prednisolone (cont.)
DRUG INTERACTIONS: 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.
PREGNANCY: There are no adequate studies in
pregnant women of
prednisolone.
NURSING MOTHERS: Prednisolone has not been adequately evaluated in
nursing mothers.
SIDE EFFECTS: 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, high blood pressure, 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,
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
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 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.
Reference: FDA Prescribing Information
Last Editorial Review: 8/7/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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