions
Enters target cells and binds to intracellular corticosteroid receptors, thereby initiating
many complex reactions that are responsible for its anti-inflammatory and
immunosuppressive effects.

Indications
• Replacement therapy in adrenal cortical insufficiency
• Hypercalcemia associated with cancer
• Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg,
pemphigus), status asthmaticus, and autoimmune disorders
• Hematologic disorders: thrombocytopenia purpura, erythroblastopenia
• Ulcerative colitis, acute exacerbations of multiple sclerosis and palliation in some
leukemias and lymphomas
• Trichinosis with neurologic or myocardial involvement

Contraindications and cautions

• Contraindicated with infections, especially tuberculosis, fungal infections,
amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation.
• Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis
with impending perforation, diverticulitis, active or latent peptic ulcer,
inflammatory bowel disease, CHF, hypertension, thromboembolic disorders,
osteoporosis, seizure disorders, diabetes mellitus; hepatic disease; pregnancy
(monitor infants for adrenal insufficiency).

Available forms
Tablets—1, 2.5, 5, 10, 20, 50 mg; oral solution—5 mg/5 mL, 5 mg/mL; syrup—5 mg/5
mL

Dosages
ADULTS
Individualize dosage depending on severity of condition and patient's response.
Administer daily dose before 9 AM to minimize adrenal suppression. If long-term
therapy is needed, consider alternate-day therapy. After long-term therapy, withdraw drug
slowly to avoid adrenal insufficiency. Initial dose, 5–60 mg/day PO. For maintenance
therapy, reduce initial dose in small increments at intervals until lowest dose that
maintains satisfactory clinical response is reached.
PEDIATRIC PATIENTS
• Physiologic replacement: 0.05–2 mg/kg/day PO or 4–5 mg/m2/day PO in equal
divided doses q 12 hr.
• Other indications: Individualize dosage depending on severity of condition and
patient's response rather than by strict adherence to formulae that correct adult
doses for age or body weight. Carefully observe growth and development in
infants and children on prolonged therapy.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–2 hr 1–1.5 days

Metabolism: Hepatic; T1/2: 3.5 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts,
increased IOP, glaucoma (long-term therapy)
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention,
thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias
• Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased
carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect),
increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels,
HPA suppression with systemic therapy longer than 5 days
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea,
vomiting, increased appetite, weight gain (long-term therapy)
• Hypersensitivity: Hypersensitivity or anaphylactoid reactions
• Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass,
osteoporosis, spontaneous fractures (long-term therapy)
• Other: Immunosuppression, aggravation or masking of infections; impaired
wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae;
subcutaneous fat atrophy

Interactions
Drug-drug
• Increased therapeutic and toxic effects with troleandomycin, ketoconazole
• Increased therapeutic and toxic effects of estrogens, including hormonal
contraceptives
• Risk of severe deterioration of muscle strength in myasthenia gravis patients who
also are receiving ambenonium, edrophonium, neostigmine, pyridostigmine
 • Decreased steroid blood levels with barbiturates, phenytoin, rifampin
• Decreased effectiveness of salicylates
Drug-lab test
• False-negative nitroblue-tetrazolium test for bacterial infection
• Suppression of skin test reactions

Nursing considerations
Assessment
• History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis
with impending perforation, diverticulitis, active or latent peptic ulcer,
inflammatory bowel disease, CHF, hypertension, thromboembolic disorders,
osteoporosis, seizure disorders, diabetes mellitus; hepatic disease; lactation
• Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP,
peripheral perfusion, prominence of superficial veins, R, adventitious sounds,
serum electrolytes, blood glucose

Interventions
• Administer once-a-day doses before 9 AM to mimic normal peak corticosteroid
blood levels.
• Increase dosage when patient is subject to stress.
• Taper doses when discontinuing high-dose or long-term therapy.
• Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Teaching points
• Do not stop taking the drug without consulting your health care provider.
• Avoid exposure to infections.
• Report unusual weight gain, swelling of the extremities, muscle weakness, black
or tarry stools, fever, prolonged sore throat, colds or other infections, worsening
of the disorder for which the drug is being taken.

Adverse effects in Italic are most common; those in Bold are life-threatening.