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Prednisone (Oral Route) Proper Use - Mayo Clinic.
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Prednisone Tablets (prednisone) dose, indications, adverse effects, interactions from localhost - Description and Brand Names
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding.
Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.
The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended.
Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur.
Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:.
Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.
If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away.
If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away. Treatment was most beneficial in those with absence seizures and early Lennox-Gastaut syndrome. In another retrospective case series, 32 mentally retarded children received various steroids for intractable epilepsy. Eight of those, ages 9 months to 6 years, received prednisone at varying doses and duration 0. All 3 patients who responded had complex partial seizures.
Of those 3 patients, 2 relapsed in less than 1 month after prednisone discontinuation. Infants and children with infantile spasms and children with other types of non-specified intractable seizures were included in the analysis.
The mean age of patients in the non-specified intractable seizures group was Prednisone was reported to be ineffective in all 30 patients with other seizure types. A corticosteroid taper may be considered.
One study used prednisone 0. Guidelines state corticosteroid avoidance, early corticosteroid weaning, or very low dose maintenance corticosteroid therapy are all acceptable therapeutic approaches. When corticosteroids are used, if no rejection episodes in the past 6 months have occurred and significant corticosteroid side effects are present, attempt corticosteroid weaning. Corticosteroid withdrawal can be successfully achieved 3 to 6 months after transplantation in many patients such as older patients, non-multiparous women, and those without circulating anti-HLA antibodies or rejection history.
Patients received aspirin mg orally daily during thalidomide therapy. The use of granulocyte colony-stimulation factor was permitted as indicated. The progression-free survival time evaluated via an independent review facility was significantly improved in patients with CDexpressing systemic anaplastic large-cell lymphoma sALCL or PTCL who received brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone CHP compared with cyclophosphamide, doxorubicin, vincristine, and prednisone CHOP The progression-free survival PFS time evaluated via an independent review facility was significantly improved in patients with CDexpressing sALCL or peripheral T-cell lymphoma who received brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone CHP compared with cyclophosphamide, doxorubicin, vincristine, and prednisone CHOP A suggested taper is 40 mg PO twice daily on days 1 to 5; then 40 mg PO once daily on days 6 to 10; then 20 mg PO once daily on days 11 to Start therapy as early as possible and within 72 hours after starting specific PCP therapy.
Recommended for patients with moderate to severe infection, defined by a PaO2 less than 70 mmHg at room air or an alveolar-arterial DO2 gradient of 35 mmHg or more.
The benefits of starting corticosteroids after 72 hours are unclear. Recommended for patients with moderate to severe infection, defined by a PaO2 less than 70 mmHg at room air or an alveolar-arterial DO2 gradient more than 35 mmHg. Corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, and on patient response.
There is no absolute maximum dosage. Specific guidelines for dosage adjustments in hepatic impairment are not available; prednisone is converted to prednisolone, the active moiety, by the liver. The use of oral prednisolone instead of oral prednisone may be preferred in patients with significant hepatic dysfunction see Prednisolone monograph ; doses are equivalent i. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
Immediate-release tablet: If given once daily or every other day, administer in the morning to coincide with the body's normal cortisol secretion. Delayed-release tablet Rayos : Administer the delayed-release tablets once daily by having the patient swallow them whole; do not break, divide or chew.
When deciding the administration time for the delayed-release tablets, consider the pharmacokinetics and the disease or condition being treated. Prednisone is released from the tablet beginning approximately 4 hours after intake of the first dose. Oral solution or syrup: Administer using a calibrated measuring device for accurate measurement of the dose. Generic: - Protect from moisture - Store at controlled room temperature between 68 and 77 degrees F Deltasone: - Store at controlled room temperature between 68 and 77 degrees F Predone: - Store at controlled room temperature between 68 and 77 degrees F RAYOS: - Protect from light - Protect from moisture - Store at 77 degrees F; excursions permitted to degrees F Sterapred: - Store at controlled room temperature between 68 and 77 degrees F Sterapred DS: - Protect from moisture - Store at controlled room temperature between 68 and 77 degrees F.
