PREDNISOLONE

PREDNISOLONE (pred-niss'oh-lone) Prelone PREDNISOLONE ACETATE Pred Forte, Pred Mild PREDNISOLONE SODIUM PHOSPHATE AK-Pred, Inflamase Forte, Inflamase Mild Classifications: adrenal corticosteroid; glucocorticoid; Therapeutic: corticosteroid; glucocorticoid Prototype: Prednisone Pregnancy Category: C

Availability

Prednisolone: 1 mg, 2.5 mg, 5 mg tablet; 5 mg/5 mL, 15 mg/5 mL syrup;

Acetate: 1% ophthalmic suspension;

Sodium Phosphate: 5 mg/5 mL liquid; 0.125%, 1%, 0.9%, 0.11% ophthalmic solution

Action

Analog of hydrocortisone with 3–5 times greater potency. Mineralocorticoid properties are minimal, and potential for sodium and water retention as well as potassium loss is reduced.

Therapeutic Effect

Effective as an anti-inflammatory agent.

Uses

Principally as an antiinflammatory and immunosuppressant agent.

Contraindications

Fungal infections; GI bleeding; pregnancy (category C).

Cautious Use

Cataracts; coagulopathy; diabetes mellitus; seizure disorders; renal disease; psychosis; emotional instability; GI disorders.

Route & Dosage

Antiinflammatory Adult: PO 5–60 mg/d in single or divided doses Ophthalmic See Appendix A-1 Child: PO 0.1–2 mg/kg/d in divided doses

Administration

Oral

• Give with meals to reduce gastric irritation. If distress continues, consult physician about possible adjunctive antacid therapy.

Alternate-Day Therapy (ADT) for Patient on Long-Term Therapy

• With ADT, the 48-h requirement for steroids is administered as a single dose every other morning.
• Be aware that ADT minimizes adverse effects associated with long-term treatment while maintaining the desired therapeutic effect.
• See PREDNISONE for numerous additional nursing implications.

Adverse Effects (≥1%)

Endocrine: Hirsutism (occasional), adverse effects on growth and development of the individual and on sperm. Special Senses: Perforation of cornea (with topical drug). Body as a Whole: Sensitivity to heat; fat embolism, hypotension and shock-like reactions. CNS: Insomnia. GI: Gastric irritation or ulceration. Skin: Ecchymotic skin lesions; vasomotor symptoms. Also see PREDNISONE.

Interactions

Drug: barbiturates, phenytoin, rifampin increase steroid metabolism, therefore may need increased doses of prednisolone; amphotericin B, diuretics add to potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; vaccines, toxoids may inhibit antibody response. Food: Licorice may elevate plasma levels and adverse effects.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 1–2 h. Duration: 1–1.5 d. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: HPA suppression: 24–36 h; in urine. Half-Life: 3.5 h.

Nursing Implications

Assessment & Drug Effects

• Be alert to subclinical signs of lack of improvement such as continued drainage, low-grade fever, and interrupted healing. In diseases caused by microorganisms, infection may be masked, activated, or enhanced by corticosteroids. Observe and report exacerbation of symptoms after short period of therapeutic response.
• Be aware that temporary local discomfort may follow injection of prednisolone into bursa or joint.

Patient & Family Education

• Adhere to established dosage regimen (i.e., do not increase, decrease, or omit doses or change dose intervals).
• Report gastric distress or any sign of peptic ulcer.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug