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Prednisone 12 day taper 48 tablets.How and when to take prednisolone tablets and liquid
Prednisone 12 day taper 48 tablets
Your doctor may direct you to take prednisolone 1 to 4 times a day or take a single dose every other day. It may help to mark your calendar with reminders or use a pill box. If you are using the prednisolone dose pack, follow the dosing schedule on the package, unless directed otherwise by your doctor. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.
If you suddenly stop using this medication, you may have withdrawal symptoms such as weakness, weight loss, nausea, muscle pain, headache, tiredness, dizziness. To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used prednisolone for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.
See also Precautions section. Nausea, heartburn, headache, dizziness, menstrual period changes, trouble sleeping, increased sweating, or acne may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects.
Many people using this medication do not have serious side effects. Because this drug works by weakening the immune system, it may lower your ability to fight infections. This may make you more likely to get a serious rarely fatal infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection such as cough, sore throat, fever, chills. Use of this medication for prolonged or repeated periods may result in oral thrush or a yeast infection.
Contact your doctor if you notice white patches in your mouth or a change in vaginal discharge. This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet. A very serious allergic reaction to this drug is rare.
However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. Call your doctor for medical advice about side effects. In Canada - Call your doctor for medical advice about side effects.
You may report side effects to Health Canada at Before taking prednisolone, tell your doctor or pharmacist if you are allergic to it; or to prednisone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of:. This drug may make you dizzy. Alcohol or marijuana cannabis can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana cannabis.
This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding.
Consult your doctor or pharmacist for more information. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.
This medication may mask signs of infection. It can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others such as chickenpox, measles, flu. Consult your doctor if you have been exposed to an infection or for more details. Avoid contact with people who have recently received live vaccines such as flu vaccine inhaled through the nose.
This medication may slow down a child's growth if used for a long time. Consult the doctor or pharmacist for more details. See the doctor regularly so your child's height and growth can be checked. During pregnancy, prednisolone should be used only when clearly needed. It may rarely harm an unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for an extended period of time may have hormone problems.
This medication passes into breast milk. However, this drug is unlikely to harm a nursing infant. Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Atenolol; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Atracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. Azilsartan; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Benazepril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bendroflumethiazide; Nadolol: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Bismuth Subsalicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Bupivacaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use. Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk.
Bupropion; Naltrexone: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone.
Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary. Prednisone is a P-glycoprotein P-gp substrate.
Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown. Caffeine; Sodium Benzoate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia.
Canagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Captopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution. Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure. Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection. Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab.
Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpropamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Chlorthalidone; Clonidine: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone.
Choline Salicylate; Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Cisatracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects.
Dapagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment.
Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids. Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection.
Desmopressin: Major Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Dextromethorphan; Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 DPP-4 inhibitor use; a DPP-4 dose adjustment may be necessary.
Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications. Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution.
Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. Dulaglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids. For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea.
Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited.
When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Empagliflozin; Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Empagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Enalapril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Enzalutamide: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with enzalutamide; a dosage increase may be necessary.
Concurrent use may decrease the exposure of prednisone. Ephedrine: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage. Ephedrine; Guaifenesin: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Erlotinib: Moderate Monitor for symptoms of gastrointestinal GI perforation e. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Ertugliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Estrogens: Moderate Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens. Concurrent use may increase the exposure of corticosteroids.
Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect. Caution is warranted if these drugs are coadministered. Exenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Fluoxymesterone: Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema. Administer these drugs in combination with caution. Fosamprenavir: Moderate Concomitant use of prednisone and fosamprenavir may result in altered prednisone plasma concentrations.
Amprenavir, the active metabolite of fosamprenavir, is an inducer of P-gp and a potent inhibitor and moderate inducer of CYP3A4. Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Fosphenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with fosphenytoin; a dosage increase may be necessary. Gallium Ga 68 Dotatate: Moderate Repeated administration of high corticosteroid doses prior to gallium Ga 68 dotatate may result in false negative imaging. Corticosteroids can down-regulate somatostatin subtype 2 receptors: thereby, interfering with binding of gallium Ga 68 dotatate to malignant cells that overexpress these receptors.