Prednisone is contraindicated in patients with a hypersensitivity to prednisone or to any components of the formulation. Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy. Although true corticosteroid hypersensitivity is rare, it is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids. It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists.
Such patients should be carefully monitored during and following the administration of any corticosteroid. Patients receiving high-dose systemic corticosteroid therapy, such as prednisone, for any period of time are at risk to develop immunosuppression; patients receiving moderate dosages of systemic corticosteroids for short periods or low doses for prolonged periods also may be at risk.
When given in combination with other immunosuppressive agents, there is a risk of significant immunosuppression. Corticosteroids may increase the risks related to infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection. The degree to which the dose, route and duration of corticosteroid administration correlates with the specific risks of infection is not well characterized, however, with increasing doses of corticosteroids, the rate of occurrence of infectious complications increases.
Corticosteroids may also mask some signs of current infection. Although the FDA-approved product labeling states that corticosteroids are contraindicated in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate therapy is administered simultaneously.
Avoid use of prednisone in patients with a fungal infection or bacterial infection that is not adequately controlled with anti-infective agents. Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids.
Rule out infection with latent or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or who have unexplained diarrhea. Use corticosteroids with caution in patients with known or suspected Strongyloides threadworm infestation as the immunosuppressive effects may lead to disseminated infection, severe enterocolitis, and sepsis.
Cases of severe and disseminated strongyloidiasis have been reported following use of corticosteroids in combination with tocilizumab to treat patients with coronavirus disease COVID Before giving these drugs together to patients from strongyloidiasis endemic areas, consider administering ivermectin as prophylactic treatment.
Reserve systemic corticosteroid therapy in active tuberculosis for patients with fulminating or disseminated disease and only in conjunction with appropriate antituberculosis therapy. Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients.
Furthermore, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Advise patients receiving immunosuppressive doses of systemic corticosteroids to avoid exposure to persons with a viral infection i. Instruct patients to get immediate medical advice if exposure occurs. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin may be indicated.
If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin may be indicated. Avoid the use of corticosteroids in active ocular herpes infection due to the risk of corneal perforation. Corticosteroids should not be used in cerebral malaria. As glucocorticoids can produce or aggravate Cushing's syndrome, glucocorticoids should be avoided in patients with Cushing's disease unless when needed to correct hypocortisolism that may occur during use of treatments for the condition.
Acute adrenal insufficiency and even death may occur following abrupt discontinuation of systemic therapy. In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels. Withdraw prolonged systemic corticosteroid therapy greater than 2 weeks gradually.
HPA suppression can last for up to 12 months following cessation of systemic chronic therapy. Recovery of HPA axis function is generally prompt and complete upon discontinuation of short-term or topical corticosteroid therapy. Like all corticosteroids, prednisone therapy may impair immune and adrenocortical function. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as surgery, acute blood loss, or infectious conditions, even after the corticosteroid has been discontinued.
Patients should advise the attending physician of the corticosteroid they have received within the last 12 months, and the disease for which they were being treated. Identification cards which include the name of the patient's disease, the currently administered type and dose of corticosteroid, and the patient's physician should be carried with the patient at all times.
Corticosteroid therapy, including prednisone therapy, has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction, and should therefore be used cautiously in these patients. As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal disease or insufficiency.
Systemic corticosteroids, such as prednisone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. Metabolic clearance of corticosteroids is decreased in hypothyroidism and increased in hyperthyroidism. Changes in thyroid disease status of a patient may necessitate adjustment in dosage.
Systemic corticosteroids should be used with caution in patients with active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since steroids may increase the risk of a gastrointestinal GI perforation.
Signs of peritoneal irritation following GI perforation in patients receiving corticosteroids may be minimal or absent. Corticosteroids should not be used in patients where there is a possibility of impending GI perforation, abscess, or pyogenic infection. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with severe hepatic disease with cirrhosis. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with neuromuscular disease disorders e.
This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years. Use with caution in patients with glaucoma; prednisone can cause increased intraocular pressure with possible damage to the optic nerves. If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored.
