prednisolone (Pediapred, FloPred, Orapred, Orapred ODT, Millipred, Millipred DP, Prelone Syrup, Veripred 20)
Classes: Corticosteroids
Dosing and uses of Pediapred, Orapred (prednisolone)
Adult dosage forms and strengths
oral solution
- 5mg/5mL
- 10mg/5mL
- 15mg/5mL
- 20mg/5mL
- 25mg/5mL
tablet
- 5mg
tablet, dose pack
- 5mg (6 days [21 tabs])
- 5mg (12 days [48 tabs])
tablet, orally disintegrating
- 10mg
- 15mg
- 30mg
Rheumatoid Arthritis
5-7.5 mg PO qDay
Multiple Sclerosis
200 mg/day PO for 1 week, then 80 mg PO every other day for 1 month
Acute Exacerbation of COPD (Off-label)
30-40 mg PO qDay for 10-14 days
Bells Palsy (Off-label)
60 mg PO qDay for 5 days; then taper down by 10 mg daily for 5 days for total duration time of 10 days
Pediatric dosage forms and strengths
oral solution
- 5mg/5mL
- 10mg/5mL
- 15mg/5mL
- 20mg/5mL
- 25mg/5mL
tablet
- 5mg
tablet, dose pack
- 5mg (6 days [21 tabs])
- 5mg (12 days [48 tabs])
tablet, orally disintegrating
- 10mg
- 15mg
- 30mg
Inflammation
0.1-2 mg/kg/day PO in single daily dose or divided q6-12hr; not to exceed 80 mg/day
Acute Asthma
1-2 mg/kg/day in single daily dose or divided q12hr for 3-5 days
Nephrotic Syndrome
First 4 weeks: 60 mg/m²/day or 2 mg/kg/day PO divided q8hr until urine is protein free for 3 consecutive days; not to exceed 28 days; dose not to exceed 80 mg/day
Subsequent 4 weeks: 40 mg/m² or 1-1.5 mg/kg PO every other day; not to exceed 80 mg/day
Maintenance in frequent relapses: 0.5-1 mg/kg/dose PO every other day for 3-6 months
Treatment may have to be individualized
Pediapred, Orapred (prednisolone) adverse (side) effects
Frequency not defined
Acne
Adrenal suppression
Delayed wound healing
Diabetes mellitus
GI perforation
Glucose intolerance
Hepatomegaly
Hypokalemic alkalosis
Increased transaminases
Insomnia
Menstrual irregularity
Myopathy
Neuritis
Osteoporosis
Peptic ulcer
Perianal pruritus
Pituitary adrenal axis suppression
Pseudotumor cerebri (on withdrawal)
Psychosis
Seizure
Ulcerative esophagitis
Urticaria
Vertigo
Weight gain
Warnings
Contraindications
Documented hypersensitivity
Systemic fungal infection, varicella, superficial herpes simplex keratitis
Receipt of live or attenuated live vaccine; Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) state that administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (<2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages (replacement therapy)
Cautions
Use with caution in cirrhosis, diabetes, ocular herpes simplex, hypertension, diverticulitis, following myocardial infarction, thyroid disease, seizure disorders, hypothyroidism, myasthenia gravis, hepatic impairment, peptic ulcer disease, osteoporosis, ulcerative colitis, psychotic tendencies, untreated systemic infections, renal insufficiency, pregnancy
Thromboembolic disorders or myopathy may occur
Delayed wound healing is possible
Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated
Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored)
Some suggestion (not fully substantiated) of slightly increased cleft palate risk if corticosteroids are used in pregnancy
Parenteral forms (prednisolone sodium phosphate) have been discontinued
Suppression of hypothalamic-pituitary-adrenal axis may occur particularly in patients receiving high doses for prolonged periods or in young children; discontinuation of therapy should be done through slow taper
Posterior subcapular cataract formation associated with prolonged use of corticosteroids
Prolonged use of corticosteroids may increase risk of secondary infections
Increase in intraocular pressure associated with prolonged use of corticosteroids
Long-term use associated with fluid retention and hypertension
Development of Kaposi's sarcoma associated with prolonged corticosteroid use
Acute myopathy associated with high dose of corticosteroids
Corticosteroid use may cause psychiatric disturbances
Pregnancy and lactation
Pregnancy category: C
Lactation: Excreted in breast milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Pediapred, Orapred (prednisolone)
Mechanism of action
Glucocorticosteroid; elicits mild mineralocorticoid activity and moderate anti-inflammatory effects; controls or prevents inflammation by controlling rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular leveL
Absorption
Duration: 18-36 hr
Peak plasma time: 5 min (IV); 1 hr (PO)
Distribution
Protein bound: 65-91% (lower in elderly)
Vd: 0.22-0.7 L/kg
Metabolism
Extensively metabolized in liver
Elimination
Half-life: 3.6 hr (normal renal function); 3-5 hr (end-stage renal disease)
Dialyzable: Hemodialysis, no
Renal clearance: 9.5 mL/min
Excretion: Urine (mainly)