prednisolone (Flo-Pred, Pediapred, Orapred, Orapred ODT) (cont.)

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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.

Steroids increase blood sugar (glucose) levels and, therefore, reduce the effect of drugs used for treating diabetes.

Activity of cyclosporine and corticosteroids increase when both drugs are combined. Seizures have been reported.

PREGNANCY: Prednisolone can cause fetal harm (cleft lip or palate) when used by pregnant women.

NURSING MOTHERS: Prednisolone is secreted in human milk at 5% to 25% of the nursing mother's blood level. High doses of prednisolone may cause growth problems in the infant.

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.

Medically Reviewed by a Doctor on 8/7/2014


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