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Prednisolone Acetate Ophthalmic Suspension

Antiinflammatory, Corticosteroid, Immunosuppressive drug, Glucocorticoid, Autoimmune disease, Ulcerogenic drug

Brand Names

Delta-Cortef®, Key-Pred 25®, Meticorten®, Predalone 50®, PredniSONE, PrednisTab®, Prelone®, Solu-Delta-Cortef®, Sterisol-20®

Drug Information

Pharmacology

Synthetic glucocorticoid

Contraindications

General
  • Contraindicated in fungal, bacterial and viral disease.
  • Contraindicated in pregnancy except in cases where potential benefits outweigh the risk of teratogenicity. May also induce early parturition in late pregnancy.
  • IM injection is contraindicated in patients with idiopathic thrombocytopenia.
  • Animals on high dose or long term therapy should be tapered off.
  • Use with caution in heart disease, osteoporosis and diabetes.
  • Except in emergency situations don’t use in patients with tuberculosis, chronic nephritis, Cushing’s disease or GI ulceration.
  • Because PredniSONE requires conversion to the active compound PrednisoLONE by the liver, some clinicians believe that only PrednisoLONE should be used in patients with liver disease.
General
  • May induce parturition in large animals.

Adverse Effects

General
  • May lower seizure threshold, alter mood and behavior, diminish response to pyrogens and stimulate appetite.
  • Excessive doses can be teratogenic in early gestation.
  • High dose or long term use may inhibit growth in nursing newborns.
  • Polyuria, polydipsia and polyphagia are common.
  • Thinning of skin, alopecia, muscle atrophy and Cushing’s disease are possible.
  • Panting, vomiting, diarrhea, elevated liver enzymes, GI ulceration, pancreatitis, lipidemia, worsening or activation of diabetes mellitus, depression, lethargy and aggression are also possible.
  • High dose may delay wound healing and decrease ability to fight infection.
  • May result in inhibition of endogenous steroid production after withdrawal – gradual withdrawal is advised to avoid iatrogenic adrenal suppression.
General
  • May induce parturition in large animals.
Cat
  • Cardiac disease or exacerbation of existing heart disease may be associated with the administration of long acting corticosteroids.

Interactions

General Interactions
  • May cause increased glucose, cholesterol, potassium, and alkaline phosphatase blood levels.

Category Interactions
Antacid
  • Oral glucocorticoid absorption may be reduced.
Anticholinesterase
  • Anticholinesterase agents in myasthenia gravis patients with concurrent glucocorticoid use may cause profound muscle weakness.
Anticoagulant
  • May result in increased or decreased anticoagulant activity.
Corticosteroid
  • Other corticosteroids concurrently may increase the risk for side effects.
Estrogen agent
  • Increased or prolonged glucocorticoid activity may result.
Immunosuppressive drug
  • Additive immunosuppression is expected with other drugs that suppress immune response.
Macrolide antibiotic
  • Increased or prolonged glucocorticoid activity may result.
NSAID-Non Steroidal Antiinflammatory Drug
  • May increase risk for GI and renal effects
Potassium Depleting Diuretic
  • Hypokalemia may result with other drugs that cause potassium loss.
Ulcerogenic drug
  • Increased risk for GI ulceration is possible with other drugs that may cause GI ulceration.
Vaccination
  • Live attenuated virus vaccines should not be given concurrently as virus replication may be augmented.
  • Administration of vaccine, bacterin or toxoid may be less effective if given concurrently.

Drug Interactions
Amphotericin B
  • Hypokalemia may occur with amphotericin B.
Asparaginase
  • In humans toxicity is increased when given with PredniSONE.
Aspirin / Acetylsalicylic acid
  • Salicylate levels may be reduced.
Cyclophosphamide
  • Cyclophosphamide metabolism may be decreased.
CycloSPORINE
  • CycloSPORINE will decrease metabolism of both when used concurrently and cause increased blood levels of both.
ePHEDrine sulfate
  • Increased or prolonged glucocorticoid activity may result.
Erythromycin
  • Increased risk of drug toxicosis may result.
Insulin
  • May increase the insulin requirements of diabetics.
Ketoconazole
  • Increased or prolonged glucocorticoid activity may result.
Mitotane
  • Mitotane may alter metabolism.
Montelukast Sodium
  • Severe peripheral edema has been reported in a human receiving both drugs, presumably due to increased renal tubular sodium and fluid retention. After prednisone was discontinued, edema resolved; clinical significance is not clear.
PHENobarbital
  • PHENobarbital may increase glucocorticoid metabolism.
Phenytoin sodium
  • Phenytoin may increase glucocorticoid metabolism.
RiFAMpin
  • Rifampin may increase glucocorticoid metabolism.
Theophylline
  • Activity of either may be altered.

Comments

PredniSONE sodium succinate (Solu Delta-Cortef® ) is recommended to be used immediately after reconstitution.
Glucocorticoid activity is 4 times that of hydrocortisone.
For information regarding compatibility in solution or combination with other drugs, refer to specialized reference material.
Discontinue for at least 4 days prior to intradermal skin testing as results may be affected.
PrednisoLONE is thought to be much more bioavailable in cats and horses as compared to PredniSONE.

Available Forms

Human
  • PrednisoLONE tabs- 5 mg; Delta-Cortef®, generic. PredniSONE tabs- 1, 2.5, 5, 10, 20 and 50 mg; generic. PrednisoLONE syrup- 15 mg/5 mLin 240 mL; Prelone®. PredniSONE oral solution or syrup- 1 mg/mL in 30, 120, 240 and 500 mL. PrednisoLONE acetate injection- 25 mg/mL, 50 mg/mL in 10 and 30 mL vials; Key-Pred 25®, Predalone 50 ®, Predcor-50®, generic.
Veterinary – General
  • PrednisoLONE tablets- 5 and 20 mg; Delta-Cortef®, PrednisTab®, generic. Approved for dog. Prenisolone acetate for injection- 25 mg/mL, 50 mg/mL and 100 mg/mL; several trade names and generic. PrednisoLONE sodium succinate for injection 20 mg/mL in 50 mL vial; Solu-Delta-Cortef®, Sterisol-20®, generic. Approved for dogs, cats and horses PredniSONE sodium phosphate for injection- 100 mg/ vial, 500 mg/vial; Cortisate-20®. Approved for IV use in dogs. PredniSONE suspension for injection- 10 mg/mL, 40 mg/mL; Meticorten®. Approved for dog, cat and horse.

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