Prednisone oral: Indications, Dosage, & Side effects

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.


  • For the treatment of the following skin diseases:

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

    • Congenital adrenal hyperplasia
    • Hypercalcemia of malignancy
    • Nonsuppurative thyroiditis
    • Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice, however, synthetic analogs may be used in conjunction with mineralocorticoids if required)
  • Acute episodes of enteritis and colitis in patients with Crohn's disease and ulcerative colitis.


  • 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
  • Oncologic uses:

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

    • Acute exacerbations of multiple sclerosis
    • Cerebral edema associated with malignancies (primary or metastatic brain tumors),  craniotomy, or head injury.
  • 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.
  • Nephrotic syndrome or nephritis associated with autoimmune conditions.


  • Respiratory conditions:

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

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

    • Trichinosis with neurologic or myocardial involvement
    • Tuberculous meningitis
    • Acute or chronic solid organ rejection.
  • Off Label Use of Prednisone in Adults include:

    • Autoimmune hepatitis
    • Bell palsy
    • Acute exacerbations of Chronic obstructive pulmonary disease
    • Duchenne muscular dystrophy
    • For the treatment of glucocorticoid remediable aldosteronism
    • Graves orbitopathy
    • Transplant ineligible Multiple myeloma
    • Pericarditis
    • Metastatic prostate cancer
    • Subacute Thyroiditis
    • Type 2 amiodarone-induced thyrotoxicosis
    • Herpes zoster
    • Takayasu arteritis
    • Giant cell arteritis
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General dosing of prednisone as anti-inflammatory/ immunosuppressive drug and in the treatment of endocrine disorders:

    • 5 - 60 mg/day orally.
Note: The dose depends on the condition treated. Alternate day treatment is better if used on a long-term basis. It should be tapered if used for a longer duration.

How to taper Prednisone?

    • Day 1:
      • 30 mg divided as 10 mg at breakfast, 5 mg at lunch, 5 mg at dinner, and 10 mg at bedtime
    • Day 2:
      • 25 mg divided as 5 mg at breakfast, 5 mg at lunch, 5 mg at dinner, and 10 mg at bedtime
    • Day 3:
      • 20 mg divided as 5 mg 4 times a day (with meals and at bedtime)
    • Day 4:
      • 15 mg divided as 5 mg 3 times a day (breakfast, lunch, and bedtime)
    • Day 5:
      • 10 mg divided as 5 mg twice daily (breakfast and bedtime)
    • Day 6:
      • 5 mg at breakfast
  • Various tapering regimens are used. Any of the tapering regimens may be followed.

Indication-specific dosing:

Off-label use in the treatment of Acute asthma:

    • 40 - 60 mg/day orally for 3 - 10 days in one or two divided doses (NAEPP 2007).

Use as an antineoplastic agent:

    • 10 mg orally once a day to 100 mg/m² /day depending on the indication.

Off label use in the treatment of Autoimmune hepatitis:

    • 60 mg orally once a day for one week, followed by
    • 40 mg once a day for one week, then
    • 30 mg once a day for 2 weeks, then
    • 20 mg once a day for the maintenance of remission.
    • The usual duration is less than 6 months as monotherapy and 6 months or more in combination with azathioprine.
    • When used in combination with azathioprine, the dose of prednisone should be halved.
  • The dose should be gradually reduced by 5 mg weekly until 10 mg/day and then more gradually by 2.5 mg per week until 5 mg per day.

Off label use in the treatment of Bell palsy:

    • 60 mg orally once a day for 5 days, followed by a tapering dose over 5 days.
    • Treatment should begin within 72 hours of the onset of symptoms.

Acute exacerbation of Chronic obstructive pulmonary disease:

    • 40 mg once a day for 5 - 7 days (GOLD 2018)

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


Off label dose in the treatment of moderate to severe Crohn disease:

    • 40 - 60 mg orally once a day for 7 - 14 days, followed by a 5 mg decrement per week until 20 mg then taper by 2.5 mg per week.
    • The lowest effective dose may be continued for up to 3 months.

