Prednisolone is a steroid medication used to treat many different inflammatory conditions allergic disorders, endocrine disorders, etc.
When is Prednisolone used?
The medicine is used to treat adrenal cortex insufficiency, congenital adrenal hyperplasia, subacute thyroiditis, contact dermatitis, serum sickness, persistent or seasonal allergic rhinitis, angioedema, rheumatoid arthritis, ankylosing systemic systemic volostlerocytes, obstructive arthritis periarteritis nodosa, recurrent polychondritis, systemic vasculitis, exfoliative dermatitis, severe seborrheic dermatitis, pemphigus, severe psoriasis. Its use is recommended in the treatment of autoimmune diseases, inflammatory lesions of the joints, eye diseases, lesions of the respiratory and liver organs, as well as cardiovascular, neurological and oncological diseases.
It is often used in transplantation to prevent a rejection reaction.
How does it work?
Prednisolone is a synthetic glucocorticoid drug, a dehydrated analogue of hydrocortisone. It has anti-inflammatory, anti-allergic, immunosuppressive, anti-shock effects, increases the sensitivity of β-adrenergic receptors to endogenous catecholamines.
How to use Prednisolone?
The tablets are taken orally. In each specific case, the dose of the drug is selected individually. When choosing a dose, the circadian rhythm of glucocorticoid secretion in the body must be taken into account, in this regard, 2/3 of the daily dose or the entire dose is recommended to be taken in the morning hours (8 am) and 1/3 of the dose in the evening. When the drug is discontinued, the dosage is gradually reduced until it is completely discontinued.
For adults, in the treatment of acute conditions, the drug is prescribed in a starting dose of 20 to 30 mg, a daily maintenance dose of 5 to 10 mg. If necessary, the initial daily dose may be from 15 to 100 mg.
For children, the drug is prescribed at 1 or 2 mg per kg of body weight, and the maintenance dose for children is from 300 to 600 μg per kg of body weight of the child. The daily dose for the treatment of children should be divided into 4 or 6 doses.
Prednisolone is not used if the patient has ulcerative lesions of the stomach or duodenum, renal failure, osteoporosis, a predisposition to thromboembolism, severe hypertension, shingles, chickenpox and Cushing’s syndrome.
The incidence and severity of side effects depend on the duration of use, the size of the dose used and the possibility of observing the circadian rhythm of prednisolone administration.
- Endocrine system: suppression of adrenal function, decreased glucose tolerance, “steroid” diabetes mellitus or manifestation of latent diabetes mellitus, Cushing’s syndrome (moon face, pituitary obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, myasthenia gravis) growth retardation and delayed sexual development in children;
- Digestive system: oral candidiasis, nausea, vomiting, pancreatitis, “steroid” ulcers of the stomach and duodenum, erosive esophagitis, bleeding and perforation of the gastrointestinal tract, increased or decreased appetite, flatulence, hiccups. In rare cases: an increase in the activity of hepatic transaminases and alkaline phosphatase;
- Cardiovascular system: increased blood pressure, arrhythmias, bradycardia; increased severity of chronic heart failure, ECG changes characteristic of hypokalemia, hypercoagulation, thrombosis (in predisposed patients);
- Nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, cerebellar pseudotumor, headache, convulsions;
- Sensory organs: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral eye infections, trophic changes in the cornea, exophthalmos;
- Metabolism: hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating;
- Musculoskeletal system: growth retardation and ossification processes in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely – pathological bone fractures, aseptic necrosis of the humerus and femur head), muscle tendon rupture, “steroid” myopathy, decreased muscle mass (atrophy);
- Skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, acne, striae, a tendency to develop pyoderma and candidiasis;
- Urinary system: frequent nighttime urination, urolithiasis due to increased excretion of calcium and phosphate;
- Immune system: generalized (skin rash, itching of the skin, anaphylactic shock) and local allergic reactions;
- Adverse reactions due to mineralocorticoid activity: fluid and sodium retention (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, weakness and fatigue);
- Others: exacerbation of infections (the occurrence of this side effect is facilitated by jointly used immunosuppressants and vaccinations), leukocyturia.
