Composition
Tab 5 mg/20 mg: Prednisolone 5 mg/20 mg. Syp: Per 5 ml: Prednisolone 15 mg. Inj: Per Amp: Prednisolone 25 mg.
Indications & Dosage
Mild to moderate acute asthma, Severe or life-threatening acute asthma: ORAL: Adult: 40-50 mg daily for at least 5 days. Children 1 month-11 years: 1-2 mg/kg once daily (max. per dose 40 mg) for up to 3 days, longer if necessary; 12-17 years: 40-50 mg daily for at least 5 days. Suppression of inflammatory and allergic disorders: ORAL: Adult: Initially 10-20 mg daily 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 2.5-15 mg daily, higher doses may be needed. In severe disorder initial dose may be increased up to 60 mg daily. Children 1 month-18 yrs: initially 1-2 mg/kg once daily (usual max 60 mg daily), then reduced after a few days if appropriate. BY IM INJ: Adult: 25-100 mg 1-2 times a week, as prednisolone Acetate Idiopathic thrombocytopenic purpura: ORAL: Adult & Children: 1 mg/kg daily, gradually reduce dose over several weeks Ulcerative colitis, Crohns disease: ORAL: Adult: Initially 20-40 mg daily to be taken in the morning after breakfast until remission occurs, followed by reducing doses, higher up to 60 mg daily may be used in some cases. Neuritic pain or weakness heralding rapid onset of permanent nerve damage (during reversal reactions multibacillary leprosy): ORAL: Adult: Initially 40-60 mg daily, dose to be instituted at once. Generalized myasthenia gravis: ORAL: Adult: Initially 10 mg once daily on alternate days, then increased in steps of 10 mg once daily on alternate days, increased to 1-1.5 mg/kg once daily on alternate days (max. per dose 100 mg), or daily, initially 5 mg daily, increased in steps of 5 mg daily, maintenance; 60-80 mg daily, alternatively maintenance 0.75-1 mg/kg daily, ventilated patients may be started on 1.5 mg/kg (max. 100 mg) on alternate days. Ocular myasthenia: ORAL: Adult: Usual dose 10-40 mg once daily on alternate days, reduce to minimum effective dose. Reduction in rate of joint destruction in moderate to severe rheumatoid arthritis: ORAL: Adult: 7.5 mg daily. Polymyalgia rheumatic: ORAL: Adult: 10-15 mg daily until remission of disease activity; maintenance 7.5-10 mg daily, reduce gradually to maintenance dose. Giant cell (temporal) arteritis: ORAL: Adult: 40-60 mg daily until remission of disease activity, the higher dose being used if visual symptoms occur; maintenance 7.5-10 mg daily, reduce gradually to maintenance dose. Polyarteritisnodosa, Polymyositis, Systemic lupus erythematosus: ORAL: Adult: Initially 60 mg daily, to be reduced gradually; maintenance 10-15 mg daily. Anorexia (symptom control in palliative care): ORAL: Adult: 15-30 mg daily. Pneumocystis pneumonia in moderate to severe infections associated with HIV infection: ORAL: Adult: 50-80 mg daily for 5 days, the dose is then reduced to complete 21 days of treatment; Children :2 mg/kg (max 80 mg/day) for 5 days, then the dose is reduced over the next 16 days and then stopped. Corticosteroid treatment should be started at the same time as the anti-pneumocystis therapy or not later than 24-72 hours afterwards. The corticosteroid should be withdrawn before anti pneumocystis treatment is complete Multiple sclerosis: ORAL: Adult: 200 mg/day for 1 week followed by 80 mg every other day for 1 month. Rheumatoid arthritis: ORAL: Adult: 5-7.5 mg daily; adjust dose as necessary. Juvenile idiopathic arthritis, Connective tissue disorders and systemic lupus erythematosus: Children 1 month-18 yrs: initially 1-2 mg/kg once daily (usual max 60 mg daily), then reduced after a few days if appropriate. Autoimmune hepatitis: Children 1 month-18 yrs: Initially 2 mg/kg once daily (max 40 mg daily) then reduced to minimum effective dose. Corticosteroid replacement therapy: Children 12-18 yrs: 2-2.5 mg/ square meter daily in 1-2 divided doses adjusted according to response. Infantile spasms: Children 1 month-2 yrs: Initially 10 mg 4 times daily for14 days (if seizures not controlled after 7 days increase to 20 mg 3 times daily for 7 days), reduce dose gradually over 15 days until stopped. Patients taking 40 mg daily, reduce dose in steps of 10 mg every 5 days, then stop; patients taking 60 mg daily, reduce dose to 40 mg daily for 5 days, then 20 mg daily for 5 days, .then 10 mg daily for 5 days, then stop. Nephrotic syndrome: Children 1 month-18 yrs: Initially 60 mg/square meter once daily (max 80 mg daily) for 4-6 week until proteinuria ceases then 40mg/square meter on alternate days for 4-6 week, then withdraw by reducing dose gradually; prevention of-relapse 0.5-1 mg/kg once daily or on alternate days for 3-6 months.
Administration
IM: Shake suspension well before withdrawing. Intra-articular: Attach a 206-246 needle to empty syringe, using aseptic technique, so prescriber can remove a few drops of synovial fluid to confirm that needle is in the joint. The aspirating syringe is then exchanged with a prednisolone-filled syringe to inject drug into joint
Contraindications
Systemic fungal infections unless specific anti-infective therapy is used, head injury, stroke.
Precautions
Active infections not controlled by antibiotics, latent or active amoebiasis, history of TB, septicaemia, symptoms may be masked, avoid or maintain extreme cautions in chickenpox, measles, psychiatric disorders, renal impairment, hepatic failure, cirrhosis, active peptic ulcer, myasthenia gravis, previous steroid myopathy, osteoporosis, epilepsy, hypothyroidism, diabetes, adrenal suppression, hypertension, recent MI, congestive heart failure, thromboembolic disorders, glaucoma, corneal perforation. Withdraw gradually, withdrawal symptoms may include fever, myalgia, arthralgia, rhinitis, itchy skin nodules and weight loss.
Interactions
Live vaccines or other vaccines, anticoagulants, hypoglycaemia agents, antihypertensives, diuretics, erythromycin, rifamycin, amphotericin, azole antifungals, ritonavir, cyclosporin, cardiac glycosides, Oestrogens including oral contraceptives, somatropin, Carbamazepine, phenytoin, primicane, barbiturates. Muscle relaxants, NSAIDs, salicylates, sympathomimetics, mifepristone, methotrexate, theophylline, aprepitant.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Endocrine irregularities including menstrual problems, cushingoid state, adrenal suppression, growth suppression in children, increased susceptibility to infection, increased severity of infection, fluid/electrolyte disturbance, hypertension, negative protein, nitrogen and calci-um balance, myopathy, tendon rupture, osteoporosis, osteonecrosis and fractures, impaired wound healing, sweating, hirsutism, striae, telangiectasia, acne, GI disturbance, peptic ulceration, acute pancreatitis, candidiasis, psychiatric effects, neurological effects, insomnia, diabetes, impaired glucose tolerance, weight gain, increased appetite, ocular disturbances including cataracts, raised intraocular pressure, optic nerve damage, corneal changes, glaucoma, thromboembolism, leukocytosis.