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.
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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