Use of corticosteroids may produce posterior subcapsular cataracts and may enhance the establishment of secondary ocular infection due to bacteria, fungi or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should not be used in active ocular herpes simplex because of possible corneal perforation.
Existing emotional instability or psychosis may be aggravated by corticosteroids. Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychosis. Use prednisone with caution in patients with a seizure disorder; systemic steroids can lower the seizure threshold. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i.
This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteopenia or osteoporosis at any age. Growth and development of pediatric patients on prolonged corticosteroid therapy should be carefully observed. Special consideration should be given to patients at increased risk of osteoporosis e.
Consider interventions to reduce bone loss or treat glucocorticoid-induced osteoporosis in affected patients. To minimize the risk of glucocortoicoid-induced bone loss, the smallest possible effective dosage and duration should be used. Current recommendations suggest that all interventions be initiated in any patient in whom glucocorticoid therapy with at least the equivalent of 5 mg of prednisone for at least 3 months is anticipated.
Prednisone has been used in infants, children, and adolescents; however, consider pediatric-specific issues before initiating treatment. Safety and efficacy have not been established for the use of corticosteroids in neonates. Adverse effects in newborns have included complications of treatment such as gastrointestinal bleeding, intestinal perforation, hyperglycemia, and hypertension. The potential for growth inhibition in any pediatric patient should be monitored during prolonged therapy, and the potential for growth effects should be weighed against the clinical benefit obtained and the availability of other treatment alternatives.
Administration of corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen.
Further, children receiving corticosteroids are immunosuppressed, and are therefore more susceptible to infection. Normally innocuous infections can become fatal in these children, and care should be taken to avoid exposure to these diseases. Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome pediatric patients more than 2 years of age , and aggressive lymphomas and leukemias patients greater than 1 month of age.
Other indications for pediatric use of corticosteroids e. Indicated vaccination procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy e.
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted. In patients who have received high-dose, systemic corticosteroids for 2 weeks or longer, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine.
If systemic corticosteroids such as prednisone must be used during pregnancy, the potential risks should be discussed with the patient. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. Based on findings from human and animal studies, corticosteroids can cause fetal harm when administered to a pregnant woman.
Published epidemiological studies suggest a small but inconsistent increased risk of orofacial clefts with use of systemic corticosteroids during the first trimester. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. Intrauterine growth restriction and decreased birth weight have also been reported with maternal use of systemic corticosteroids during pregnancy; however, the underlying maternal condition may also contribute to these risks.
There are no adequate and well-controlled studies in pregnant women. Corticosteroids distribute into breast milk, and the manufacturer states that in order to minimize infant exposure, the lowest dose should be prescribed to lactating women to achieve the desired clinical effect.
Prednisone concentrations in breast milk are low, and no adverse effects have been reported in the breast-fed infant with maternal use of any corticosteroid during breast-feeding; prednisone is generally considered compatible to use during lactation. Published case reports of systemic prednisone use during pregnancy that indicate little risk to a nursing infant due to lack of reported side effects. Prednisone is converted to prednisolone in vivo, and peak concentrations in human milk appear in about 1 hour after a dose; the total daily dose reaching the infant is approximately 0.
Prednisolone and methylprednisolone have similar data available regarding systemic use during lactation. High doses of corticosteroids administered to lactating women for long periods could potentially produce problems in the breastfed infant including growth and development and interfere with endogenous corticosteroid production. At higher daily prednisone doses, avoidance of breast-feeding during times of peak milk concentrations can help limit infant exposure; however, such adjustments are rarely necessary.
Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Use systemic corticosteroids such as prednisone with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use. According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.
The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration.
According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences.
Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression.
Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection.
Acetaminophen; Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance.
Acetaminophen; Aspirin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Aspirin; Diphenhydramine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH.
Acetohexamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment.
Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells.
