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Medication Safety Issues
Sound-alike/look-alike issues:
PrednisoLONE may be confused with predniSONE
Pediapred® may be confused with Pediazole®
Prelone® may be confused with Prozac®
Pronunciation
(pred NISS oh lone)
U.S. Brand Names
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of palpebral and bulbar conjunctivitis; corneal injury from chemical, radiation, thermal burns, or foreign body penetration; endocrine disorders, rheumatic disorders, collagen diseases, dermatologic diseases, allergic states, ophthalmic diseases, respiratory diseases, hematologic disorders, neoplastic diseases, edematous states, and gastrointestinal diseases; resolution of acute exacerbations of multiple sclerosis; management of fulminating or disseminated tuberculosis and trichinosis; acute or chronic solid organ rejection
Use: Dental
Treatment of a variety of oral diseases of allergic, inflammatory, or autoimmune origin
Pregnancy Risk Factor
C
Pregnancy Considerations
Ophthalmic prednisolone was shown to be teratogenic in animal studies and adverse events have been observed with corticosteroids in animal reproduction studies. Prednisolone crosses the placenta; prior to reaching the fetus, prednisolone is converted by placental enzymes to prednisone. As a result, the amount of prednisolone reaching the fetus is ~8-10 times lower than the maternal serum concentration (healthy women at term; similar results observed with preterm pregnancies complicated by HELLP syndrome). Some studies have shown an association between first trimester corticosteroid use and oral clefts; adverse events in the fetus/neonate have been noted in case reports following large doses of systemic corticosteroids during pregnancy. Women exposed to prednisolone during pregnancy for the treatment of an autoimmune disease may contact the OTIS Autoimmune Diseases Study at 877-311-8972.
Lactation
Enters breast milk/use caution (AAP rates “compatible”)
Breast-Feeding Considerations
Prednisolone is excreted into breast milk with peak concentrations occurring ~1 hour after the maternal dose. The milk/plasma ratio was found to be 0.2 with doses ?30 mg/day and 0.1 with doses <30 mg/day. Following a maternal dose of prednisolone 80 mg/day, a breast-feeding infant would ingest <0.1% of the dose.
Contraindications
Hypersensitivity to prednisolone or any component of the formulation; acute superficial herpes simplex keratitis; live or attenuated virus vaccines (with immunosuppressive doses of corticosteroids); systemic fungal infections; varicella
Warnings/Precautions
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.
• Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections) or prolong or exacerbate viral infections. Exposure to chickenpox should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria or viral hepatitis. Use with caution in patients with tuberculosis.
• Kaposi's sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered.
• Myopathy: Acute myopathy has been reported with high dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.
• Ocular effects: Prolonged use of corticosteroids may result in glaucoma; damage to the optic nerve (not indicated for treatment of optic neuritis), defects in visual acuity and fields of vision, and posterior subcapsular cataract formation may occur. Use following cataract surgery may delay healing or increase the incidence of bleb formation.
• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Pre-existing psychiatric conditions may be exacerbated by corticosteroid use.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with HF; long-term use has been associated with fluid retention and hypertension.
• Diabetes: Use with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.
• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, peptic ulcer, ulcerative colitis) due to perforation risk.
• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis; long-term use has been associated with fluid retention.
• Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred especially during initial treatment with corticosteroids.
• Myocardial infarction (MI): Use with caution following acute MI; corticosteroids have been associated with myocardial rupture.
• Osteoporosis: Use with caution in patients with osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures.
• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.
• Seizure disorders: Use with caution in patients with a history of seizure disorder; seizures have been reported with adrenal crisis.
• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid ones.
Special populations:
• Elderly: Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
• Pediatrics: May affect growth velocity; growth should be routinely monitored in pediatric patients.
Other warnings/precautions:
• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.
Adverse Reactions
Frequency not defined.