Glecaprevir; Pibrentasvir: Moderate Caution is advised with the coadministration of glecaprevir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; glecaprevir is a P-gp inhibitor. Moderate Caution is advised with the coadministration of pibrentasvir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects.
Prednisone is a substrate of P-glycoprotein P-gp ; pibrentasvir is a P-gp inhibitor. Glimepiride: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glimepiride; Rosiglitazone: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glipizide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Glipizide; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glyburide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Glyburide; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Glycerol Phenylbutyrate: Moderate Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. Golimumab: Moderate The safety and efficacy of golimumab in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with golimumab may be at a greater risk of developing an infection. Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Haloperidol: Moderate Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol.
Hemin: Moderate Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin. Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Hydrochlorothiazide, HCTZ; Methyldopa: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Hydrochlorothiazide, HCTZ; Moexipril: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Ibritumomab Tiuxetan: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections. If coadministration is necessary, close clinical monitoring is advised and therapy should be accompanied by appropriate antimicrobial therapies as indicated. Incretin Mimetics: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Indapamide: Moderate Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids. Coadminister with caution and careful monitoring. Inebilizumab: Moderate Concomitant usage of inebilizumab with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection.
Consider the risk of additive immune system effects when coadministering therapies that cause immunosuppression with inebilizumab. Infliximab: Moderate Many serious infections during infliximab therapy have occurred in patients who received concurrent immunosuppressives that, in addition to their underlying Crohn's disease or rheumatoid arthritis, predisposed patients to infections. The impact of concurrent infliximab therapy and immunosuppression on the development of malignancies is unknown.
In clinical trials, the use of concomitant immunosuppressant agents appeared to reduce the frequency of antibodies to infliximab and appeared to reduce infusion reactions. Insulin Degludec; Liraglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Insulin Glargine; Lixisenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Insulins: Moderate Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary. Irbesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Isavuconazonium: Moderate Concomitant use of isavuconazonium with prednisone may result in increased serum concentrations of prednisone. Prednisolone, the active metabolite of prednisone, is a substrate of the hepatic isoenzyme CYP3A4; additionally prednisone is a substrate of the drug transporter P-glycoprotein P-gp.
Caution and close monitoring for adverse effects, such as corticosteroid-related side effects, are advised if these drugs are used together. Isoniazid, INH; Rifampin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifampin; a dosage increase may be necessary. Isoproterenol: Moderate The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids. Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0.
Isotretinoin: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use. Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. Itraconazole: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone. Monitor patients for corticosteroid-related side effects if both prednisone and itraconazole are taken.
Ketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole. Concurrent use may increase the exposure of prednisone. In a study, ketoconazole inhibited 6 beta-hydroxylase and increased the exposure of biologically active unbound prednisolone after oral prednisone administration.
L-Asparaginase Escherichia coli: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. Ledipasvir; Sofosbuvir: Moderate Caution and close monitoring of prednisone-associated adverse reactions is advised with concomitant administration of ledipasvir. Prednisone is a substrate of the drug transporter P-glycoprotein P-gp ; ledipasvir is a P-gp inhibitor.
Taking these drugs together may increase prednisone plasma concentrations. Letermovir: Moderate A clinically relevant increase in the plasma concentration of prednisolone the active metabolite of prednisone may occur if given with letermovir. In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified.
Prednisolone is a CYP3A4 substrate. Levoketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole. Lidocaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Liraglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Lisinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Live Vaccines: Contraindicated Live vaccines should generally not be administered to an immunosuppressed patient. Live vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses. If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule.
Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Patients on corticosteroid treatment for 2 weeks or more may be vaccinated after steroid therapy has been discontinued for at least 3 months in accordance with general recommendations for the use of live vaccines.
The CDC has stated that discontinuation of steroids for 1 month prior to live vaccine administration may be sufficient. Live vaccines should not be given to individuals who are considered to be immunocompromised until more information is available.
Lixisenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Lonafarnib: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with lonafarnib. Lonapegsomatropin: Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin.
If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. Loop diuretics: Moderate Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss.