Off label dose in the treatment of Dermatomyositis and polymyositis:

    • 1 mg/kg orally once a day (range: 0.5 - 1.5 mg/kg/day).
    • Prednisone is usually used in conjunction with steroid-sparing therapies.
    • The dose may be slowly tapered after 2 - 8 weeks depending on the response.
    • The dose may be gradually tapered over 6 - 12 months.
    • The lowest effective dose may be used as once daily or on alternate days to prevent disease flares.

Off label use in the treatment of Duchenne muscular dystrophy:

    • 0.75 mg/kg/day or 10 mg/kg/weekend orally divided over two days.
    • Patients who experience adverse reactions, the dose may be decreased to 0.3 mg/kg/day.

Off Label use in the treatment of Giant cell arteritis:

    • 40 - 60 mg orally daily.
    • The dose may be tapered after 2 - 3 months.
    • Typically, the patient requires 1 - 2 years of treatment.
    • Alternate day dosing of 30 - 40 mg may be as efficacious as daily dosing.

Off label use in the treatment of Glucocorticoid remediable aldosteronism:

    • 2.5 - 5 mg orally once a day at bedtime to suppress early morning ACTH surge.

Use in the treatment of acute flares of Gout:

    • 0.5 mg/kg/day orally for 5 - 10 days or
    • 30 - 40 mg/day given once a day or in two divided doses until clinical improvement, followed by a 7 -10 days taper.
    • The dose should be tapered off more slowly (over 14 to 21 days) in patients with frequent flares)

Off label use in the treatment of Graves orbitopathy:

    • 0.4 - 0.5 mg/kg/day orally 1 - 3 days after radioactive iodine treatment.
    • The dose should be continued for 1 month and then gradually tapered over 2 months.

Off label use in the treatment of Herpes zoster:

    • 60 mg orally once a day for 7 days.
    • This is followed by 30 mg once a day for 7 days, then 15 mg once a day for 7 days.

Off label dose in the treatment of Immune thrombocytopenic purpura:

Immune thrombocytopenia in pregnancy:

    • 10 - 20 mg/day (ACOG 2016).
    • Continue for 21 days then taper the dose to the minimum effective dose.

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

  • Class III-IV lupus nephritis:
    • 0.5 - 1 mg/kg/day orally after pulse therapy.
    • The dose is tapered after a few weeks to the lowest effective dose.
    • It is administered in combination with an immunosuppressive agent.
  • Class V lupus nephritis:
    • 0.5 mg/kg/day orally for six months in combination mycophenolate mofetil.
    • The dose may be increased if the improvement is not seen after 6 months of therapy (0.5 - 1 mg/kg/day after pulse therapy in combination with cyclophosphamide for an additional 6 months).

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

  • Older than 65 years of age or Less than 65 years of age and transplant-ineligible:
    • 60 mg/m² /day orally for four days (days 1 - 4) every six weeks for 9 cycles (dexamethasone at a dose of 20 mg is substituted for prednisone on day one of each cycle) in combination with daratumumab, bortezomib, and melphalan.
    • After cycle 9, daratumumab is continued as monotherapy or
    • 60 mg/m²/day orally for four days (days 1 - 4) every six weeks in combination with bortezomib and melphalan) for 9 cycles or
    • 2 mg/kg/day orally for 4 days (days 1 - 4) every six weeks in combination with melphalan and thalidomide for 12 cycles.
  • Older than 65 years of age:
    • 2 mg/kg/day orally for four days (days 1 - 4) every 6 weeks in combination with melphalan for 12 cycles.

Use in the treatment of acute exacerbations of Multiple sclerosis:

    • 200 mg orally daily for one week, followed by 80 mg every other day for one month.

Off label use in the treatment of Pericarditis:

  • Acute or recurrent pericarditis as an alternative agent:
    • 0.2 - 0.5 mg/kg/day orally for 2 - 4 weeks.
    • The dose may be tapered over three months.

Tuberculosis pericarditis:

    • 1 - 2 mg/kg orally once a day for 5 - 7 days followed by 6 - 8 weeks of tapering or
    • 60 mg orally once a day for 4 weeks, followed by
    • 30 mg once a day for 4 weeks, then
    • 15 mg once a day for 2 weeks, and then
    • 5 mg once a day for one week.