The risk of a prednisolone overdose increases significantly with prolonged use of the drug in high doses. In case of an overdose, patients experience an increase in blood pressure, peripheral edema and an increase in side effects.
To stabilize the condition, it is recommended to temporarily stop taking the drug and adjust the dosage.
Interaction with other drugs
Avoid using Prednisolone with the following drugs:
- oral hypoglycemic drugs
- indirect anticoagulants
- acetylsalicylic acid
- amphotericin B
- cardiac glycosides
- carbonic anhydrase inhibitors
- loop diuretics
- estrogens and oral estrogen-containing contraceptives
- growth hormone
- vitamin D
- M-anticholinergics (including antihistamines and tricyclic antidepressants)
- isoniazid and mexiletine
- adrenocorticotropic hormone
- ergocalciferol and parathyroid hormone
- cyclosporine and ketoconazole
- androgens and steroid anabolic drugs
- mitotane and other inhibitors of adrenal cortex function
- live antiviral vaccines and other types of immunization
- antipsychotics (neuroleptics) and azathioprine
- antithyroid drugs
- thyroid hormones.
Pregnancy and breastfeeding
Prednisolone can be used in the treatment of pregnant women, but only under medical supervision.
When using the drug in the treatment of women in the lactation stage, it is necessary to make sure that the breastfed baby does not suffer from hyperbilirubinemia.
Before starting treatment, the patient should be examined to identify possible contraindications. Clinical examination should include examination of the cardiovascular system, X-ray examination of the lungs, examination of the stomach and duodenum, urinary system, organ of vision. Before and during steroid therapy, it is necessary to monitor a complete blood count, the concentration of glucose in the blood and urine, and plasma electrolytes. During the period of treatment with glucocorticosteroids, especially in large doses, it is not recommended to vaccinate due to a decrease in its effectiveness.
Medium to high doses of glucocorticosteroids can cause high blood pressure.
In case of tuberculosis, the drug can be prescribed only in conjunction with anti-tuberculosis drugs.
With intercurrent infections or septic conditions, it is necessary to simultaneously take antibiotics.
With long-term treatment with glucocorticosteroids, it is necessary to take potassium to avoid hypokalemia.
In Addison’s disease, the drug should not be taken simultaneously with barbiturates due to the risk of developing acute adrenal insufficiency (addison crisis).
Glucocorticosteroid hormones can cause growth retardation in children and adolescents. Prescribing the drug every other day usually avoids or minimizes the likelihood of developing this side effect.
In elderly patients, the frequency of adverse reactions increases.
Sudden drug cancelation (especially high doses) may cause a “withdrawal” syndrome: decreased appetite, nausea, lethargy, generalized musculoskeletal pain, asthenia.
The likelihood of adrenal insufficiency as a result of taking the drug can be reduced by gradual drug withdrawal. After drug withdrawal, adrenal insufficiency can last for months, therefore, in case of any stressful situation in this period, hormonal therapy should be resumed.
With hypothyroidism and cirrhosis of the liver, the effect of glucocorticosteroid hormones may be enhanced.
Treatment with glucocorticosteroid drugs requires medical control in diabetes mellitus (including family history), osteoporosis (the risk is higher in the postmenopausal period), hypertension, chronic psychotic reactions (glucocorticosteroid hormones can cause mental disorders and increase emotional instability in anamberculosis), glaucoma, steroid myopathy, stomach and duodenal ulcers, epilepsy, herpes simplex of the eye (danger of corneal perforation).
Due to the weak mineralocorticoid effect for replacement therapy for adrenal insufficiency, prednisolone is used with mineralocorticoids.
In patients with diabetes mellitus, it is necessary to control the blood glucose level and, if necessary, correct therapy.