Prednisone is a corticosteroid medication used to treat a variety of conditions, ranging from allergies and asthma to autoimmune disorders and certain types of cancer. It works by reducing inflammation and suppressing the immune system's response. Prednisone can be taken orally or through injection, and the dosage and duration of treatment vary depending on the condition being treated and individual patient factors.

While prednisone can be highly effective in managing symptoms and controlling inflammation, it also carries potential side effects, especially with long-term use or at high doses. Some common side effects include weight gain, increased appetite, mood swings, insomnia, fluid retention, elevated blood sugar levels, and weakened immune function. Long-term use can also lead to more serious complications such as osteoporosis, cataracts, and adrenal insufficiency.

Prednisone is a glucocorticoid that has anti-inflammatory/ immune-modulatory effects. It is used to treat the following conditions:

• For the control of severe allergic conditions due to drug hypersensitivity reactions, seasonal or perennial allergic rhinitis, and serum sickness that does not adequately respond to conventional therapy.

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• For the treatment of the following skin diseases:
  • Severe erythema multiforme and Stevens-Johnson syndrome.
  • Severe seborrheic dermatitis.
  • Exfoliative dermatitis
  • Erythroderma
  • Mycosis fungoides
  • Atopic dermatitis
  • Bullous dermatitis herpetiformis
  • Contact dermatitis
  • Pemphigus

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• For the following endocrine disorders:
  • Adrenal hyperplasia is congenital
  • hypercalcemia in cancer patients
  • thyroiditis without suppuration
  • Adrenocortical insufficiency, either primary or secondary (hydrocortisone or cortisone is the drug of choice, however, synthetic analogues may be used in conjunction with mineralocorticoids if required)

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• Acute episodes of enteritis and colitis in patients with Crohn's disease and ulcerative colitis.

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• For the treatment of the following blood disorders:
  • Acquired autoimmune hemolytic anemia
  • Congenital erythroid hypoplastic anemia/ Diamond-Blackfan anemia
  • Immune thrombocytopenic purpura in adults
  • Secondary thrombocytopenia in adults.
  • Pure red cell aplasia.
  • Erythroblastopenia

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• Oncologic uses:
  • For the treatment of acute leukemia and aggressive lymphomas.
  • Palliative management of leukemias and lymphomas in adults
  • Acute leukemia of childhood.

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• Nervous system:
  • Acute exacerbations of multiple sclerosis
  • Cerebral edema associated with malignancies (primary or metastatic brain tumors),  craniotomy, or head injury.

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• Ophthalmic diseases:
  • Severe allergic and inflammatory diseases of the eye and its adnexa
  • Uveitis
  • Severe allergic conjunctivitis
  • Allergic corneal marginal ulcers
  • Anterior segment inflammation
  • Chorioretinitis
  • Diffuse posterior uveitis and choroiditis
  • Herpes zoster ophthalmicus
  • Iridocyclitis
  • Iritis
  • Keratitis
  • Optic neuritis
  • Sympathetic ophthalmia.

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• Nephrotic syndrome or nephritis associated with autoimmune conditions.

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• Respiratory conditions:
  • Acute exacerbations of chronic obstructive pulmonary disease
  • Allergic bronchopulmonary aspergillosis
  • Pneumocystis carinii pneumonia associated with hypoxemia.
  • Berylliosis
  • Loeffler syndrome
  • Hypersensitivity pneumonitis
  • Aspiration pneumonitis
  • Asthma
  • Symptomatic sarcoidosis.
  • Idiopathic bronchiolitis obliterans with organizing pneumonia
  • Idiopathic eosinophilic pneumonia
  • Idiopathic pulmonary fibrosis

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• Rheumatic disorders:
  • Acute gout flares.
  • Acute and subacute bursitis
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Relapsing polychondritis
  • Dermatomyositis
  • Polymyositis
  • Polymyalgia rheumatica
  • Rheumatoid arthritis
  • Sjögren syndrome
  • Systemic lupus erythematosus
  • Acute nonspecific tenosynovitis
  • Epicondylitis
  • Posttraumatic osteoarthritis
  • Vasculitis.
  • Acute rheumatic carditis
  • Systemic lupus erythematosus.
  • Psoriatic arthritis

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• Miscellaneous conditions:
  • Tuberculous meningitis
  • Trichinosis with neurologic or myocardial involvement
  • Acute or chronic solid organ rejection.

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• Off Label Use of Prednisone in Adults includes:
  • Acute exacerbations of Chronic obstructive pulmonary disease
  • Duchenne muscular dystrophy
  • Type 2 amiodarone-induced thyrotoxicosis
  • Herpes zoster
  • For the treatment of glucocorticoid remediable aldosteronism
  • Graves orbitopathy
  • Transplant ineligible Multiple myeloma
  • Pericarditis
  • Metastatic prostate cancer
  • Subacute Thyroiditis
  • Takayasu arteritis
  • Giant cell arteritis
  • Autoimmune hepatitis
  • Bell palsy

Prednisone Dose in Adults

General dosing of prednisone as an anti-inflammatory/ immunosuppressive drug and in the treatment of endocrine disorders:  

• Prednisone is a medication used to treat various conditions like inflammation, immune system disorders, and hormone-related issues.
• The typical starting dose when taken by mouth is between 5 to 60 milligrams per day, depending on what's being treated and how the patient responds.
• For long-term treatment, doctors might suggest taking it every other day instead of every day.

When stopping prednisone after long-term use, it's important to gradually reduce the dose to prevent withdrawal symptoms. Here's an example of a tapering schedule:

• Day 1: Take 30 milligrams, divided into 10 milligrams before breakfast, 5 milligrams at lunch, 5 milligrams at dinner, and 10 milligrams at bedtime.
• Day 2: Take 5 milligrams at breakfast, lunch, dinner, and 10 milligrams at bedtime.
• Day 3: Take 5 milligrams four times a day, with meals and at bedtime.
• Day 4: Take 5 milligrams three times a day, at breakfast, lunch, and bedtime.
• Day 5: Take 5 milligrams twice a day, at breakfast and bedtime.
• Day 6: Take 5 milligrams before breakfast.

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Indication-specific dosing:

Prednisone off-label use in the treatment of Acute asthma:  

• The typical oral dose is 40 to 60 milligrams per day, taken for 3 to 10 days.
• It can be given all at once or split into two doses.

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Prednisone Use as an antineoplastic agent:

• The oral dose of prednisone can vary widely.
• Normally, it ranges from 10 milligrams daily to 100 milligrams per square meter of body surface area per day, depending on the specific type of cancer and treatment protocol.