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

    • 40 mg orally two times a day for 5 days within 72 hours of PCP treatment followed by
    • 40 mg once a day on days 6 through 10, followed by
    • 20 mg once a day on days 11 through 21.

Off label dose in the treatment of Polymyalgia rheumatica:

    • 12.5 - 25 mg orally once a day
    • Initial doses of less than 7.5 mg/day or more than 30 mg/day should be avoided.
    • Single daily doses should be preferably used.
    • The dose should be tapered to 10 mg/day within 4 - 8 weeks.
    • If relapse occurs, the dose should be increased to the pre-relapse dose and then gradually tapered by 1 mg every 4 weeks until discontinuation.

Off label use in the treatment of metastatic Prostate cancer:

    • 5 mg orally two times a day in combination with abiraterone until disease progression or unacceptable toxicity or
    • 10 mg once a day in combination with cabazitaxel for up to 10 cycles or
    • 5 mg two times a day in combination with docetaxel for up to 10 cycles.

Off label dose in the treatment of Rheumatoid arthritis:


Off label use in the treatment of Subacute thyroiditis:

    • 40 mg/day orally for 1 - 2 weeks.
    • Gradually taper the dose over 2 - 4 weeks depending on clinical response.

Off label use in the treatment of Takayasu arteritis:

    • 40 - 60 mg orally daily.
    • Taper the dose to the lowest effective dose when the ESR and CRP levels are normal.
    • The usual duration is 1 - 2 years.

 Type 2 amiodarone-induced thyrotoxicosis:

    • 40 mg orally once a day for 14 -28 days
    • Gradually taper the dose over 2 - 3 months depending on clinical response.

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

    • 1 mg/kg/day orally
    • Gradually reduce the dose after 1 - 2 weeks.
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Children" collapse_text="Dose in Children" ] General dosing as an anti-inflammatory or immunosuppressive drug:
  • 0.05 - 2 mg/kg/day orally as a single dose or in two to four divided doses.

Use in the treatment of acute exacerbation of Asthma: 

  • Infants and Children less than 12 years of age:
    • Emergency care or hospital doses:
      • 1 - 2 mg/kg/day orally in two divided doses to the maximum daily dose of 60 mg/day.
      • It should be continued until the peak expiratory flow rate is 70% of predicted or personal best
    • Short-course “burst” as Outpatient treatment:
      • 1 - 2 mg/kg/day orally in one or two divided doses for 3 - 10 days.
      • The maximum daily dose is 60 mg/day.
      •  Burst therapy should be continued until the patient's symptoms resolve or the patient achieves a peak expiratory flow rate of 80% of personal best.
      • The usual duration of treatment is 3 -10 days.
  • Children older than 12 years and Adolescents:
    • Emergency care or hospital doses:
      • 40 - 80 mg/day orally in one or two divided doses until the peak expiratory flow is 70% of predicted or personal best.
    • Short-course “burst” Outpatient therapy:
      • 40 - 60 mg/day orally in one or two divided doses for 3 - 10 days
      • Burst therapy should be continued until the symptoms resolve and the peak expiratory flow is at least 80% of the personal best.
      • The usual duration of treatment is 3 - 10 days.
  • Infants and Children less than 12 years:
    • 1 - 2 mg/kg/day for 3 - 5 days
  • The maximum daily dose is age-dependent:
    • Infants and Children less than 2 years:
      • 20 mg/day orally.
    • Children 2 - 5 years:
      • 30 mg/day orally.
    • Children 6 - 11 years:
      • 40 mg/day orally.
  • Children older than 12 years and Adolescents:
    • 1 mg/kg/day orally for 5 - 7 days to a maximum daily dose of 50 mg/day.

Use in the maintenance therapy of non-acute Asthma:

  • Infants and Children less than 12 years:
    • 0.25 - 2 mg/kg/day orally administered as once daily or on alternate days as needed to the maximum daily dose of 60 mg/day.
  • Children older than 12 years and Adolescents:
    • 7.5 - 60 mg orally once a day administered as once daily or on alternate days as needed.

