Category:

• Miscellaneous

Description:

• Corticosteroid (systemic)

Indications:

• Anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases including those of hematologic, allergic, inflammatory, neoplastic, and autoimmune origin

Contraindications:

• Systemic fungal infections

Precautions:

• Pregnancy category B; compatible with breast feeding

• Psychosis, acute glomerulonephritis, amebiasis, cerebral malaria, child < 2 years

• Elderly, AIDS, tuberculosis, diabetes mellitus, glaucoma, osteoporosis

• Ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis

• Peptic ulcer, ocular herpes simplex, live virus vaccines, hypertension

Adverse Reactions (Side Effects):

• CNS: depression, headache, mood changes, psychosis, seizures, vertigo

• CV: CHF, hypertension, tachycardia, thromboembolism, thrombophlebitis

• EENT: blurred vision, cataracts, increased intraocular pressure

• GI: abdominal distension, diarrhea, GI hemorrhage (esophagitis, peptic ulcer) increased appetite, nausea, pancreatitis

• HEME: leukocytosis

• METAB: Cushingoid syndrome, decreased glucose tolerance, decreased testosterone levels, growth suppression in children, HPA axis suppression, hypocalcemia, hypokalemia, metabolic alkalosis, sodium and fluid retention

• MS: aseptic necrosis of femoral and humeral heads, fractures, muscle mass loss, osteoporosis, weakness

• SKIN: acne, bruising, ecchymosis, petechiae, poor wound healing, striae, suppression of skin test reactions, thin fragile skin

Dosage:

Administered orally (tablet, solution)

• Adult:   PO 50-60mg daily divided 1-4 times daily

  • Physiologic replacement: PO 4-5mg per square meter daily

  • Hepatic disease: Conversion to active metabolite, prednisolone, may be impaired; use prednisolone at same dosage

• Child:   

  • Anti-inflammatory/immunosuppressive: PO 0.05-2 mg/kg/day divided 1-4 times

  • Acute asthma: PO I-2 mg/kg/day divided 1-2 times daily for 3-5 days

  • Asthma, long-term therapy: PO <1 year 10mg every other day, 1-4 years 20mg every other day, 5-13 years 30mg every other day, >13 years 40mg every other day

Drug interactions:

• NSAIDs: increased risk of GI ulceration

• Antidiabetics: increased blood glucose in patients with diabetes

• Salicylates: enhanced elimination of salicylates; possible subtherapeutic salicylate concentrations

• Cyclosporine: possible increased concentrations of both drugs, seizures