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Prednisone off label use in the treatment of Autoimmune hepatitis:  

• Initial Phase: Start with 60 milligrams daily for 1 week.
• Second Phase: Then, reduce to 40 milligrams daily for 1 week.
• Third Phase: Followed by 30 milligrams daily for 2 weeks.
• Maintenance Phase: Finally, maintain remission with 20 milligrams daily. This maintenance phase typically lasts less than 6 months if used alone. If used in combination with azathioprine, it can be continued for at least 6 months.

If combined with azathioprine, half of the usual dose should be given. The dosage can then be tapered down gradually to maintain remission. For example, it may be decreased by 5 milligrams per week until reaching 10 milligrams daily, then reduced by 2.5 milligrams per week down to 5 milligrams daily.

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Prednisone off label use in the treatment of Bell palsy:  

• Initial Phase: Take 60 milligrams daily for 5 days.
• Tapering Phase: After the initial 5 days, taper the dose over the next 5 days.

It's crucial to start treatment within 72 hours of the onset of symptoms for the best chance of effectiveness.

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Prednisone Acute exacerbation of Chronic obstructive pulmonary disease:

• Initial Phase: Take 40 milligrams once daily.
• Duration: Continue this dosage for 5 to 7 days.

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Prednisone Use as an alternative agent in the treatment of classic congenital adrenal hyperplasia:  

• Dosage: 5 to 7.5 milligrams per day
• Frequency: Divide the total dose into two equal doses

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Prednisone off-label dose in the treatment of moderate to severe Crohn's disease:

• Initial Phase: Take 40 to 60 milligrams daily for 7 to 14 days.
• Tapering Phase: After the initial treatment period, gradually reduce the dosage. For example, decrease by 5 milligrams per week until reaching 20 milligrams, then decrease by 2.5 to 5 milligrams per week thereafter.
• Duration: This tapering regimen can be continued for up to 3 months, but specific taper regimens may vary.

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Prednisone off label dose in the treatment of Dermatomyositis and polymyositis:  

• Initial Phase: Take 1 milligram per kilogram of body weight daily.
• Dosage Range: The dosage can range from 0.5 to 1.5 milligrams per kilogram per day, depending on individual factors such as response and tolerance.
• Duration: This initial dosage is often continued for 2 to 8 weeks, depending on response.
• Tapering Phase: After the initial treatment period, slow tapering of the dose is typically considered. Tapering regimens can vary widely but often involve decreasing the dosage by 5 to 10 milligrams per week.
• Duration of Tapering: Tapering may continue for 6 to 12 months to reach a low once-daily or every-other-day dose to prevent disease flare.

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Prednisone off-label use in the treatment of Duchenne muscular dystrophy:  

• Initial Dosage: 0.75 milligrams per kilogram of body weight per day
• Alternative Dosage: 10 milligrams per kilogram over a weekend, divided into two days
• Adjustment for Adverse Reactions: If adverse reactions occur, the daily dose may be reduced to 0.3 milligrams per kilogram per day
• Maximum Studied Dosage: Doses as high as 1.5 milligrams per kilogram per day have been studied, but there's no evidence that doses above 0.75 milligrams per kilogram per day provide greater efficacy.

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Prednisone off Label use in the treatment of Giant cell arteritis:  

• Initial Dosage: 40 to 60 milligrams per day
• Duration of Treatment: Typically requires 1 to 2 years of treatment
• Tapering: Tapering may begin after 2 to 3 months of treatment
• Alternative Dosage: Dosing of 30 to 40 milligrams per day has demonstrated similar efficacy

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Prednisone off label use in the treatment of Glucocorticoid remediable aldosteronism:  

• Initial Dosage: 2.5 to 5 milligrams once daily
• Timing: Preferably taken at bedtime to suppress early morning ACTH surge.

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Prednisone Use in the treatment of acute flares of Gout:  

• Initial Dosage Option 1: 0.5 milligrams per kilogram of body weight per day for 5 to 10 days, followed by discontinuation.
• Initial Dosage Option 2: 30 to 40 milligrams per day given once daily or divided into two doses until symptom improvement.
• Tapering Option 1: After symptom improvement, follow with a 7- to 10-day taper.
• Tapering Option 2: In patients with multiple prior flares, consider a longer taper of 14 to 21 days.

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Prednisone off label use in the treatment of Graves orbitopathy:  

• Initial Dosage: 0.4 to 0.5 milligrams per kilogram of body weight per day
• Timing: Start treatment 1 to 3 days after radioactive iodine treatment
• Duration of Initial Treatment: Continue for 1 month
• Tapering: Gradually taper over 2 months

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Prednisone off-label use in the treatment of Herpes zoster:  

• Initial Dosage: 60 milligrams per day for 7 days
• Second Phase Dosage: 30 milligrams per day for 7 days
• Final Phase Dosage: 15 milligrams per day for 7 days

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Prednisone off label dose in the treatment of Immune thrombocytopenic purpura:

For the treatment of immune thrombocytopenia (ITP), the typical off-label oral doses of prednisone are:

• Non-pregnant Patients:
  • Initial Dosage: 1 to 2 milligrams per kilogram of body weight per day.
• Pregnant Patients:
  • Initial Dosage: 10 to 20 milligrams per day.
  • Adjustment: Adjust to the minimum effective dose needed to achieve a response.
  • Duration: Generally continue for at least 21 days.
  • Tapering: Taper to the minimum effective dose required to maintain platelet count.

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Prednisone off label use as an induction agent in the treatment of Lupus nephritis:  

Class III-IV Lupus Nephritis:

• Initial Dosage: 0.5 to 1 milligram per kilogram of body weight per day (after glucocorticoid pulse).
• Tapering: Taper after a few weeks to the lowest effective dose.
• Combination Therapy: Use in combination with an immunosuppressive agent.

Class V Lupus Nephritis:

• Initial Dosage: 0.5 milligrams per kilogram of body weight per day for 6 months in combination with mycophenolate mofetil.
• If Not Improved After 6 Months:
  • Additional Dosage: 0.5 to 1 milligram per kilogram of body weight per day (after a glucocorticoid pulse) for an additional 6 months.
  • Combination Therapy: Use in combination with cyclophosphamide.

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Prednisone off label use in the treatment of transplant-ineligible Multiple Myeloma:

For patients aged ≥65 years or <65 years and transplant-ineligible:

• Option 1: 60 milligrams per square meter of body surface area per day for 4 days (days 1 to 4) every 6 weeks for 9 cycles. (Dexamethasone at a dose of 20 milligrams is substituted for prednisone on day 1 of each cycle) in combination with daratumumab, bortezomib, and melphalan. After cycle 9, daratumumab is continued as a single agent.
• Option 2: 60 milligrams per square meter of body surface area per day for 4 days (days 1 to 4) every 6 weeks in combination with bortezomib and melphalan for 9 cycles.
• Option 3: 2 milligrams per kilogram of body weight per day for 4 days (days 1 to 4) every 6 weeks in combination with melphalan and thalidomide for 12 cycles.