Adalimumab: Moderate Closely monitor for the development of signs and symptoms of infection if coadministration of a corticosteroid with adalimumab is necessary. Adalimumab treatment increases the risk for serious infections that may lead to hospitalization or death. Patients taking concomitant immunosuppressants including corticosteroids may be at greater risk of infection. Albiglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Alefacept: Contraindicated Patients receiving other immunosuppressives should not receive concurrent therapy with alefacept; there is the possibility of excessive immunosuppression and subsequent risks of infection and other serious side effects. In clinical efficacy trials, concurrent treatment of alefacept with these types of agents did not occur. The duration of the period following treatment with alefacept that is appropriate before starting other immunosuppressive therapy has not been evaluated.
Alemtuzumab: Moderate Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression. Monitor patients carefully for signs and symptoms of infection. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Both corticosteroids and thiazide diuretics cause increased renal potassium loss. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Alogliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects.
Ambenonium Chloride: Moderate Concomitant use of anticholinesterase agents, such as ambenonium chloride, and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents used to treat myasthenia should be withdrawn at least 24 hours before initiating corticosteroid therapy.
Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures. If coadministration occurs, closely monitor patients for seizure activity.
Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients.
Amiloride; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment.
Aminosalicylate sodium, Aminosalicylic acid: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.
Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.
Aprepitant, Fosaprepitant: Moderate Use caution if prednisone and aprepitant, fosaprepitant are used concurrently and monitor for an increase in prednisone-related adverse effects for several days after administration of a multi-day aprepitant regimen. The active metabolite of prednisone, prednisolone, is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions.
However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important.
Arsenic Trioxide: Moderate Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide. Articaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Corticosteroids may potentiate the hypokalemic effects of epinephrine. Asparaginase Erwinia chrysanthemi: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy.
Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions.
Aspirin, ASA: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Monitor for decreased response to prednisone during concurrent use. Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Caffeine; Dihydrocodeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Caffeine; Orphenadrine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Carisoprodol: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Carisoprodol; Codeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Dipyridamole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Omeprazole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Oxycodone: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Pravastatin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Atazanavir: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Atenolol; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Atracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers.
Clinical improvement or recovery after stopping therapy may require weeks to years. Azilsartan; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Benazepril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bendroflumethiazide; Nadolol: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bismuth Subsalicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Boceprevir: Major Concurrent administration of systemic corticosteroids, such as prednisone, and boceprevir is not recommended. If prednisone and boceprevir are coadministered, close monitoring for corticosteroid-related adverse events and for decreased boceprevir efficacy is advised.
If prednisone dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Predictions about the interaction can be made based on the metabolic pathway of prednisone. Prednisone is metabolized by the hepatic isoenzyme CYP3A4 and the drug efflux transporter P-glycoprotein P-gp ; boceprevir inhibits both the isoenzyme and the drug efflux pump.
Coadministration may result in elevated prednisone plasma concentrations. Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Brompheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Bupivacaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk.
Bupropion; Naltrexone: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use. Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone.
Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone. Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary.
Prednisone is a P-glycoprotein P-gp substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown. Caffeine; Sodium Benzoate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea.
Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. Canagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Captopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbinoxamine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution. Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure.
Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection. Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpropamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorthalidone; Clonidine: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone.
Choline Salicylate; Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Cisatracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor.
Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects. Dapagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment.
Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids. Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Desmopressin: Major Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Dextromethorphan; Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Digoxin: Moderate Hypokalemia, hypomagnesemia, or hypercalcemia increase digoxin's effect. Corticosteroids can precipitate digoxin toxicity via their effect on electrolyte balance. It is recommended that serum potassium, magnesium, and calcium be monitored regularly in patients receiving digoxin. Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 DPP-4 inhibitor use; a DPP-4 dose adjustment may be necessary.
Diphenhydramine; Hydrocodone; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications. Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias.
Dulaglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids.
For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea. Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources.
Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Empagliflozin; Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Empagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Enalapril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Enzalutamide: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with enzalutamide; a dosage increase may be necessary. Concurrent use may decrease the exposure of prednisone.
Ephedrine: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage.
Ephedrine; Guaifenesin: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Erlotinib: Moderate Monitor for symptoms of gastrointestinal GI perforation e. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Ertugliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Estrogens: Moderate Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. Caution is warranted if these drugs are coadministered. Exenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Fluoxymesterone: Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease.
Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema. Administer these drugs in combination with caution. Fosamprenavir: Moderate Concomitant use of prednisone and fosamprenavir may result in altered prednisone plasma concentrations.
Amprenavir, the active metabolite of fosamprenavir, is an inducer of P-gp and a potent inhibitor and moderate inducer of CYP3A4. Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Fosphenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with fosphenytoin; a dosage increase may be necessary.
Gallium Ga 68 Dotatate: Moderate Repeated administration of high corticosteroid doses prior to gallium Ga 68 dotatate may result in false negative imaging. Corticosteroids can down-regulate somatostatin subtype 2 receptors: thereby, interfering with binding of gallium Ga 68 dotatate to malignant cells that overexpress these receptors. Glecaprevir; Pibrentasvir: Moderate Caution is advised with the coadministration of glecaprevir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects.
Prednisone is a substrate of P-glycoprotein P-gp ; glecaprevir is a P-gp inhibitor. Moderate Caution is advised with the coadministration of pibrentasvir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; pibrentasvir is a P-gp inhibitor.
Send the page " " to a friend, relative, colleague or yourself. We do not record any personal information entered above. Commonly-prescribed oral corticosteroid with little mineralocorticoid activity; metabolized to prednisolone; prednisone is roughly 4 times as potent as hydrocortisone as a glucocorticoid Used in many conditions in adult and pediatric patients, including asthma, COPD, SLE, rheumatoid and psoriatic arthritis, prevention of transplant rejection, and many allergic, dermatologic, and inflammatory states If long-term therapy required, the lowest possible effective dose should be used.
For acute conditions, parenteral steroid therapy is recommended initially. NOTE: Hydrocortisone and cortisone are the preferred agents; prednisone has little to no mineralocorticoid properties.
NOTE: Hydrocortisone is the preferred glucocorticoid in infants. Titrate to response. The usual range is 5 mg to 30 mg PO once daily. Renal transplant guidelines recommend a calcineurin inhibitor CNI such as tacrolimus and an antiproliferative agent such as mycophenolate plus or minus corticosteroids for initial prophylaxis. In patients at low immunologic risk who receive induction therapy, corticosteroid discontinuation during first week after transplantation is suggested.
Some evidence exists that steroids may be safely stopped in most patients after 3 to 12 months on combination therapy with a CNI and mycophenolate. Data suggest that the risk of steroid withdrawal depends on the use of concomitant immunosuppressives, immunological risk, ethnicity, and time after transplantation.
Once the prednisone taper is completed without a flare, the cyclosporine dose is tapered to alternate day dosing such that the patient is taking prednisone one day and cyclosporine the next day. Once patients reach their maximal response, therapy is continued for another 3 months and then tapered. Multiple dosage regimens have been studied. Dosage requirements are variable though and should be individualized based on the response of the patient and tolerance to treatment.
The American College of Gastroenterology states that corticosteroids are not effective for maintenance of medically-induced remission in Crohn's disease and should not be used for long-term treatment.
Corticosteroids for Crohn's disease are more effective for small-bowel involvement than for colonic involvement. Because of the potential complications of steroid use in this disease, steroids should be used selectively and in the lowest dose possible.
Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission. Total course of treatment may range from 3 to 10 days. Dosing in the afternoon at PM may be helpful for patients prone to nocturnal symptoms, with no increase in adrenal suppression.
Consider add-on low dose oral corticosteroids CS 7. Add CS only after exclusion of other contributory factors and consideration of other add-on treatments.
In pediatric patients, the use of oral corticosteroids is usually limited to a few weeks until asthma control is improved and the patient can be stabilized on other, preferred treatments. Increase by 5 mg every 2 to 3 days as needed. For chronic use, may change to every other day therapy.
Usual dosage ranges from 5 to 30 mg PO once daily. Use the lowest effective dose usually less than 7. American College of Rheumatology guidelines recommend 0. Taper the dose after a few weeks to the lowest effective dose that maintains control.
Insufficient data exist to recommend a specific steroid taper because nephritis and extrarenal manifestations vary from patient to patient.
