Drug Guide

Generic Name

Prednisone

Brand Names Meticorten, Deltasone, Paracort, Servisone, Delta-dome, Orasone, Fernisone, Prednicen-m, Cortan, Liquid Pred, Prednisone Intensol, Rayos

Classification

Therapeutic: Anti-inflammatory, Immunosuppressant

Pharmacological: Glucocorticoid

FDA Approved Indications

Inflammatory and autoimmune conditions (e.g., asthma, rheumatoid arthritis, lupus), allergic reactions, certain cancers, adrenal insufficiency

Mechanism of Action

Prednisone is a corticosteroid that suppresses inflammatory responses and immune function by modulating the transcription of various anti-inflammatory genes and inhibiting inflammatory cytokines.

Dosage and Administration

Adult: Dosage varies depending on condition, typically 5-60 mg/day orally, divided or single dose. Tapering required when discontinuing after long-term use.

Pediatric: Dosing is based on weight or surface area; commonly 0.14-2 mg/kg/day.

Geriatric: Start at lower doses due to increased risk of side effects; monitor closely.

Renal Impairment: Use with caution; dosage adjustments may be necessary based on clinical response.

Hepatic Impairment: Use cautiously; no specific adjustment guidelines, monitor liver function.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed throughout body tissues and fluids.

Metabolism: Primarily hepatic, via reduction and conjugation processes.

Excretion: Excreted mainly in urine as inactive metabolites.

Half Life: Approximately 2-3 hours, but biological effects last much longer.

Contraindications

Fungal infections, hypersensitivity to prednisone or other corticosteroids.

Precautions

Use with caution in latent or active infections, diabetes mellitus, hypertension, osteoporosis, mental health disorders, gastrointestinal ulcers, and during pregnancy/lactation.

Adverse Reactions - Common

Increased appetite (Common)
Insomnia (Common)
Mood changes (Common)
Fluid retention (Common)

Adverse Reactions - Serious

Adrenal suppression (Serious with long-term use)
Osteoporosis (Serious)
Hyperglycemia, diabetes mellitus exacerbation (Serious)
Peptic ulceration (Serious)
Infections, delayed wound healing (Serious)

Drug-Drug Interactions

NSAIDs (risk of GI bleeding), Diuretics (potassium loss), Live vaccines (immunosuppressive effect), CYP3A4 inhibitors (increase prednisone levels).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor weight, blood pressure, blood glucose, signs of infection, mood, and electrolyte levels.

Diagnoses:

Risk for infection; Risk for osteoporosis; Altered mental status

Implementation: Administer with food to minimize GI upset. Taper dose gradually to discontinue.

Evaluation: Assess efficacy through symptom resolution; monitor for adverse effects.

Patient/Family Teaching

Do not stop medication abruptly; follow physician’s instructions for tapering.
Report signs of infection, mood changes, or adverse reactions promptly.
Use additional contraception, as corticosteroids may affect pregnancy.

Special Considerations

Black Box Warnings:

Use with caution in patients predisposed to infections; high doses or prolonged use increases risk of metabolic, psychiatric, and osteoporotic effects.

Genetic Factors: Genetic polymorphisms can affect metabolism via CYP3A4 enzyme.

Lab Test Interference: May cause alterations in blood glucose, serum electrolytes, and other labs.

Overdose Management

Signs/Symptoms: Acute overdose may cause hyperglycemia, mood swings, increased blood pressure, increased appetite, and gastrointestinal discomfort.

Treatment: Supportive care; activated charcoal if recent ingestion; monitoring and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for specified periods as per manufacturer’s instructions.