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

  • Infants, Children, and Adolescents:
    • 1 - 2 mg/kg/day orally for two weeks to the maximum daily dose of 60 mg/day.
    • The dose should be tapered over 6 - 8 weeks to a dose of 0.1 - 0.2 mg/kg/day or 2.5 - 5 mg daily.

Dose in the treatment of Bell palsy: 

  • Infants, Children, and Adolescents less than 16 years:
    • 1 mg/kg/day orally for one week.
    • Taper the dose over the next week.
    • Treatment should be ideally started within 72 hours of the onset of symptoms.
    • The maximum daily dose should not exceed 60 mg/day.
  • Adolescents 16 years of age and older:
    • 60 mg orally daily for 5 days.
    • The dose should be tapered over the next 5 days.
    • Treatment should ideally begin within 72 hours of the onset of symptoms.

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.
  • Actively growing Infants, Children, and Adolescents:
    • Prednisone should be avoided in this group of patients as it impedes the statural growth.
    • Short-acting systemic glucocorticoid like hydrocortisone should be used.
  • Fully grown Adolescents:
    • 5 - 7.5 mg orally in two divided doses.

Dose in the treatment of Crohn disease:

  • Children and Adolescents:
    • 1 - 2 mg/kg/day orally to a maximum daily dose of 60 mg/day.
    • It is continued for 2 - 4 weeks until remission is achieved and then gradually tapered off.

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

  • Children and Adolescents:
    • 2 mg/kg/day orally divided once or two times a day to a maximum daily dose of 60 mg/day in combination with other immunosuppressants like methotrexate.
    • The dose is continued for 4 weeks and then decreased by 20% of the initial dose if an adequate response is seen.

Dose in the treatment of Immune thrombocytopenia:

  • Infants, Children, and Adolescents:
    • 1 - 2 mg/kg/day orally.
    • The dose is titrated according to the platelets count.
    • A rapid taper is recommended if an adequate response is seen.

Dose in the treatment of Juvenile idiopathic arthritis:

  • Infants older than 6 months, Children and Adolescents:
    • 1 mg/kg/day orally administered once a day to a maximum daily dose of 60 mg/day.
    • It may be used in combination with pulse methylprednisolone therapy.
    • Clinical response should be evaluated at one to two weeks and then at one month of therapy.
    • The dose should be adjusted based on the clinical response (it may be tapered off if the patient improves or increased to 2 mg/kg/day (maximum of 100 mgday) if the condition worsens).
    • The patient should be reassessed again after one month and the dose adjusted (patients whose condition do not improve may require pulse methylprednisolone therapy).
    • Additional therapy may be used if little improvement is noted after three months of treatment.

Dose in the treatment of Lupus nephritis:

  • With concurrent methylprednisolone pulse therapy:
      • 0.5 - 1.5 mg/kg/day orally to a maximum daily dose of 60 mg/day.
      • The dose should be tapered over six months to 10 mg/day or less according to clinical response.
      • It should be used in combination with cyclophosphamide or mycophenolate.
    • Without concurrent methylprednisolone pulse therapy:
      • 2 mg/kg/day orally for six weeks in combination with cyclophosphamide or mycophenolate.
      • The maximum daily dose is variable and should be tapered over six months:
        • For the first 1 - 4 weeks, the maximum daily dose of 80 mg/day may be used
        • For weeks 5 and 6, a maximum daily dose of 60 mg/day may be used.

Dose in the treatment of Malignancy:

  • Hodgkin lymphoma (BEACOPP regimen):
    • Children and Adolescents:
      • 40 mg/m² /day orally in two divided doses on days 0 - 13 in combination with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, and procarbazine.

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

  • Children and Adolescents:
    • Note: Ideal body weight should be used in obese individuals
      • 2 mg/kg/day or 60 mg/m² /day orally once a day to a maximum daily dose of 60 mg/day for 4 - 6 weeks.
      • The dose is then adjusted to an alternate-day schedule of 1.5 mg/kg/dose (maximum daily dose of 40 mg/dose) or 40 mg/m²/dose orally on alternate days.
    • Relapse:
      • 2 mg/kg/day or 60 mg/m² /day orally once a day to a maximum daily dose of 60 mg/day.
      • The dose should be continued until complete remission for at least 3 days.
      • The dose is then adjusted to an alternate-day schedule of 1.5 mg/kg/dose (maximum of 40 mg/dose) or 40 mg/m² /dose on alternate days.
      • Treatment should continue for at least four weeks and then tapered off.
  • Maintenance therapy for frequently relapsing SSNS:
    • The usual effective dosage range is 0.1 - 0.5 mg/kg/dose on alternating days

Dose in the treatment of Physiologic replacement:

  • Children and Adolescents:
    • 2 - 2.5 mg/m²/day orally

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

Note: Treatment should begin within 72 hours of PCP therapy initiation. 