Some patients may require long-term therapy. If needed, the long-term maintenance dose is 0. In patients with severe skin reactions, higher initial doses e. Adjust until a satisfactory response is noted; taper as clinically indicated.
High-dose corticosteroids are controversial; administration has been associated with decreased survival. Depending on the indication, the initial dose may be gradually tapered after 1 to 2 weeks and discontinued by 4 to 6 weeks, as guided by symptoms. Oral corticosteroids are usually reserved for cases not responding to standard topical treatments.
Use lowest effective dose. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine. Corticosteroid use in ARDS is controversial. The initial dosage may vary from 5 to 60 mg PO per day. Guidelines use a dose of 0. Taper to 0. Guidelines suggest use of prednisone with cyclophosphamide or azathioprine, and a minimum of 6 months duration. Objective responses may not be noted until at least 3 months of therapy.
Exact duration of treatment and need for long-term maintenance should be individualized to clinical response and tolerance of therapy. Chronic doses of prednisone 15 mg to 20 mg PO once daily may be adequate as maintenance therapy.
Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Weight-based dosing: 0. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, as guided by symptoms. Chemotherapy cycle is repeated every 57 days. Depending on indication, gradually taper the initial dose after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Guidelines recommend as adjunct therapy for meningitis. Routine use outside of CNS involvement is not recommended; however, select patients may benefit.
The National Institutes of Health NIH COVID treatment guidelines recommend prednisone as an alternative corticosteroid for hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation ECMO. The NIH recommends 40 mg PO once daily or in 2 divided doses for up to 10 days or until hospital discharge whichever comes first.
The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting prednisone. Treatment cycles may be repeated when the granulocyte and platelet counts returned to normal. Response may be gradual over several months. The optimal dosage of melphalan and prednisone plus thalidomide has not been clearly established and dosages have varied in randomized controlled trials.
In one study, previously untreated patients between 65 and 75 years of age received melphalan 0. Thalidomide was stopped after day 4 of the last cycle.
In another study, patients aged 75 years and older received melphalan 0. In cycles 1 through 4, bortezomib 1. In cycles 5 to 9, bortezomib 1. Dosage not established. The progression-free survival time was not significantly improved with carfilzomib, melphalan, and prednisone compared with bortezomib, melphalan, and prednisone in a randomized, phase 3 trial the CLARION trial ; additionally, serious and fatal adverse reactions occurred more often in the carfilzomib-containing arm.
There is not sufficient evidence to support the use of this drug combination for this indication. If side effects e. NOTE: The definitive treatment for median-nerve entrapment is surgery. Corticosteroids are temporary measures; patients who have intermittent pain and paresthesias without any fixed motor sensory deficits may respond to conservative therapy.
Initially, 20 mg to 30 mg PO once daily has been recommended. Some experts give a combination of prednisone and azathioprine. For maintenance, prednisone 5 mg to 15 mg PO once daily has been recommended. Doses for the various manifestations of SLE vary widely. Maintenance doses are usually 10 to 20 mg PO once daily or 20 to 40 mg PO every other day. Initially, large doses e. Individualize dose and titrate to response. After symptoms controlled, decrease dose slowly every 5 to 7 days.
Maintenance doses for chronic conditions are usually 10 to 20 mg PO once daily or 20 mg to 40 mg PO every other day. The treatment combination demonstrated superior results over colchicine alone in the treatment of primary amyloidosis. A multicenter, randomized, controlled trial confirmed that this shorter duration of low dose prednisone is equivalent to using 40 mg of prednisone for a longer duration i.
Data from studies indicate that systemic glucocorticoids shorten recovery time; improve lung function FEV-1improve oxygenation, and reduce the risk of early relapse, treatment failure, and the length of hospitalization. Taper dose over at least 6 weeks. There is variation in the literature with regard to dosage regimens. Prednisone 0. Use of IV methylprednisolone for a few days may precede oral corticosteroid use. While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value.
Higher quality data are needed to establish the benefits vs. Experts generally agree that patients who have neurologic deficits should receive a corticosteroid; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation.
