Prednisone
Class: corticosteroid – glucocorticoid
Indications (NB some may be unlicensed): allergy, asthma, rheumatic disease, inflammatory conditions, nausea/vomiting, inflammation in gastrointestinal obstruction, sweating, itch, hypercalcaemia, hiccup, pain, dyspnoea (lymphangitis), liver capsule pain, tenesmus, appetite
Contraindications/cautions: infections, gastrointestinal bleeding, diabetes, congestive heart failure, mood disorders
Adverse reactions: common: insomnia (decrease by giving as single dose in the morning); less common: sodium/fluid retention, GI ulceration, delayed wound healing, thinning of skin (on prolonged use), proximal muscle weakness, Cushing’s syndrome, weight gain, depression, mania, delirium
Metabolism/clearance: metabolised by the metabolising enzyme CYP3A mainly in the liver
Interactions:
- increased clinical effect/toxicity of prednisone (due to increased blood concentrations) may occur with some CYP metabolising enzyme inhibitors (see above) e.g. aprepitant, clarithromycin, fluconazole, fluoxetine, grapefruit juice, itraconazole, ketoconazole, valproate
- decreased clinical effect/toxicity of prednisone (due to decreased blood concentrations) may occur with some CYP metabolism enzyme inducers (see above) e.g. carbamazepine, phenobarbitone, phenytoin, rifampicin, St John’s wort
- increased risk of GI bleed/ulceration when given with NSAIDs (e.g. diclofenac)
| Dosing: | |
|---|---|
| oral: | 5 to 60 mg usually once a day – dexamethasone used more commonly in palliative care |
| subcut: | not available |
| rectal: | not available |
Syringe driver: not available
Mechanism of action: decreases inflammatory response thought to be via induction of lipocortin, an anti-inflammatory protein
Notes:
- 0.75 mg dexamethasone has an equivalent anti-inflammatory effect to 5 mg prednisone or 20 mg hydrocortisone
- on discontinuation decrease dose slowly (taper) unless the patient has been taking it for less than 5 days in which case dose tapering is not necessary
- alteration in mood not usually seen below 40 mg prednisone (6 mg dexamethasone) per day
- corticosteroid induced insomnia responds to benzodiazepines (e.g. temazepam)
- corticosteroid induced mood disorder is usually depression and rarely mania
- metabolised to prednisolone