prednisolone (Orapred, Pediapred)

Prednisolone is a synthetic adrenal corticosteroid (cortisone). Corticosteroids are natural substances produced by the adrenal glands located adjacent to the kidneys. Corticosteroids have potent anti-inflammatory properties, and are used in a wide variety of inflammatory conditions such as arthritis, colitis, asthma, bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. There are numerous preparations of corticosteroids including tablets, capsules, liquids, topical creams and gels, inhalers, eye drops, as well as injectable and intravenous solutions. The FDA approved prednisolone in June 1955.

What brand names are available for prednisolone?

Flo-Pred, Pediapred, Orapred, Orapred ODT

Is prednisolone available as a generic drug?

Yes

Do I need a prescription for prednisolone?

Yes

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/a>, 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.

Dosage requirements of corticosteroids vary among individuals and the diseases being treated. The usual starting dose range is 5 mg to 60 mg daily depending on the disease being treated. Doses are adjusted based on patient response. In general, the lowest possible effective dose is used. Corticosteroids given in multiple doses throughout the day are more effective, but also more toxic than alternate-day therapy where twice the daily dose is administered every other morning. Prednisolone should be taken with food to reduce irritation of the stomach and intestines.

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.

Combining aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids increases the risk of gastrointestinal side effects.

Combining corticosteroids with potassium-depleting agents (for example, diuretics) increases the risk of low blood potassium (hypokalemia). Vaccines are less effective in patients on prolonged corticosteroid treatment because corticosteroids suppress the immune system. Corticosteroids may also allow organisms contained in live attenuated vaccines to replicate.

What preparations of prednisolone are available?

• Tablets: 5 mg.
• Tablets (Disintegrating): 10, 15, 30 mg
• Syrup or Suspension: 5, 10, 15, 20 or 25 mg/5 ml (teaspoon).

How should I keep prednisolone stored?

Store at room temperature, 15 C to 30 C (59 F to 86 F). Do not refrigerate.