Prednisone

Prednisone

[1 tablet 6 cents]

ADMINISTRATION ROUTES:

  • PO, NG

ALTERNATIVE NAMES:

  • Apo-Prednisone

ICU INDICATIONS:

  1. relative corticosteroid insufficiency in patients with severe septic shock
  2. adrenal insufficiency
  3. steroid responsive inflammatory conditions

PRESENTATION AND ADMINISTRATION:

  • PO / NG:
    Prednisone sodium phosphate liquid 5mg/ml
    Apo-prednisone 20mg (pink), 20mg (white), 5mg, 1mg

DOSAGE:

  • PO:
    Initially 10mg-100mg daily as a single morning dose or divided doses depending on indication.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO:
    Asthma: 0.5-1mg/kg for 24 hours, then every 12 hours for two doses, then 1mg/kg daily.
    Croup: 1mg/kg stat and in 12 hours; severe 4mg/kg then 1mg/kg 8 hourly

CLINICAL PHARMACOLOGY:

  • Prednisone is a steroid hormone which has glucocorticoid and mineralocorticoid properties.
  • 1mg prednisone = hydrocortisone 4mg in glucocorticoid activity, 0.8mg in mineralocorticoid

CONTRAINDICATIONS:

  1. Systemic fungal infections

WARNINGS

  • Steroid induced myopathy:
    An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (e.g., myasthenia gravis), or in patients receiving concomitant therapy with neuromuscular blocking drugs. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
  • Adrenal-insufficiency due to steroids:
    In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated.
  • Infections:
    Corticosteroids may mask some signs of infection, and new infections may appear during their use.

Blood pressure:

  • Average and large doses of hydrocortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic derivatives except when used in large doses.

PRECAUTIONS

  • General:
    There is an enhanced effect of corticosteroids in patients with hypothyroidism and in those with cirrhosis. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
  • Laboratory Tests: No tests in addition to routine ICU tests are required
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of corticosteroids and may require increases in corticosteroid dose to achieve the desired response.

ADVERSE REACTIONS

  • Fluid and Electrolyte Disturbances:
    Sodium retention; fluid retention; congestive heart failure in susceptible patients; potassium loss; hypokalemic alkalosis; hypertension.
  • Musculoskeletal:
    Muscle weakness; steroid myopathy, loss of muscle mass; osteoporosis; tendon rupture, particularly of the Achilles tendon; vertebral compression fractures; aseptic necrosis of femoral and humeral heads; pathologic fracture of long bones.
  • Gastrointestinal:
    Peptic ulcer with possible perforation and hemorrhage; pancreatitis; abdominal distention; ulcerative esophagitis; increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT) and alkaline phosphatase have been observed following corticosteroid treatment.
  • Dermatologic:
    Impaired wound healing; thin fragile skin; petechiae and ecchymoses; facial erythema; increased sweating; may suppress reactions to skin tests.
  • Neurological:
    Convulsions; increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment; vertigo; headache.
  • Endocrine:
    Menstrual irregularities; development of Cushingoid state; suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness; decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; increased requirements for insulin or oral hypoglycemic agents in diabetics.

Critical Care Drug Manual

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