For patients aged ≥65 years:

• Option 1: 2 milligrams per kilogram of body weight per day for 4 days (days 1 to 4) every 6 weeks in combination with melphalan for 12 cycles.

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Prednisone Use in the treatment of acute exacerbations of Multiple sclerosis:

• Initial Dosage: 200 milligrams per day for 1 week
• Tapering Dosage: 80 milligrams every other day for 1 month

It's important to note that while prednisone is mentioned here, treatment guidelines typically recommend the use of high-dose intravenous or oral methylprednisolone for acute exacerbations of multiple sclerosis.

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Prednisone off label use in the treatment of Pericarditis:

Acute or Recurrent Pericarditis (alternative agent):

• Initial Dosage: 0.2 to 0.5 milligrams per kilogram of body weight per day for 2 to 4 weeks.
• Tapering Dosage: Taper the dose over 3 months.

Tuberculosis Pericarditis:

• Option 1: 1 to 2 milligrams per kilogram of body weight once daily for 5 to 7 days, followed by 6 to 8 weeks of tapering.
• Option 2: 60 milligrams once daily for 4 weeks, followed by 30 milligrams once daily for 4 weeks, 15 milligrams once daily for 2 weeks, and 5 milligrams once daily for 1 week.

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Prednisone off label use in the treatment of Pneumocystis pneumonia in HIV-infected patients:

• Initial Dosage (Days 1-5): 40 milligrams twice daily for 5 days, beginning as early as possible and within 72 hours of starting PCP therapy.
• Subsequent Dosage (Days 6-10): 40 milligrams once daily.
• Tapering Dosage (Days 11-21): 20 milligrams once daily.

Prednisone is used as adjunctive therapy in addition to standard treatment for PCP in HIV-infected patients.

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Prednisone off label dose in the treatment of Polymyalgia rheumatica:  

Initial Dosage:

• Dosage Range: 12.5 to 25 milligrams daily
• Considerations: Higher doses within this range may be considered for patients at high risk of relapse and low risk of adverse events. Lower doses within this range may be considered for patients with high risk factors for side effects such as diabetes, osteoporosis, or glaucoma. Single daily doses are preferred over divided daily doses. Avoid initial doses ≤7.5 milligrams per day or >30 milligrams per day.

Tapering:

• For initial dosing, taper to a dose of 10 milligrams per day within 4 to 8 weeks.
• If relapse occurs, increase dosing to the pre-relapse dose and gradually taper back to the dose at which the relapse occurred within 4 to 8 weeks.
• Once remission is achieved (initial or relapse therapy), taper the daily dose by 1 milligram every 4 weeks (or by 1.25 milligram decrements if using schedules such as 10 milligrams and 7.5 milligrams on alternate days) until discontinuation.

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Prednisone off label use in the treatment of metastatic Prostate cancer:  

In combination with abiraterone:

• Dosage: 5 milligrams twice daily
• Duration: Until disease progression or unacceptable toxicity

In combination with cabazitaxel:

• Dosage: 10 milligrams once daily
• Duration: For up to 10 cycles

In combination with docetaxel:

• Dosage: 5 milligrams twice daily
• Duration: For up to 10 cycles

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Prednisone off label dose in the treatment of Rheumatoid arthritis:

• Dosage: 10 milligrams or less daily (American College of Rheumatology 2002).

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Prednisone off label use in the treatment of Subacute thyroiditis:  

• Initial Dosage: 40 milligrams per day for 1 to 2 weeks
• Tapering Dosage: Gradually taper over 2 to 4 weeks or longer depending on clinical response

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Prednisone off label use in the treatment of Takayasu arteritis:  

• Initial Dosage: 40 to 60 milligrams daily
• Tapering Dosage: Taper to the lowest effective dose when erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are normal
• Usual Duration: 1 to 2 years

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Prednisone dose in the treatment of Type 2 amiodarone-induced thyrotoxicosis:

• Initial Dosage: 40 milligrams once daily for 14 to 28 days
• Tapering Dosage: Gradually taper over 2 to 3 months depending on clinical response

It's recommended to use prednisone in combination with an antithyroid agent if the etiology of thyrotoxicosis cannot be unequivocally determined or if the patient is too clinically unstable to allow a trial of monotherapy.

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Prednisone off label dose in the treatment of Tuberculosis for severe paradoxical reactions (Iris):

• Initial Dosage: 1 milligram per kilogram of body weight per day
• Duration: Administer for 1 to 2 weeks
• Tapering: Gradually reduce the dosage after the initial 1 to 2 weeks

Prednisone Dose in Children

General dosing as an anti-inflammatory or immunosuppressive drug:  

For infants, children, and adolescents, the typical oral dose of prednisone for anti-inflammatory or immunosuppressive purposes is:

• Dosage Range: 0.05 to 2 milligrams per kilogram of body weight per day
• Frequency: Divided doses every 6 to 24 hours

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Prednisone Use in the treatment of acute exacerbation of Asthma:

For Infants and Children <12 years:

• Emergency Care or Hospital Doses:
  • 1 to 2 milligrams per kilogram of body weight per day in 2 divided doses; maximum daily dose: 60 milligrams/day. Continue until peak expiratory flow is 70% of predicted or personal best.
• Short-course "Burst" (Outpatient):
  • 1 to 2 milligrams per kilogram of body weight per day in divided doses 1 to 2 times daily for 3 to 10 days; maximum daily dose: 60 milligrams/day. Continue until symptoms resolve or peak expiratory flow is at least 80% of personal best.

For Children ≥12 years and Adolescents:

• Emergency Care or Hospital Doses:
  • 40 to 80 milligrams per day in divided doses 1 to 2 times daily until peak expiratory flow is 70% of predicted or personal best.
• Short-course "Burst" (Outpatient):
  • 40 to 60 milligrams per day in divided doses 1 to 2 times daily for 3 to 10 days. Continue until symptoms resolve and peak expiratory flow is at least 80% of personal best.

According to GINA 2014:

• For Infants and Children <12 years:
  • Oral: 1 to 2 milligrams per kilogram of body weight per day for 3 to 5 days.
  • Maximum daily dose age-dependent:
    • Infants and Children <2 years: 20 milligrams/day
    • Children 2 to 5 years: 30 milligrams/day
    • Children 6 to 11 years: 40 milligrams/day
• For Children ≥12 years and Adolescents:
  • Oral: 1 milligram per kilogram of body weight per day for 5 to 7 days; maximum daily dose: 50 milligrams/day.

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Prednisone Use in the maintenance therapy of non-acute Asthma:

For Infants and Children <12 years:

• Oral: 0.25 to 2 milligrams per kilogram of body weight per day administered as a single dose in the morning or every other day as needed for asthma control.
• Maximum daily dose: 60 milligrams/day.

For Children ≥12 years and Adolescents:

• Oral: 7.5 to 60 milligrams daily administered as a single dose in the morning or every other day as needed for asthma control.

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Prednisone Use in the treatment of Autoimmune hepatitis as monotherapy or in combination with azathioprine:

For the treatment of autoimmune hepatitis in infants, children, and adolescents, the typical oral doses of prednisone are:

• Initial Dosage: 1 to 2 milligrams per kilogram of body weight per day for 2 weeks
• Maximum Daily Dose: 60 milligrams/day
• Tapering: Taper upon response over 6 to 8 weeks to a dose of 0.1 to 0.2 milligrams per kilogram of body weight per day or 2.5 to 5 milligrams daily.

It's important to note that an alternate day schedule has been used to decrease the risk of adverse effects, but it may lead to a higher incidence of relapse in some cases, so its use is not suggested.

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Prednisone Dose in the treatment of Bell palsy:

For Infants, Children, and Adolescents <16 years:

• Oral: 1 milligram per kilogram of body weight per day for 1 week, then taper over 1 week.
• Ideally, treatment should start within 72 hours of onset of symptoms.
• Maximum daily dose: 60 milligrams/day.

For Adolescents ≥16 years:

• Oral: 60 milligrams daily for 5 days, followed by a 5-day taper.
• Treatment should begin within 72 hours of onset of symptoms.

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Prednisone Dose in the treatment of Congenital adrenal hyperplasia:

Note: The dose should be individualized by monitoring growth, bone age, and hormone levels. Fludrocortisone and sodium supplementation may be required in some patients.

• For Infants, Children, and Adolescents (actively growing):
  • Not recommended due to the potential to impede statural growth more than shorter-acting systemic glucocorticoids such as hydrocortisone.
• For Adolescents (fully grown):
  • Oral: 5 to 7.5 milligrams daily in divided doses 2 times daily.

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Prednisone Dose in the treatment of Crohn disease:

For the treatment of Crohn's disease in children and adolescents:

• Oral Dosage: 1 to 2 milligrams per kilogram of body weight per day
• Maximum Daily Dose: 60 milligrams/day
• Duration: Continue for 2 to 4 weeks until remission is achieved
• Tapering: Gradually taper off the medication after achieving remission.

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Prednisone Dose in the treatment of moderately severe Dermatomyositis as initial treatment:

For the initial treatment of moderately severe dermatomyositis in children and adolescents:

• Oral Dosage: 2 milligrams per kilogram of body weight per day, divided once or twice daily
• Maximum Daily Dose: 60 milligrams/day
• Duration: Continue for 4 weeks
• Tapering: If there is an adequate patient response after 4 weeks, begin tapering. Most recommend an initial 20% reduction in dose with subsequent wean based upon response.
• Combination Therapy: Use in combination with other immunosuppressants, such as methotrexate.

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Prednisone Dose in the treatment of Immune thrombocytopenia:

For the treatment of immune thrombocytopenia (ITP) in infants, children, and adolescents:

• Oral Dosage: 1 to 2 milligrams per kilogram of body weight per day
• Titration: Adjust the dose according to platelet count
• Tapering: When and if possible, a rapid taper is recommended
• Maximum Duration of Therapy: A maximum duration of therapy of 14 days has been suggested
• Alternative Dosage: Some have used a higher dose with a shorter course of 4 milligrams per kilogram of body weight per day for 3 to 4 days

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Prednisone Dose in the treatment of Juvenile idiopathic arthritis:

For the treatment of juvenile idiopathic arthritis in infants (≥6 months), children, and adolescents:

• Oral Dosage (Initial): 1 milligram per kilogram of body weight per day administered once daily (maximum daily dose: 60 milligrams/day)
• Combination Therapy: May be used in combination with methylprednisolone pulse therapy
• Evaluation of Response:
  • Evaluate initial response at 1 to 2 weeks and then at 1 month of therapy.
  • If the patient improves, taper prednisone.
  • If unchanged, continue current prednisone therapy.
  • If worsened, increase dose to 2 milligrams per kilogram of body weight per day (maximum daily dose: 100 milligrams/day).
• After 1 Month:
  • If improvement, begin taper.
  • If the condition worsens or remains unchanged, increase or continue prednisone dose at 2 milligrams per kilogram of body weight per day (maximum daily dose: 100 milligrams/day) and/or consider adding or repeating methylprednisolone pulse therapy.
• After 3 Months:
  • If improvement (prednisone dose <50% of starting dose), continue taper and reassess monthly.
  • If the patient remains unchanged (prednisone dose >50% of starting dose) or worsened, additional therapy should be considered.

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Prednisone Dose in the treatment of Lupus nephritis:

For the treatment of lupus nephritis in children and adolescents:

• Initial Therapy with Concurrent Methylprednisolone Pulse Therapy:
  • Prednisone: 0.5 to 1.5 milligrams per kilogram of body weight per day
  • Maximum daily dose: 60 milligrams/day
  • Taper usually over 6 months to a dose ≤10 milligrams/day according to clinical response
  • Use in combination with cyclophosphamide or mycophenolate.
• Initial Therapy without Concurrent Methylprednisolone Pulse Therapy:
  • Prednisone: 2 milligrams per kilogram of body weight per day for 6 weeks
  • Maximum daily dose varies:
    • For weeks 1 to 4: Maximum daily dose: 80 milligrams/day
    • For weeks 5 and 6: 60 milligrams/day
  • Taper over 6 months
  • Use in combination with cyclophosphamide or mycophenolate.

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Prednisone Dose in the treatment of Malignancy:

For the treatment of Hodgkin lymphoma in children and adolescents using the BEACOPP regimen:

• Oral Dosage: 40 milligrams per square meter of body surface area per day
• Administration: Divide the total daily dose into two equal doses
• Duration: Administer on days 0 to 13 of the treatment cycle
• Combination: Use in combination with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, and procarbazine.