Ophthalmic formulation:
Endocrine & metabolic: Hypercorticoidism (rare)
Ocular: Conjunctival hyperemia, conjunctivitis, corneal ulcers, delayed wound healing, glaucoma, intraocular pressure increased, keratitis, loss of accommodation, optic nerve damage, mydriasis, posterior subcapsular cataract formation, ptosis, secondary ocular infection
Oral formulation:
Cardiovascular: Cardiomyopathy, CHF, edema, facial edema, hypertension
Central nervous system: Convulsions, headache, insomnia, malaise, nervousness, pseudotumor cerebri, psychic disorders, vertigo
Dermatologic: Bruising, facial erythema, hirsutism, petechiae, skin test reaction suppression, thin fragile skin, urticaria
Endocrine & metabolic: Carbohydrate tolerance decreased, Cushing's syndrome, diabetes mellitus, growth suppression, hyperglycemia, hypernatremia, hypokalemia, hypokalemic alkalosis, menstrual irregularities, negative nitrogen balance, pituitary adrenal axis suppression
Gastrointestinal: Abdominal distention, increased appetite, indigestion, nausea, pancreatitis, peptic ulcer, ulcerative esophagitis, weight gain
Hepatic: LFTs increased (usually reversible)
Neuromuscular & skeletal: Arthralgia, aseptic necrosis (humeral/femoral heads), fractures, muscle mass decreased, muscle weakness, osteoporosis, steroid myopathy, tendon rupture, weakness
Ocular: Cataracts, exophthalmus, eyelid edema, glaucoma, intraocular pressure increased, irritation
Respiratory: Epistaxis
Miscellaneous: Diaphoresis increased, impaired wound healing
Metabolism/Transport Effects
Substrate of CYP3A4 (minor); Inhibits CYP3A4 (weak)
Drug Interactions
Acetylcholinesterase Inhibitors: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Risk C: Monitor therapy
Aminoglutethimide: May increase the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Amphotericin B: Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy
Antacids: May decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
Antidiabetic Agents: Corticosteroids (Systemic) may diminish the hypoglycemic effect of Antidiabetic Agents. In some instances, corticosteroid-mediated HPA axis suppression has led to episodes of acute adrenal crisis, which may manifest as enhanced hypoglycemia, particularly in the setting of insulin or other antidiabetic agent use. Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Aprepitant: May increase the serum concentration of Corticosteroids (Systemic). Risk D: Consider therapy modification
Barbiturates: May increase the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Bile Acid Sequestrants: May decrease the absorption of Corticosteroids (Oral). Risk C: Monitor therapy
Calcitriol: Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol. Risk C: Monitor therapy
Calcium Channel Blockers (Nondihydropyridine): May decrease the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy
CycloSPORINE: Corticosteroids (Systemic) may increase the serum concentration of CycloSPORINE. CycloSPORINE may increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Estrogen Derivatives: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy
Fluconazole: May decrease the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Fosaprepitant: May increase the serum concentration of Corticosteroids (Systemic). The active metabolite aprepitant is likely responsible for this effect. Risk D: Consider therapy modification
Isoniazid: Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid. Risk C: Monitor therapy
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Loop Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Corticosteroids (Systemic). Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk D: Consider therapy modification
Mitotane: May decrease the serum concentration of Corticosteroids (Systemic). Risk D: Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
Neuromuscular-Blocking Agents (Nondepolarizing): May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Risk D: Consider therapy modification
NSAID (COX-2 Inhibitor): Corticosteroids (Systemic) may enhance the adverse/toxic effect of NSAID (COX-2 Inhibitor). Risk C: Monitor therapy
NSAID (Nonselective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of NSAID (Nonselective). Risk C: Monitor therapy
Primidone: May increase the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Quinolone Antibiotics: May enhance the adverse/toxic effect of Corticosteroids (Systemic). Risk of tendon-related side effects, including tendonitis and rupture, may be enhanced. Risk C: Monitor therapy
Rifamycin Derivatives: May increase the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Salicylates: May enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor therapy
Thiazide Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide Diuretics. Risk C: Monitor therapy
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live virus vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Warfarin: Corticosteroids (Systemic) may enhance the anticoagulant effect of Warfarin. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase gastric mucosal irritation).
Food: Prednisolone interferes with calcium absorption. Limit caffeine.
Herb/Nutraceutical: St John's wort may decrease prednisolone levels. Avoid cat's claw, echinacea (have immunostimulant properties).
Storage
Store Orapred ODT® at 20°C to 25°C (68°F to 77°F) in blister pack. Protect from moisture.
Mechanism of Action
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and volume of the lymphatic system
Pharmacodynamics/Kinetics
Duration: 18-36 hours
Protein binding (concentration dependent): 65% to 91%; decreased in elderly
Metabolism: Primarily hepatic, but also metabolized in most tissues, to inactive compounds
Half-life elimination: 3.6 hours; End-stage renal disease: 3-5 hours
Excretion: Primarily urine (as glucuronides, sulfates, and unconjugated metabolites)
Dosage
Dose depends upon condition being treated and response of patient; dosage for infants and children should be based on severity of the disease and response of the patient rather than on strict adherence to dosage indicated by age, weight, or body surface area. Oral dosage expressed in terms of prednisolone base. Consider alternate day therapy for long-term therapy. Discontinuation of long-term therapy requires gradual withdrawal by tapering the dose. Patients undergoing unusual stress while receiving corticosteroids, should receive increased doses prior to, during, and after the stressful situation.