  • Infants and Children:
    • 1 mg/kg/dose orally two times a day on days 1 - 5, then
    • 0.5 - 1 mg/kg/dose two times a day on days 6 - 10, then
    • 0.5 mg/kg/dose once a day for days 11 - 21
  • Adolescents:
    • 40 mg orally two times a day on days 1 - 5, followed by
    • 40 mg once a day on days 6 - 10, followed by
    • 20 mg once a day on days 11 - 21 or until the PCP treatment is completed.

Dose in the treatment of Ulcerative colitis:

  • Children and Adolescents:
    • 1 - 2 mg/kg/day orally to a maximum daily dose of  60 mg/day.
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Pregnancy & lactation" collapse_text="Dose in Pregnancy & lactation" ]

Pregnancy Risk Factor C/D (product specific)

    • In animal studies, prednisone or prednisolone have been shown to cross the placental boundary and cause adverse reactions.
    • Hypoadrenalism may occur in newborns due to maternal use of corticosteroids.
    • Corticosteroids should only be administered when indicated during pregnancy, especially in the first trimester.
    • Prednisone should always be used when indicated. The placental enzymes that limit its passage to embryos make it preferable over other corticosteroids.
    • If asthma is not controlled properly, patients with asthma are more likely to have adverse maternal outcomes. This increases the likelihood of preterm births, perinatal mortality, preeclampsia and low birth weight infants.
    • Inhaled corticosteroids should be used if possible. However, severe persistent asthma and acute exacerbations of asthma should be managed with oral prednisone.
    • Prednisone, also known as Likeise or ephedrine, may be used to treat pregnant women with lupus.
    • Prednisone can also be used in pregnancy-associated immune tubocytopenia.
    • It could be used to treat primary adrenal deficiency in pregnant women.
Use of prednisone while breastfeeding
    • Breast milk contains both prednisone (prednisolone) and prednisone (prednisolone).
    • Peak concentrations can be observed up to two hours after oral prednisone is administered to a mother.
    • When used in breastfeeding, corticosteroids can be tolerated at their usual dosages. However, it is important to monitor the child for hypoadrenalism and growth suppression.
    • Prednisone should not be used during breastfeeding if corticosteroids have been prescribed.
    • Experts recommend that the baby be fed after four hours of maternal prednisone administration.

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[bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Renal Dose" collapse_text="Renal Dose" ] The manufacturer has not recommended any dosage adjustments in patients with renal disease. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Dose in Liver disease" collapse_text="Dose in Liver disease" ] The manufacturer has not recommended any dosage adjustments in patients with liver disease. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Side effects" collapse_text="Side effects" ]

Frequency not defined.

  • Cardiovascular:
    • Cardiac failure
    • Hypertension
  • Central nervous system:
    • Emotional lability
    • Headache
    • Increased intracranial pressure with papilledema
    • Myasthenia
    • Psychiatric disturbance including
      • Euphoria,
      • Insomnia,
      • Mood swings,
      • Personality changes,
      • Severe depression
    • Seizure
    • Vertigo
  • Dermatologic:
    • Diaphoresis
    • Facial erythema
    • Skin atrophy
    • Urticaria
  • Endocrine & metabolic:
    • Cushing’s syndrome
    • Decreased serum potassium
    • Diabetes mellitus
    • Fluid retention
    • Growth suppression in children
    • Hypokalemic alkalosis
    • Hypothyroidism (enhanced)
    • Menstrual disease
    • Negative nitrogen balance (due to protein catabolism)
    • Sodium retention
  • Gastrointestinal:
    • Abdominal distention
    • Carbohydrate intolerance
    • Pancreatitis
    • Peptic ulcer with possible perforation and hemorrhage
    • Ulcerative esophagitis
  • Hematologic & oncologic:
    • Bruise
    • Kaposi’s sarcoma
    • Petechia
  • Hepatic:
    • Increased serum alkaline phosphatase
    • Increased serum ALT
    • Increased serum AST
  • Hypersensitivity:
    • Anaphylaxis
    • Hypersensitivity reaction
  • Infection:
    • Infection
  • 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
  • Ophthalmic:
    • Exophthalmos
    • Glaucoma
    • Increased intraocular pressure
    • Subcapsular posterior cataract
  • Miscellaneous:
    • Wound healing impairment
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Contraindications & warnings" collapse_text="Contraindications & warnings" ]

Contraindication to Prednisone Include:

 
      • Allergy reactions to prednisone and any component of the formulation
      • Patients receiving immunosuppressive doses prednisone can be administered live or attenuated vaccines.
      • Systemic fungal infections
      • Infection of the eye with herpes simplex
      • Measles
      • Except in emergencies, chickenpox is not an issue
      • Peptic ulcer disease
      • Diverticulitis
      • Uncontrolled viral and bacterial infections
Warnings and Precautions
    • Suppression of the adrenals:
      • HPA axis suppression may occur in patients who are treated for prolonged periods of time or with high dosages.
      • Prednisone abruptly stopped can cause adrenal crisis, especially for patients who are in stressful situations like trauma, surgery, or infection.
      • You should gradually reduce the dosage and take extra care when switching from inhalation to parenteral steroids.
      • Prednisone-treated patients who take prednisone doses higher than 20 mg are particularly at risk
    • Anaphylactoid reactions
      • Although rare, anaphylactoid reactions have been reported in connection with its use.
    • Immunosuppression:
      • Prednisone can cause immunosuppression, which results in an increase of secondary infections, exacerbation and lengthening of illness. It also masks the symptoms of acute infection and limits the effectiveness of vaccines.
      • Patients are advised not to come in contact with measles or chickenpox patients while they are undergoing treatment.
      • Patients with acute viral hepatitis and cerebral malaria should avoid it.
      • Steroids should not be used in tuberculosis patients (except for tuberculous pericarditis and TB meningitis).
      • For the prevention of tuberculosis reactivation, patients should be closely monitored.
      • Tuberculosis patients who live in the tropics or have a history of traveling to the tropics or unexplained diarrhea need to be examined and treated for active or latent amebiasis before starting therapy.
      • Patients with Strongyloides infection should be cautious.
    • Kaposi Sarcoma:
      • Kaposi sarcoma has been reported in several cases. This is due to prolonged corticosteroids use.
      • If the symptoms persist, discontinue treatment.
    • Myopathy
      • Acute myopathy may be caused by steroids, particularly in high doses.
      • Patients who have a history of neuromuscular or muscular disorder are particularly at risk.
      • Muscle weakness can affect the muscles of the legs, eyes, and respiratory muscles.
      • Myopathy should be checked clinically as well as with creatine kinase levels.
    • Psychiatric disorders:
      • Corticosteroids can cause mood swings, insomnia, personality changes, severe depression, or frank psychotic manifestations.
      • It can worsen a preexisting mental condition.
    • Cardiovascular disease
      • Hypertension, electrolyte disturbances and fluid retention are all possible side effects of corticosteroids.
      • Patients with hypertension and heart failure should use it with caution.
      • Prednisone should be avoided in patients with a history of myocardial injury.
    • Diabetes:
      • Hyperglycemia can be caused by corticosteroids, which may affect glucose regulation and production.
      • Patients with diabetes mellitus should use it with caution.
    • Gastrointestinal Disease:
      • Patients suffering from gastrointestinal conditions such as diverticulitis, fresh or latent pepticules, active and/or latent peptic ulcers, non-specific ulcerative colitis, and fresh intestinal anastomoses should not use it due to the higher risk of gastrointestinal perforation.
    • Head injury
      • High doses of corticosteroids should not be used on patients with head injuries. This could lead to an increase in mortality.
    • Hepatic impairment
      • Patients suffering from cirrhosis or hepatic impairment should be cautious about taking the drug.
    • Myasthenia gravis:
      • Patients with neuromuscular disorders such as myasthenia gravis should not use it. Exacerbations of symptoms may occur.
    • Ocular disease:
      • Use of it can lead to an increase in intraocular pressure, cataract development, and glaucoma.
      • These conditions should be monitored regularly by patients.
      • Patients with active herpes simplex should also avoid it.
      • Patients who have had a history of herpes eye infection in the past should be cautious about taking this drug.
    • Osteoporosis
      • High doses of medication for prolonged periods are more at risk for osteopenia or osteoporosis.
      • Periodic assessments should be done on patients for osteoporosis, and any risk of fractures.
    • Renal impairment
      • Steroids cause fluid retention. Patients with impaired renal function should not take steroids.
    • Seizure disorders:
      • Patients who are at high risk for developing seizures should be cautious when using it.
    • Thyroid disease:
      • Patients with a changing thyroid condition may require that the dose be adjusted.
      • It is quickly cleared in hyperthyroid states and slowly removed in hypothyroid states.