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Prednisone Dose in the treatment of (SSNS) steroid-sensitive Nephrotic syndrome:

For the treatment of steroid-sensitive nephrotic syndrome (SSNS) in children and adolescents:

• Initial Episode:
  • Oral Dosage: 2 milligrams per kilogram of body weight per day or 60 milligrams per square meter of body surface area per day once daily
  • Maximum Daily Dose: 60 milligrams/day
  • Duration: Administer for 4 to 6 weeks
  • Adjustment: After 4 to 6 weeks, adjust to an alternate-day schedule of 1.5 milligrams per kilogram per dose or 40 milligrams per square meter per dose on alternate days as a single dose
  • Maximum Dose for Alternate-Day Schedule: 40 milligrams per dose
• Relapse:
  • Oral Dosage: Same as initial episode
  • Maximum Daily Dose: 60 milligrams/day
  • Duration: Continue until complete remission for at least 3 days, then adjust to an alternate-day schedule
  • Adjustment: After achieving complete remission, adjust to an alternate-day schedule as described above. The recommended duration of alternate-day dosing is variable but may continue for at least 4 weeks then taper. Some patients may require up to 3 months of treatment.
• Maintenance Therapy for Frequently Relapsing SSNS:
  • Taper previous dose down to lowest effective dose that maintains remission using an alternate-day schedule
  • Usual Effective Range: 0.1 to 0.5 milligrams per kilogram per dose on alternating days; some patients may require doses up to 0.7 milligrams per kilogram per dose every other day
• Physiologic Replacement:
  • Oral Dosage: 2 to 2.5 milligrams per square meter per day

Note: Hydrocortisone is generally preferred in growing children and adolescents due to its lower growth suppressant effects compared to prednisone.

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Prednisone Dose in the treatment of Pneumocystis jirovecii pneumonia in HIV-exposed or HIV positive patients:

For the treatment of Pneumocystis jirovecii pneumonia (PCP) in HIV-exposed/-positive individuals:

• Infants and Children:
  • Oral Dosage:
    • Days 1 to 5: 1 milligram per kilogram per dose twice daily
    • Days 6 to 10: 0.5 to 1 milligram per kilogram per dose twice daily
    • Days 11 to 21: 0.5 milligram per kilogram per dose once daily
• Adolescents:
  • Oral Dosage:
    • Days 1 to 5: 40 milligrams twice daily
    • Days 6 to 10: 40 milligrams once daily
    • Days 11 to 21: 20 milligrams once daily or until antimicrobial regimen is completed

Note: Begin treatment as soon as possible after diagnosis and within 72 hours of PCP therapy initiation.

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Prednisone Dose in the treatment of Ulcerative colitis:

For the treatment of ulcerative colitis in children and adolescents:

• Oral Dosage: 1 to 2 milligrams per kilogram of body weight per day
• Administration: Administered in the morning
• Maximum Daily Dose: 60 milligrams per day
• Assessment: If there is no response after 7 to 14 days, optimal dosing and compliance should be assessed.

Pregnancy Risk Factor C/D (product specific)

• Corticosteroids like prednisone, used during pregnancy, can affect both the mother and the fetus.
• When a pregnant woman takes prednisone, it crosses the placenta to reach the fetus, but it's converted back to prednisone by placental enzymes.
• This means the fetus gets less active prednisolone compared to what the mother receives.
• Some studies suggest a link between first-trimester corticosteroid use and birth issues like oral clefts or low birth weight, though results are mixed and may depend on factors like dosage and why the drug is taken.
• Newborns might have adrenal issues if their mother took corticosteroids during pregnancy.
• To minimize risks, doctors recommend using the lowest effective dose for the shortest time, especially avoiding high doses in the first trimester.
• For specific conditions like lupus nephritis or immune thrombocytopenia, prednisone might still be necessary during pregnancy, but close monitoring is crucial.
• Pregnant women with asthma need to balance controlling their condition with the potential risks of medications, favoring inhaled corticosteroids over systemic ones whenever possible.
• If systemic steroids like prednisone are needed, they should be used to manage acute exacerbations or severe asthma only.
• Finally, prednisone might also be used in certain conditions like primary adrenal insufficiency during pregnancy, but monitoring and caution are key.
• If you're a transplant recipient and pregnant or fathering a child, consider contacting the Transplant Pregnancy Registry International to contribute valuable information about pregnancy outcomes.

Use of prednisone while breastfeeding

• Prednisone and its breakdown product, prednisolone, can be found in breast milk, with levels influenced by the mother's dose.
• After the mother takes prednisone orally, the highest levels in breast milk typically occur about 2 hours later, and both substances have relatively short half-lives in breast milk.
• Studies have generally not found adverse effects on nursing infants, but caution is still advised due to the potential for issues like growth suppression or interference with the infant's own corticosteroid production.
• While corticosteroids are generally considered safe during breastfeeding at usual doses, monitoring the infant is recommended.
• Prednisone is often a preferred choice among oral corticosteroids for breastfeeding women.
• To minimize exposure, some guidelines suggest waiting about 4 hours after taking an oral corticosteroid before breastfeeding.

Prednisone Dose in Renal Disease:

• The manufacturer's labeling does not include dosage adjustments for renal impairment.

• In cases of hemodialysis, no additional dose supplementation is required.

Prednisone Dose in Liver Disease:

• The manufacturer's labeling does not specify any dosage adjustments for hepatic impairment.

Side effects of Prednisone include Frequency not defined.

• Central nervous system:
  • Myasthenia
  • Psychiatric disturbance including
    • Euphoria,
    • Insomnia,
    • Mood swings,
    • Personality changes,
    • Severe depression
  • Seizure
  • Vertigo
  • Emotional lability
  • Headache
  • Increased intracranial pressure with papilledema
• Cardiovascular:
  • Cardiac failure
  • Hypertension
• Hypersensitivity:
  • Anaphylaxis
  • Hypersensitivity reaction
• Endocrine & metabolic:
  • Fluid retention
  • Growth suppression in children
  • Hypokalemic alkalosis
  • Cushing’s syndrome
  • Decreased serum potassium
  • Diabetes mellitus
  • Negative nitrogen balance (due to protein catabolism)
  • Sodium retention
  • Hypothyroidism (enhanced)
  • Menstrual disease
• Dermatologic:
  • Skin atrophy
  • Urticaria
  • Diaphoresis
  • Facial erythema
• Hematologic & oncologic:
  • Bruise
  • Kaposi’s sarcoma
  • Petechia
• Gastrointestinal:
  • Pancreatitis
  • Peptic ulcer with possible perforation and hemorrhage
  • Abdominal distention
  • Carbohydrate intolerance
  • Ulcerative esophagitis
• Hepatic:
  • Increased serum alkaline phosphatase
  • Increased serum ALT
  • Increased serum AST
• Infection:
  • Infection
• Ophthalmic:
  • Increased intraocular pressure
  • Subcapsular posterior cataract
  • Exophthalmos
  • Glaucoma
• Neuromuscular & skeletal:
  • Amyotrophy
  • Aseptic necrosis of bones (femoral and humeral heads)
  • Osteoporosis
  • Pathological fracture of long bones
  • Rupture of a tendon (particularly Achilles tendon)
  • Steroid myopathy
  • Vertebral compression fracture
• Miscellaneous:
  • Wound healing impairment

Contraindications to Prednisone Include:

• Prednisone is contraindicated in individuals with hypersensitivity to prednisone or any of its components, those receiving live or live attenuated vaccines while on immunosuppressive doses of prednisone, and in cases of systemic fungal infections.
• Canadian labeling adds contraindications for herpes simplex of the eye, measles, or chickenpox (except for short-term or emergency therapy), peptic ulcer, nonspecific ulcerative colitis, diverticulitis, and viral or bacterial infections not controlled by antiinfectives.
• While documentation of allergenic cross-reactivity for corticosteroids is limited, similarities in chemical structure and pharmacologic actions suggest the possibility of cross-sensitivity.