Children: Oral:
Acute asthma: 1-2 mg/kg/day in divided doses 1-2 times/day for 3-5 days
Anti-inflammatory or immunosuppressive dose: 0.1-2 mg/kg/day in divided doses 1-4 times/day
Nephrotic syndrome:
Initial (first 3 episodes): 2 mg/kg/day or 60 mg/m2/day (maximum: 80 mg/day) in divided doses 3-4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1-1.5 mg/kg/dose or 40 mg/m2/dose given every other day for 4 weeks
Maintenance (long-term maintenance dose for frequent relapses): 0.5-1 mg/kg/dose given every other day for 3-6 months
Adults: Oral:
Usual range: 5-60 mg/day
Multiple sclerosis: 200 mg/day for 1 week followed by 80 mg every other day for 1 month
Rheumatoid arthritis: Initial: 5-7.5 mg/day; adjust dose as necessary
Ophthalmic suspension/solution: Conjunctivitis, corneal injury: Children and Adults: Instill 1-2 drops into conjunctival sac every hour during day, every 2 hours at night until favorable response is obtained, then use 1 drop every 4 hours.
Elderly: Use lowest effective dose
Dosing adjustment in hyperthyroidism: Prednisolone dose may need to be increased to achieve adequate therapeutic effects
Hemodialysis: Slightly dialyzable (5% to 20%); administer dose posthemodialysis
Peritoneal dialysis: Supplemental dose is not necessary
Dosage: Combination Regimens
Lymphoma, Hodgkin's:
LOPP
MOPP
Dental Usual Dosing
Anti-inflammatory or immunosuppressive dose: Oral:
Children: 0.1-2 mg/kg/day in divided doses 1-4 times/day
Adults: Usual range: 5-60 mg/day
Administration: Oral
Administer oral formulation with food or milk to decrease GI effects.
Orapred ODT®: Do not break or use partial tablet. Remove tablet from blister pack just prior to use. May swallow whole or allow to dissolve on tongue.
Monitoring Parameters
Blood pressure; blood glucose, electrolytes; intraocular pressure (use >6 weeks); bone mineral density
Test Interactions
Response to skin tests
Dietary Considerations
Should be taken after meals or with food or milk to decrease GI effects; increase dietary intake of pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus.
Patient Education
Take exactly as directed; do not increase dose or discontinue abruptly without consulting prescriber. Avoid alcohol. Limit intake of caffeine or stimulants. Prescriber may recommend increased dietary vitamins, minerals, or iron. If you have diabetes, monitor glucose levels closely (antidiabetic medication may need to be adjusted). Inform prescriber if you are experiencing greater-than-normal levels of stress (medication may need adjustment). Some forms of this medication may cause GI upset (oral medication should be taken with meals to reduce GI upset; small frequent meals and frequent mouth care may reduce GI upset). You may be more susceptible to infection (avoid crowds and exposure to infection). Report promptly excessive nervousness or sleep disturbances; any signs of infection (sore throat, unhealed injuries); excessive growth of body hair or loss of skin color; vision changes; excessive or sudden weight gain (>3 lb/week); swelling of face or extremities; respiratory difficulty; muscle weakness; change in color of stools (black or tarry) or persistent abdominal pain; or worsening of condition or failure to improve. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Ophthalmic: For ophthalmic use only. Wash hands before using. Tilt head back and look upward. Put drops of suspension inside lower eyelid. Close eye and roll eyeball in all directions. Do not blink for 1/2 minute. Apply gentle pressure to inner corner of eye for 30 seconds. Do not use any other eye preparation for at least 10 minutes. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Do not share medication with anyone else. Wear sunglasses when in sunlight; you may be more sensitive to bright light. Inform prescriber if condition worsens or fails to improve or if you experience eye pain, disturbances of vision, or other adverse eye response.
Geriatric Considerations
Useful in patients with inability to activate prednisone (liver disease). Because of the risk of adverse effects, systemic corticosteroids should be used cautiously in the elderly, in the smallest possible dose, and for the shortest possible time. For long-term use, monitor bone mineral density and institute fracture prevention strategies.
