- The initial dosage of prednisone varies depending on the condition being treated and the age of the patient.
- The starting dose may be from 5 to 60 mg per day and often is adjusted based on the response of the condition being treated.
- Corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment.
- Prolonged therapy with prednisone causes the adrenal glands to atrophy and stop producing cortisol.
- When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover. (See side effects.)
- It is recommended that prednisone be taken with food.
PREDNISONE DRUG INTERACTIONS.
Prednisone interacts with many drugs. Here are a few examples of prednisone interactions with other drugs.
- The risk of hypokalemia (low potassium) increases when corticosteroids are combined with drugs that reduce potassium levels (for example, amphotericin B, diuretics), leading to serious side effects such as heart enlargement and congestive heart failure.
- Corticosteroids may increase or decrease the response to warfarin (Jantoven, Coumadin), a blood thinner. Therefore, warfarin therapy should be monitored closely.
- The response to diabetic drugs may be reduced because prednisone increases blood glucose.
- Prednisone may increase the risk of tendon rupture in patients treated with fluoroquinolone type antibiotics. Examples of fluoroquinolones include ciprofloxacin (Cipro) and levofloxacin (Levaquin). The elderly are especially at risk, and tendon rupture may occur during or after treatment with fluoroquinolones.
- Combining aspirin, ibuprofen (Motrin) or other nonsteroidal anti-inflammatory agents (NSAIDS) with corticosteroids increases the risk of stomach related side effects.
- Barbiturates, carbamazepine, rifampin and other drugs that increase the activity of liver enzymes that breakdown prednisone reduce blood levels of prednisone. Conversely, ketoconazole, itraconazole (Sporanox), ritonavir (Norvir), indinavir (Crixivan), macrolide antibiotics such as erythromycin, and other drugs that reduce the activity of liver enzymes that breakdown prednisone increase blood levels of prednisone.
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