Warnings and Precautions

Suppression of the adrenals:

• Prednisone can cause hypercortisolism or suppression of the hypothalamic-pituitary-adrenal (HPA) axis, especially in younger children or those on high doses for extended periods.
• This suppression may lead to adrenal crisis, so withdrawal should be gradual and cautious.
• Special care is needed when switching from systemic corticosteroids to inhaled products to avoid adrenal insufficiency or steroid withdrawal, especially in adults receiving over 20 mg per day of prednisone or its equivalent.
• Fatalities have occurred in asthmatic patients when transitioning from systemic to aerosol steroids, as the latter may not provide sufficient systemic steroid levels for conditions like trauma, surgery, or infections.

Anaphylactoid reactions

• Rare instances of anaphylactoid reactions have been reported in patients undergoing corticosteroid treatment.

Immunosuppression:

• Prolonged corticosteroid use may heighten the risk of secondary infections and mask ongoing infections, including fungal or viral ones.
• It might also extend or worsen viral infections or impede the response to certain vaccines.
• Corticosteroids aren't suitable for treating viral hepatitis or cerebral malaria.
• Patients with latent tuberculosis or tuberculosis reactivity need close monitoring, and corticosteroid use should be restricted in active tuberculosis cases unless it's fulminating or disseminated and combined with anti-tuberculosis treatment.
• Before starting corticosteroids, it's crucial to rule out latent or active amebiasis, especially in patients with recent travel to tropical regions or unexplained diarrhea.
• Extreme caution is advised in patients with Strongyloides infections due to the risk of hyperinfection, dissemination, and potential fatalities.

Kaposi Sarcoma:

• Prolonged corticosteroid treatment has been linked to the development of Kaposi sarcoma, as reported in some cases.
• If this condition is observed, discontinuing therapy should be considered.

Myopathy

• High doses of corticosteroids have been associated with acute myopathy, particularly in individuals with neuromuscular transmission disorders.
• This condition can affect muscles involved in vision and breathing.
• It's important to monitor creatine kinase levels, and recovery may take longer than usual.

Psychiatric disorders:

• Corticosteroid use can lead to various psychiatric disturbances, such as euphoria, insomnia, mood swings, personality changes, severe depression, or even psychotic manifestations.
• Existing psychiatric conditions may worsen with corticosteroid treatment.

Cardiovascular disease

• Corticosteroids should be used cautiously in patients with cardiovascular issues like heart failure and hypertension, as long-term use may lead to electrolyte imbalances, fluid retention, and elevated blood pressure.
• Patients with a recent history of myocardial infarction should also be cautious, as there have been reports of left ventricular free wall rupture associated with corticosteroid use.

Diabetes:

• Corticosteroids should be used cautiously in patients with diabetes mellitus as they can affect glucose production and regulation, potentially leading to elevated blood sugar levels (hyperglycemia).
• Regular monitoring of blood glucose levels is recommended in such patients.

Gastrointestinal Disease:

• Corticosteroids should be used cautiously in patients with gastrointestinal diseases such as diverticulitis, active or latent peptic ulcer, and ulcerative colitis, as they may increase the risk of perforation in the gastrointestinal tract.
• Close monitoring is advisable in these patients to detect any signs of worsening symptoms or complications.

Head injury

• High-dose corticosteroids, especially IV methylprednisolone, should be avoided in the management of head injury due to increased mortality observed in patients receiving such treatment.
• It's essential to adhere to appropriate guidelines and avoid the use of high doses of corticosteroids in this context to minimize the risk of adverse outcomes.

Hepatic impairment

• Patients with hepatic impairment, such as cirrhosis, should use corticosteroids with caution as their effects may be heightened in such individuals.
• It's important to carefully monitor these patients for any signs of adverse effects and adjust the dosage as necessary to minimize the risk of complications.

Myasthenia gravis:

• Corticosteroids should be used cautiously in patients with myasthenia gravis due to the potential for exacerbation of symptoms, particularly during the initial stages of treatment.
• Close monitoring is advisable to detect any worsening of symptoms and appropriate adjustments to the treatment plan should be made as needed.

Ocular disease:

• Patients with ocular disease, such as cataracts or glaucoma, should approach corticosteroid use with caution due to the potential for increased intraocular pressure, open-angle glaucoma, and cataract formation associated with prolonged use.
• Additionally, in individuals with a history of ocular herpes simplex, corticosteroids should be used cautiously to avoid the risk of corneal perforation.
• Routine eye examinations may be considered for chronic corticosteroid users to monitor ocular health.
• It's crucial to avoid corticosteroids in cases of active ocular herpes simplex.

Osteoporosis

• Corticosteroids should be used cautiously in patients with or at risk for osteoporosis due to the potential for increased bone loss and osteoporotic fractures associated with high doses or long-term use of these medications.
• It's important to consider the risk of osteoporosis when prescribing corticosteroids and to monitor bone health closely in susceptible individuals.

Renal impairment

• Corticosteroids should be used cautiously in patients with renal impairment due to the potential for fluid retention associated with their use.
• Monitoring for signs of fluid overload and adjusting the dose accordingly may be necessary in these patients.

Seizure disorders:

• Patients with a history of seizure disorders should use corticosteroids cautiously, as seizures have been reported, particularly in cases of adrenal crisis.
• Close monitoring for any signs of seizure activity is recommended during corticosteroid therapy in these individuals.

Systemic sclerosis (scleroderma):

• In systemic sclerosis (scleroderma), caution is advised with higher-dose corticosteroid therapy (≥15 mg/day of prednisone or equivalent) due to the increased risk of scleroderma renal crisis.
• It's recommended to avoid such high doses when possible, as they may exacerbate the condition.

Thyroid disease:

• Thyroid disease can impact the metabolism of corticosteroids, requiring dosage adjustments.
• In hyperthyroid patients, the metabolic clearance of corticosteroids increases, while in hypothyroid patients, it decreases.
• Therefore, monitoring thyroid status is important to ensure appropriate dosing.