Anesthesia and Critical Care Concerns/Other Considerations
Evidence-Based Information:
Neuromuscular Effects: ICU-acquired paresis was recently studied in five ICUs (three medical and two surgical ICUs) at four French hospitals. All ICU patients without pre-existing neuromuscular disease admitted from March 1999 through June 2000 were evaluated (de Jonghe, 2002). Each patient had to be mechanically-ventilated for ?7 days and was screened daily for awakening. The first day the patient was considered awake was Study Day 1. Patients with severe muscle weakness on Study Day 7 were considered to have ICU-acquired paresis. Among the 95 patients who were evaluated, about 25% developed ICU-acquired paresis. Independent predictors included female gender, the number of days with ?2 organ dysfunction, and administration of corticosteroids. Further studies may be required to verify and characterize the association between the development of ICU-acquired paresis and use of corticosteroids. Concurrent use of a corticosteroid and muscle relaxant appears to increase the risk of certain ICU myopathies; avoid or administer the corticosteroid at the lowest dose possible.
Adrenal Insufficiency: Patients will often have steroid-induced adverse effects on glucose tolerance and lipid profiles. When discontinuing steroid therapy in patients on long-term steroid supplementation, it is important that the steroid therapy be discontinued gradually. Abrupt withdrawal may result in adrenal insufficiency with hypotension and hyperkalemia. Patients on long-term steroid supplementation will require higher corticosteroid doses when subject to stress (eg, trauma, surgery, severe infection). Guidelines for glucocorticoid replacement during various surgical procedures have been published (Coursin, 2002; Salem, 1994).
Cardiovascular Considerations
Long-term steroid therapy is associated with fluid retention and hypertension. Glucocorticoid agents have some mineralocorticoid activity with consequent hemodynamic effects. Patients will often have steroid-induced adverse effects on glucose tolerance and lipid profiles. In discontinuing steroid therapy in patients on long-term steroid supplementation, it is important that the steroid therapy be discontinued gradually. Abrupt withdrawal may result in adrenal insufficiency with hypotension and hyperkalemia.
Steroid therapy in patients with heart failure should be administered cautiously with special attention given to signs and symptoms of fluid retention.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Ulcerative esophagitis.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Nervousness and insomnia are common; may rarely cause delirium, mood swings, euphoria, and hallucinations
Mental Health: Effects on Psychiatric Treatment
Barbiturates and carbamazepine may decrease corticosteroid effectiveness
Nursing: Physical Assessment/Monitoring
Assess other medications patient may be taking for effectiveness and interactions. Assess results of laboratory tests, therapeutic effectiveness, and adverse effects according to indications for therapy, dose, route, and duration of therapy. With systemic administration, patients with diabetes should monitor glucose levels closely. Assess knowledge/teach patient appropriate use, interventions to reduce side effects, and adverse symptoms to report. When used for long-term therapy (>10-14 days), do not discontinue abruptly; decrease dosage incrementally.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, ophthalmic, as sodium phosphate: 1% (5 mL, 10 mL, 15 mL) [contains benzalkonium chloride]
Solution, oral, as base: 15 mg/5 mL (240 mL, 480 mL)
Solution, oral, as sodium phosphate: Prednisolone base 5 mg/5 mL (120 mL, 240 mL); prednisolone base 15 mg/5 mL (240 mL)
Millipred™: Prednisolone base 10 mg/5 mL (237 mL) [dye free; grape flavor]
Orapred®: Prednisolone base 15 mg/5 mL (20 mL, 240 mL) [dye free; contains ethanol 2%, sodium benzoate; grape flavor]
Pediapred®: Prednisolone base 5 mg/5 mL (120 mL) [dye free; raspberry flavor]
Veripred™ 20: Prednisolone base 20 mg/5 mL (237 mL) [dye free, ethanol free; grape flavor]
Suspension, ophthalmic, as acetate: 1% (5 mL, 10 mL, 15 mL)
Econopred® Plus [DSC], Omnipred™: 1% (5 mL, 10 mL) [contains benzalkonium chloride]
Pred Forte®: 1% (1 mL, 5 mL, 10 mL, 15 mL) [contains benzalkonium chloride and sodium bisulfite]
Pred Mild®: 0.12% (5 mL, 10 mL) [contains benzalkonium chloride and sodium bisulfite]
Syrup, as base: 5 mg/5 mL (120 mL); 15 mg/5 mL (5 mL [DSC], 240 mL, 480 mL)
Prelone®: 15 mg/5 mL (240 mL, 480 mL) [contains ethanol 5%, benzoic acid, propylene glycol; wild cherry flavor]
Tablet, as base: 5 mg
Tablet, orally disintegrating, as sodium phosphate [strength expressed as base]:
Orapred ODT®: 10 mg, 15 mg, 30 mg [grape flavor]
Pricing: U.S. (www.drugstore.com)
Solution (Pediapred)
6.7 mg/5 mL (120): $50.87
Solution (PrednisoLONE Sodium Phosphate)
1% (5): $19.99
1% (10): $56.02
1% (15): $29.99
5 mg/5 mL (118): $26.99
15 mg/5 mL (237): $65.34
Suspension (Econopred Plus)
1% (5): $40.99
1% (10): $57.99
Suspension (Omnipred)
1% (10): $67.18
Suspension (Pred Forte)
1% (5): $36.04
1% (10): $66.07
1% (15): $94.94
Suspension (Pred Mild)
0.12% (10): $43.04
Suspension (PrednisoLONE Acetate)
1% (5): $15.99
1% (10): $20.99
1% (15): $33.99
Syrup (PrednisoLONE)
15 mg/5 mL (240): $70.90
Tablet, orally-disintegrating (Orapred ODT)
15 mg (48): $257.22
References
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Annane D, Sebille V, Charpentier C, et al, “Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock,” JAMA, 2002, 288(7):862-71.