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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 Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test.
Corticorelin Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy.
Cosyntropin Corticosteroids (Systemic) may diminish the diagnostic effect of Cosyntropin.
CycloSPORINE (Systemic) May increase serum concentrations of the active metabolite(s) of PredniSONE. PredniSONE may decrease the serum concentration of CycloSPORINE (Systemic). PredniSONE may increase the serum concentration of CycloSPORINE (Systemic).
CYP3A4 Inducers (Strong) May decrease the serum concentration of PredniSONE.
CYP3A4 Inhibitors (Strong): May increase the serum concentration of PredniSONE.
Deferasirox Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Deferasirox Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.
Denosumab May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased.
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.
[/bg_collapse]   [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Monitoring parameters" collapse_text="Monitoring parameters" ] Monitor:
  • Blood pressure
  • Weight
  • Plasma glucose
  • Electrolytes
  • Growth in children
  • Presence of infection
  • Bone mineral density
  • Assess for the hypothalamic-pituitary axis suppression with ACTH stimulation test, morning plasma cortisol test, or urinary free cortisol test
  • Monitor Blood CP
  • Occult blood loss
  • Chest x-ray at regular intervals for the reactivation of pulmonary tuberculosis or other infections.
  • Monitor for raised intraocular pressure in patients on treatment for more than 6 weeks
  • Periodic eye examination
[/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="How to administer?" collapse_text="How to administer?" ]

How to administer Prednisone?

It should be administered after meals or with milk or food to reduce the gastrointestinal side effects. Prolonged use is associated with peptic ulcers. Antacids should be administered between meals to prevent the formation of ulcers. The Delayed-release tablets should be  Swallowed whole without breaking, dividing, crushing, or chewing it. The oral solutions should be administered via the calibrated dropper. [/bg_collapse] [bg_collapse view="button-blue" color="#f7f2f2" icon="arrow" expand_text="Pharmacology & MOA" collapse_text="Pharmacology & MOA" ]

Mechanism of action of Prednisone:

  Prednisone is administered by:
      • It reduces inflammation by suppressing migration of polymorphonuclear lymphocytes and decreasing capillary permeability
      • Inhibits activity of the lymphatic systems, which suppresses the immune system.
      • Inhibits adrenal gland function at high doses, which in turn suppresses endogenous steroids production
      • Immature lymphocytes are induced to die by inhibiting glucose transport and phosphorylation. This results in an anti-cancerous effect
      • Blocks cerebral innervation of emetic centers by inhibiting prostaglandin synthesis, which results in antiemetic properties.
Orally, 50% to 90% of the drug can be absorbed.AbsorptionPatients with hepatic impairment, kidney impairment, inflammatory-bowel disease, hyperthyroidism and elderly suffer from impaired thyroid function. Only half the drug is available. Protein-boundIt isMetabolizedBy the liver to prednisolone, its active metabolite. It has been a half-life eliminationThe time it takes to reach plasma peak concentration is between 2 and 3 hours. It is excreted in the urine as a conjugated substrate.  

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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
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Prednisone 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.
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