Prednisone: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur.
Amphotericin B	Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B.
Androgens	Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens.
Antidiabetic Agents	Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents.
Bile Acid Sequestrants	May decrease the absorption of Corticosteroids (Oral).
Calcitriol (Systemic)	Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol (Systemic).
Coccidioides immitis Skin Test	The diagnostic value of the Coccidioides immitis Skin Test may be reduced by immunosuppressive medications.
Corticorelin	The therapeutic benefit of corticorelin may be reduced by corticosteroids. In particular, recent or ongoing corticosteroid medication may reduce the plasma ACTH response to corticorelin.
Cosyntropin	The diagnostic value of Cosyntropin may be diminished by systemic corticosteroids.
CycloSPORINE (Systemic)	may raise the active metabolite(s) of predniSONE's serum level. PredniSONE may lower CycloSPORINE's serum levels (Systemic). PredniSONE may raise CycloSPORINE's serum concentration (Systemic).
CYP3A4 Inducers (Strong)	may lower the level of predniSONE in the serum.
CYP3A4 Inhibitors (Strong):	PredniSONE serum levels could rise.
Deferasirox	Corticosteroids (Systemic) may intensify Deferasirox's negative/toxic effects. Particularly, there may be a higher risk of GI bleeding or ulcers.
Deferasirox	Corticosteroids may intensify Deferasirox's negative/toxic effects. Particularly, there may be a higher risk of GI bleeding or ulcers.
Denosumab	Immunosuppressants' harmful or toxic effects could be amplified. Particularly, there may be a higher risk for life-threatening infections.
DilTIAZem	May increase the serum concentration of Corticosteroids (Systemic).
Estrogen Derivatives	May increase the serum concentration of Corticosteroids (Systemic).
Fluconazole	May increase the serum concentration of PredniSONE.
Indacaterol	May enhance the hypokalemic effect of Corticosteroids (Systemic).
Isoniazid	Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid.
Loop Diuretics	Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics.
Nicorandil	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nicorandil. Gastrointestinal perforation has been reported in association with this combination.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective).
Nonsteroidal Anti-Inflammatory Agents (Nonselective)	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).
Ocrelizumab	May enhance the immunosuppressive effect of Immunosuppressants.
Pidotimod	Immunosuppressants may diminish the therapeutic effect of Pidotimod.
Quinolones	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased.
Ritodrine	Corticosteroids may enhance the adverse/toxic effect of Ritodrine.
Ritonavir	May increase the serum concentration of PredniSONE.
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.
Sargramostim	Corticosteroids (Systemic) may enhance the therapeutic effect of Sargramostim. Specifically, corticosteroids may enhance the myeloproliferative effects of sargramostim.
Siponimod	Immunosuppressants may enhance the immunosuppressive effect of Siponimod.
Somatropin	PredniSONE may enhance the therapeutic effect of Somatropin. Somatropin may diminish the therapeutic effect of PredniSONE. Growth hormone may reduce the conversion of prednisone to the active prednisolone metabolite.
Tacrolimus (Systemic)	Corticosteroids (Systemic) may decrease the serum concentration of Tacrolimus (Systemic). Conversely, when discontinuing corticosteroid therapy, tacrolimus concentrations may increase.
Tertomotide	Immunosuppressants may diminish the therapeutic effect of Tertomotide.
Thiazide and Thiazide-Like Diuretics	Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics.
Trastuzumab	May enhance the neutropenic effect of Immunosuppressants.
Urea Cycle Disorder Agents	Corticosteroids (Systemic) may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Corticosteroids (Systemic) may increase protein catabolism and plasma ammonia concentrations, thereby increasing the doses of Urea Cycle Disorder Agents needed to maintain these concentrations in the target range.
Warfarin	Corticosteroids (Systemic) may enhance the anticoagulant effect of Warfarin.
Risk Factor D (Consider therapy modification)
Antacids	May decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects.
Aprepitant	May increase the serum concentration of Corticosteroids (Systemic). Management: No dose adjustment is needed for single 40 mg aprepitant doses. For other regimens, reduce oral dexamethasone or methylprednisolone doses by 50%, and IV methylprednisolone doses by 25%. Antiemetic regimens containing dexamethasone reflect this adjustment.
Axicabtagene Ciloleucel	Corticosteroids (Systemic) may diminish the therapeutic effect of Axicabtagene Ciloleucel. Management: Avoid use of corticosteroids as premedication before axicabtagene ciloleucel. Corticosteroids may, however, be required for treatment of cytokine release syndrome or neurologic toxicity.
Baricitinib	Immunosuppressants may enhance the immunosuppressive effect of Baricitinib. Management: Use of baricitinib in combination with potent immunosuppressants such as azathioprine or cyclosporine is not recommended. Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted.
Desirudin	Corticosteroids (Systemic) may enhance the anticoagulant effect of Desirudin. More specifically, corticosteroids may increase hemorrhagic risk during desirudin treatment. Management: Discontinue treatment with systemic corticosteroids prior to desirudin initiation. If concomitant use cannot be avoided, monitor patients receiving these combinations closely for clinical and laboratory evidence of excessive anticoagulation.
Echinacea	May diminish the therapeutic effect of Immunosuppressants.
Fingolimod	Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections).
Fosaprepitant	May increase the serum concentration of Corticosteroids (Systemic). The active metabolite aprepitant is likely responsible for this effect.
Hyaluronidase	Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required.
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.
Mitotane	May decrease the serum concentration of Corticosteroids (Systemic).
Neuromuscular-Blocking Agents (Nondepolarizing)	May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur.
Nivolumab	Immunosuppressants may diminish the therapeutic effect of Nivolumab.
Roflumilast	May enhance the immunosuppressive effect of Immunosuppressants.
Sipuleucel-T	Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Management: Evaluate patients to see if it is medically appropriate to reduce or discontinue therapy with immunosuppressants prior to initiating sipuleucel-T therapy.
Tesamorelin	May decrease serum concentrations of the active metabolite(s) of PredniSONE.
Tisagenlecleucel	Corticosteroids (Systemic) may diminish the therapeutic effect of Tisagenlecleucel. Management: Avoid use of corticosteroids as premedication or at any time during treatment with tisagenlecleucel, except in the case of life-threatening emergency (such as resistant cytokine release syndrome).
Tofacitinib	Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants.
Vaccines (Inactivated)	Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation.
Vaccines (Live)	Corticosteroids (Systemic) may enhance the adverse/toxic effect of Vaccines (Live). Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Doses equivalent to less than 2 mg/kg or 20 mg per day of prednisone administered for less than 2 weeks are not considered sufficiently immunosuppressive to create vaccine safety concerns. Higher doses and longer durations should be avoided.
Risk Factor X (Avoid combination)
Aldesleukin	Corticosteroids may diminish the antineoplastic effect of Aldesleukin.
BCG (Intravesical)	Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical).
Cladribine	May enhance the immunosuppressive effect of Immunosuppressants.
Desmopressin	Corticosteroids (Systemic) may enhance the hyponatremic effect of Desmopressin.
Indium 111 Capromab Pendetide	Corticosteroids (Systemic) may diminish the diagnostic effect of Indium 111 Capromab Pendetide.
Macimorelin	Corticosteroids (Systemic) may diminish the diagnostic effect of Macimorelin.
Mifamurtide	Corticosteroids (Systemic) may diminish the therapeutic effect of Mifamurtide.
MiFEPRIStone	May diminish the therapeutic effect of Corticosteroids (Systemic). MiFEPRIStone may increase the serum concentration of Corticosteroids (Systemic). Management: Avoid mifepristone in patients who require long-term corticosteroid treatment of serious illnesses or conditions (e.g., for immunosuppression following transplantation). Corticosteroid effects may be reduced by mifepristone treatment.
Natalizumab	Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased.
Pimecrolimus	May enhance the adverse/toxic effect of Immunosuppressants.
Tacrolimus (Topical)	May enhance the adverse/toxic effect of Immunosuppressants.

