Prednisolone
 
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Mechanism :

It is a synthetic glucocorticoid with mineralocorticoid activities. It has a very rapid action. Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body immune responses to diverse stimuli.


Indication :

• Asthma acute severe

• Croup

• Nephrotic syndrome

• Transplant rejection

• Autoimmune hepatitis

• Autoimmune hemolytic anemia

• Inflammatory bowel disease

• Infantile spasm

• Intractable myoclonic seizures

• Juvenile idiopathic arthritis (JIA) - life threatening

• Vasculitis

• Uveitis

• Dermatomyositis -Juvenile

• Chemotherapy regimens

• Hodgkin’s lymphoma

• Non-Hodgkin’s lymphoma

• Acute lymphoblastic leukemia

• B -cell lymphoma & B-cell leukemia.


Contraindications :

Systemic fungal infections and known hypersensitivity to components.


Dosing :

Acute asthma:
Oral: 1-2 mg/kg as a single daily or 2 divided doses for 3-5 days.
Nephrotic syndrome:
Oral: Initially 4 weeks: 60 mg/sq m/day or 2 mg/kg/day; Max: 80 mg/day; orally in 3 divided doses until proteinuria is absent for 3 consecutive days. Next 4 weeks: 40 mg/sqm or 1.5 mg/kg oral every other day; Maximum dose: 60 mg/day.
Maintenance doses (for frequent relapses): 0.5-1 mg/kg/dose orally every other day for a period of 3-6 months.
Autoimmune hepatitis:
Oral: 2 mg/kg (Max: 40 mg) once daily.
Inflammation:
Oral: 0.1-2 mg/kg/day (Max: 80 mg/day) as a single or 6-12 hourly divided doses.
JIA, Connective tissue disorder, vasculitis:
Oral: Upto 2 mg/kg single morning dose or alternate day at lowest dose that controls disease. Avoid if possible as weaning would be difficult.
Ulcerative colitis, Crohn’s disease:
Rectal (enema) at bedtime for 2-4 weeks and continued if response is good.
Infantile spasms and intractable seizures:
2 mg/kg/day. Higher doses in infantile spasms.
Chemotherapy regimens:
Follow doses recommended for given protocol.


Adverse Effect :

Most adverse effects are caused by the mineralocorticoid activity and include congestive heart failure, hypertension, hypokalemia, cardiac enlargement, edema, and hypokalemic alkalosis.
Musculoskeletal - loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads, vertebral compression fractures, steroid myopathy, and spontaneous fractures.
Gastrointestinal - ulcerative esophagitis, abdominal distention, pancreatitis, and peptic ulcer with possible perforation and hemorrhage.
Dermatologic - impaired wound healing, hyperpigmentation of the skin and nails, thin fragile skin, bruising, subcutaneous fat atrophy, purpura, facial erythema, increased sweating, hirsutism, striae, petechiae and ecchymosis, reactions to skin tests may be suppressed.
Neurological - features of raised intracranial pressure such as headache, papilledema, vertigo, and severe mental disturbances and convulsions.
Endocrine - development of the cushingoid state, secondary adrenocortical and pituitary unresponsiveness, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, menstrual irregularities, suppression of growth in children, and increased requirements for insulin or oral hypoglycemic agents in diabetics.
Ophthalmic - increased intraocular pressure, posterior subcapsular cataracts, exophthalmos and glaucoma.
Metabolic - negative nitrogen balance due to protein catabolism, glycosuria, and hyperglycemia.


Interaction :

Amphotericin B or Potassium-Depleting Diuretics: Hypokalemia. Check serum potassium levels at frequent intervals and use potassium supplements if necessary.
Digitalis Glycosides: Enhanced possibility of arrhythmias or digitalis toxicity associated with hypokalemia.
Oral Anticoagulants: Decreased prothrombin time response. Monitor prothrombin levels and adjust anticoagulant dosage accordingly.
Antidiabetic Drugs: Diminished antidiabetic effect. Monitor for symptoms of hyperglycemia
Aspirin: increased ulcerogenic effect, decreased pharmacologic effect of aspirin.
Barbiturates, Phenytoin, or Rifampin: Increased metabolic clearance of fludrocortisone acetate because of the induction of hepatic enzymes.
Anabolic Steroids such as Oxymetholone, Methandrostenolone, Norethandrolone: Enhanced tendency toward edema.


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