Beitins IZ, Bayard F, Ances IG, et al, “The Transplacental Passage of Prednisone and Prednisolone in Pregnancy Near Term,” J Pediatr, 1972, 81(5):936-45.
Cooper MS and Stewart PM, “Corticosteroid Insufficiency in Acutely Ill Patients,” N Engl J Med, 2003, 348(8):727-34.
Coursin DB and Wood KE, “Corticosteroid Supplementation for Adrenal Insufficiency,” JAMA, 2002, 287(2):236-40.
de Jonghe B, Sharshar T, Lefaucheur JP, et al, “Paresis Acquired in the Intensive Care Unit. A Prospective Multicenter Study,” JAMA, 2002, 288(22):2859-67.
Frey BM and Frey FJ, "Clinical Pharmacokinetics of Prednisone and Prednisolone," Clin Pharmacokinet, 1990, 19(2):126-46.
Frey FJ, "Kinetics and Dynamics of Prednisolone," Endocr Rev, 1987, 8(4):453-73.
Gambertoglio JG, Amend WJ Jr and Benet LZ, "Pharmacokinetics and Bioavailability of Prednisone and Prednisolone in Healthy Volunteers and Patients: A Review," J Pharmacokinet Biopharm, 1980, 8(1):1-52.
Gamsu HR, Mullinger BM, Donnai P, et al, “Antenatal Administration of Betamethasone to Prevent Respiratory Distress Syndrome in Preterm Infants: Report of a UK Multicentre Trial,” Br J Obstet Gynaecol, 1989, 96(4):401-10.
Goedert JJ, Vitale F, Lauria C, et al, “Risk Factors for Classical Kaposi's Sarcoma,” J Natl Cancer Inst, 2002, 94(22):1712-8.
Hotchkiss RS and Karl IE, “The Pathophysiology and Treatment of Sepsis,” N Engl J Med, 2003, 348(2):138-50.
Lawrence RA, “Corticosteroid Effect on Lactation,” JAMA, 1991, 265(18):2409.
Liggins GC and Howie RN, “A Controlled Trial of Antepartum Glucocorticoid Treatment of Respiratory Distress Syndrome in Premature Infants,” Pediatrics, 1972, 50:515-25.
McGee S and Hirschmann J, “Use of Corticosteroids in Treating Infectious Diseases,” Arch Intern Med, 2008, 168(10):1034-46.
Ost L, Wettrell G, Björkhem I, et al, “Prednisolone Excretion in Human Milk,” J Pediatr, 1985, 106(6):1008-11.
Ostensen M, “Optimisation of Antirheumatic Drug Treatment in Pregnancy,” Clin Pharmacokinet, 1994, 27(6):486-503.
Pradat P, Robert-Gnansia E, Di Tanna GL, et al, “First Trimester Exposure to Corticosteroids and Oral Clefts,” Birth Defects Res A Clin Mol Teratol, 2003, 67(12):968-70.
Report of a Workshop by the British Association for Paediatric Nephrology and Research Unit, Royal College of Physicians, “Consensus Statement on Management and Audit Potential for Steroid Responsive Nephrotic Syndrome,” Arch Dis Child, 1994, 70(2):151-7.
Salem M, Tainsh RE Jr, Bromberg J, et al, “Perioperative Glucocorticoid Coverage. A Reassessment 42 Years After Emergence of a Problem,” Ann Surg, 1994, 219(4):416-25.
van Runnard Heimel PJ, Schobben AF, Huisjes AJ, et al, “The Transplacental Passage of Prednisolone in Pregnancies Complicated by Early-Onset HELLP Syndrome,” Placenta, 2005, 26(10):842-5.
International Brand Names
Lexi-Comp.com
Last full review/revision November 2009
Content last modified November 2009
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