Monitoring Parameters:

Blood Pressure

• Monitor regularly, especially in patients with hypertension or heart failure.

Weight

• Keep track of weight changes, particularly in patients at risk of fluid retention or weight gain.

Serum Glucose

• Check blood sugar levels regularly, especially in patients with diabetes or at risk of developing hyperglycemia.

Electrolytes

• Monitor electrolyte levels to ensure they remain within normal range.

Growth in Pediatric Patients

• Assess growth patterns in children regularly, as corticosteroids can affect growth.

Presence of Infection

• Look out for signs of infection and monitor for any development of new infections.

Bone Mineral Density

• Evaluate bone density periodically, especially in patients at risk of osteoporosis.

HPA Axis Suppression

• Assess HPA axis function using tests like the ACTH stimulation test or cortisol level tests, particularly in patients on long-term therapy.

Hemoglobin, Occult Blood Loss, Leukopenia, and Thrombocytopenia

• Monitor blood parameters regularly, especially in patients on combination therapy with azathioprine.

Chest X-ray

• Perform chest X-rays at regular intervals during prolonged corticosteroid therapy to monitor for any pulmonary complications.

Intraocular Pressure (IOP) and Eye Examination

• Measure IOP and conduct eye examinations periodically, especially in patients on therapy for longer than 6 weeks, to detect any ocular complications.

How to administer Prednisone?

Administration with Food

• Take after meals or with food or milk to reduce gastrointestinal discomfort.

Antacids

• Administer antacids between meals to prevent peptic ulcers.

Delayed-Release Tablets

• Swallow whole; do not break, divide, crush, or chew the tablets.

Oral Solution, Concentrate

• Administer using the provided calibrated dropper only.

Mechanism of action of Prednisone:

• Prednisone works by calming inflammation, stopping certain immune responses, and lowering the activity of the adrenal glands when taken in high doses.
• It helps by preventing the movement of certain white blood cells and reducing leakiness of blood vessels.
• It also curbs the activity of the immune system by decreasing the number of lymphocytes.
• Additionally, prednisone might hinder tumor growth by interfering with glucose transport or triggering cell death in certain immune cells.
• Some suggest it may also alleviate nausea and vomiting by blocking signals to the brain that trigger vomiting.

Absorption:

• Prednisone is absorbed into the body, typically ranging from 50% to 90%.
• However, this absorption rate may change in conditions like liver failure, kidney issues, inflammatory bowel disease, overactive thyroid, or in older adults.

Protein binding:

• Prednisone attaches to proteins in the body, but usually less than half of it binds to proteins in the blood.

Metabolism:

• The liver converts prednisone into its active form, prednisolone.

Half-life elimination:

• Prednisone stays in the body for about 2 to 3 hours before it's eliminated.

Time to peak:

• After taking immediate-release tablets orally, it reaches its highest concentration in the blood around 2 hours later.
• Delayed-release tablets take longer, about 6 to 6.5 hours.

Excretion:

• The body gets rid of prednisone primarily through urine, where it's excreted as conjugates.

International Brands of Prednisone:

• APO-PredniSONE
• JAA PredniSONE
• TEVA-PredniSONE
• Winpred
• Alfacort
• Apo-Prednisone
• Cortancyl
• Cortiol
• Cortiprex
• Cutason
• Decortin
• Decortisyl
• Dehydrocortison
• Delcortin
• Deltasone
• Deltison
• Ednapron
• Encorton
• Hostacortin
• Lexacort
• Lodotra
• Me-Korti
• Metilpres
• Nisona
• Norapred
• Nurison
• Orapred
• Panafcort
• Parmenison
• Predicor
• Prednicort
• Prednidib
• Predniment
• Prednimut
• Prednison
• Prednison Galepharm
• Prednison Streuli
• Prednison Dak
• Predone
• Predoral
• Predsone
• Presacor
• Prolix 20
• Qualisone
• Rectodelt
• Sone
• Systocor

Prednisone Brands in Pakistan:

Prednisolone And Prednisone [Eye Drops 1 %W/V]
Fortipred	Remington Pharmaceutical Industries (Pvt) Ltd.
Lophase	Epoch Pharmaceutical
Ophth-Pred	Ophth-Pharma (Pvt) Ltd.
Optopred	Sante (Pvt) Limited
Polypred	Polyfine Chempharma (Pvt) Ltd.
Pred Forte	Barrett Hodgson Pakistan (Pvt) Ltd.
Pred+	The Schazoo Laboratories Ltd.
Prednirex	Rex Pharmaceuticals Pakistan
Prednitek	Innvotek Pharmaceuticals
Prens	Vega Pharmaceuticals Ltd.
Retamide	Reko Pharmacal (Pvt) Ltd.

 

Prednisolone And Prednisone [Eye Drops 0.5 %W/V]
Predni-Pos	Ursapharm

 

Prednisolone And Prednisone [Eye Drops 0.12 %W/V]
Mildopred	Remington Pharmaceutical Industries (Pvt) Ltd.

 

Prednisolone And Prednisone [Syrup 15 Mg/5ml]
Steron	Xenon Pharmaceuticals (Pvt) Ltd.

 

Prednisolone And Prednisone [Tabs 5 Mg]
Cortisil	Syntex Pharmaceuticals
Deltacortril	Pfizer Laboratories Ltd.
Deltasol	Progressive Laboratories
Deltasone-P	Venus Pharma
Medisolone	Specific Research Laboratories
Medisolone	Specific Research Laboratories
Prednisolone	Specific Research Laboratories
Prednisolone	Unexo Labs (Pvt) Ltd.
Prednisolone	Ethical Laboratories (Pvt) Ltd.
Prednisolone	Ethical Laboratories (Pvt) Ltd.
Prednisolone	Karachi Pharmaceutical Laboratory
Prednisolone	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Prednisolone	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Prednisolone	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Presolone	Geofman Pharmaceuticals
Retacotril	Regent Laboratories Ltd.