Topically applied corticosteroids are as effective as systemic corticosteroids for anterior ocular inflammation. Common regimens from high-quality clinical trials include a prednisone or prednisolone dose of 60 mg PO per day for 5 days, followed by a 5-day taper or 25 mg PO twice daily for 10 daysin combination with appropriate antiviral treatment.
A prednisone dose of mg PO administered in descending doses over 10 days has also been used with efficacy. The American Academy of Neurology notes that for new-onset Bell's palsy, steroids are effective in increasing the probability of complete facial functional recovery according to data derived from class I high quality studies.
The optimal dose of prednisone for infantile spasms has not been determined. Based on the evidence currently available, the American Academy of Neurology and the Child Neurology Society's practice parameters for the treatment of infantile spasms state that there is insufficient evidence that oral corticosteroids are effective in the treatment of infantile spasms. There are limited data available for the treatment of refractory seizure types in pediatric patients.
Oral: 1 mg/kg (maximum dose: 60 to 80 mg/day) once daily or 2 mg/kg (maximum dose: mg) every other day; duration of therapy depends on. The standard prednisone dosage for adults is mg per day. Use our prednisone dosage chart to find the recommended and maximum dosage of prednisone. The initial dosage of prednisone may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity. Dosage and strength The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. The. Initially, 15 mg/day to 20 mg/day PO. Increase by 5 mg every 2 to 3 days as needed. Maximum: 60 mg/day PO. For chronic use, may change to every other day. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Pioglitazone; Glimepiride: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. Metolazone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.Back to Prednisolone tablets and liquid. The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. The usual dose varies between 5mg and 60mg daily but occasionally higher doses may be prescribed.
The strength of tablets range from 1mg to 25mg. There are 2 strengths of liquid with either 1mg or 10mg in every 1ml. In children, the dose may be lower than for an adult with the same problem because it is calculated based on their height and weight. Once your health problem or condition starts to get better, it's likely that your dose will go down. Your doctor may reduce your dose before you stop treatment completely. This is to reduce the risk of withdrawal symptoms. Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, with breakfast.
For example, if your dose is 40mg daily, your doctor may tell you to take 8 tablets 8 x 5mg all at the same time. Take prednisolone with breakfast so it does not upset your stomach. Taking prednisolone in the morning also means it's less likely to affect your sleep. If your prednisolone tablets are labelled as "enteric coated" or "gastro resistant", you can take these with or without food but make sure to swallow them whole.
Do not take indigestion medicines 2 hours before or after taking enteric coated or gastro resistant tablets. Sometimes, your doctor may advise you to take prednisolone on alternate days only. You may need to take it for longer, even for many years or the rest of your life.
If you miss a dose of prednisolone, take it as soon as you remember. If you do not remember until the following day, skip the missed dose and take the next one at the usual time.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine. It can be dangerous to stop taking prednisolone suddenly, especially if you have been on a high dose for a long time.
Your health condition may flare up again. You may also get withdrawal side effects including:. These side effects are most likely to happen if you have taken prednisolone for more than a few weeks or you take more than 40mg daily. Your doctor will probably want to reduce your dose gradually over several weeks to prevent these side effects.
Do not stop taking prednisolone without talking to your doctor — you will need to reduce the dose gradually. Page last reviewed: 24 February Next review due: 24 February How and when to take prednisolone tablets and liquid. It's important to take prednisolone as your doctor has advised. Dosage and strength The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. Changes to your dose Your dose may go up or down.
Your dose may go up if your symptoms get worse. How to take it Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, with breakfast.
How long to take it for This depends on your health problem or condition. You may only need a short course of prednisolone for up to 1 week. If you forget to take it If you miss a dose of prednisolone, take it as soon as you remember. Do not take a double dose to make up for a forgotten one. Stopping prednisolone It can be dangerous to stop taking prednisolone suddenly, especially if you have been on a high dose for a long time. You may also get withdrawal side effects including: severe tiredness weakness body aches joint pain These side effects are most likely to happen if you have taken prednisolone for more than a few weeks or you take more than 40mg daily.
Important: Important Do not stop taking prednisolone without talking to your doctor — you will need to reduce the dose gradually.
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