Lopinavir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Losartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Lumacaftor; Ivacaftor: Moderate Lumacaftor; ivacaftor may reduce the efficacy of prednisone and prednisolone by decreasing systemic exposure of the corticosteroid. If used together, a higher systemic corticosteroid dose may be required to obtain the desired therapeutic effect. Lumateperone: Minor The manufacturer of lumateperone recommends that concurrent use of prednisone be avoided and lists prednisone as a CYP3A4 inducer.
Lumateperone is a CYP3A4 substrate. However, prednisone is not an established CYP3A4 inducer, and the potential outcome of using this combination is unknown.
Be alert for a potential reduction in lumateperone efficacy. Macimorelin: Major Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids.
Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Mannitol: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia.
Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Mecasermin rinfabate: Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF Similar counteractive effects are expected in humans.
If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored. Mecasermin, Recombinant, rh-IGF Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF Meglitinides: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Repaglinide: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Metformin; Rosiglitazone: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Metformin; Saxagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Sitagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Methazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Methenamine; Sodium Acid Phosphate: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
Methenamine; Sodium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Methyclothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Metolazone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Metoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Metyrapone: Contraindicated Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone.
Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Micafungin: Moderate Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin.
Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects. In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin mg and oral prednisolone 20 mg.
This reaction was transient, and the subject did not develop significant anemia. Mifepristone: Major Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses e.
For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions. This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness.
Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring. Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism.
Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events. Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone 85 hours. Mitotane: Moderate Use caution if mitotane and prednisone are used concomitantly, and monitor for decreased efficacy of prednisone and a possible change in dosage requirements.
Mitotane is a strong CYP3A4 inducer and prednisone is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of prednisone. Mivacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Natalizumab: Major Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab.
Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy.
Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone.
In multiple sclerosis MS clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently. Nateglinide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Neostigmine: Moderate Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis.
If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy. Neuromuscular blockers: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Nevirapine: Major The use of prednisone to prevent nevirapine-associated rash is not recommended. In a clinical trial, concomitant use of prednisone was associated with an increase in incidence and severity of rash during the first 6 weeks of nevirapine therapy.
Nirmatrelvir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Nonsteroidal antiinflammatory drugs: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug NSAID use. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection.
Ocrelizumab: Moderate Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression. Ofatumumab: Moderate Concomitant use of ofatumumab with corticosteroids may increase the risk of immunosuppression.
Ofatumumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Olmesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Plasma concentrations and efficacy of prednisolone may be reduced if these drugs are administered concurrently. Oxymetholone: Moderate Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema. Ozanimod: Moderate Concomitant use of ozanimod with prednisone may increase the risk of immunosuppression.
In clinical studies for ulcerative colitis, the use of systemic corticosteroids did not appear to influence safety or efficacy of ozanimod. Pancuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Coadministration of pazopanib and prednisone, a CYP3A4 substrate, may cause an increase in systemic concentrations of prednisone.
Use caution when administering these drugs concomitantly. In addition, concomitant administration may predispose the patient to over-immunosuppression resulting in an increased risk for the development of severe infections. Pegaspargase: Moderate Monitor for an increase in glucocorticoid-related adverse reactions such as hyperglycemia and osteonecrosis during concomitant use of pegaspargase and glucocorticoids. Peginterferon Alfa-2a: Moderate Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives.
Penicillamine: Major Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity.
Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone.
Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Phenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with phenytoin; a dosage increase may be necessary. Photosensitizing agents topical : Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment.
Physostigmine: Moderate Concomitant use of anticholinesterase agents. If possible, withdraw anticholinesterase inhibitors at least 24 hours before initiating corticosteroid therapy. Pimozide: Moderate According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as high-dose, systemic corticosteroid therapy.
Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes TdP , and electrolyte imbalances e. Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia. Topical corticosteroids are less likely to interact. Pioglitazone; Glimepiride: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Pioglitazone; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Ponesimod: Moderate Monitor for signs and symptoms of infection. Additive immune suppression may result from concomitant use of ponesimod and high-dose corticosteroid therapy which may extend the duration or severity of immune suppression. Posaconazole: Moderate Posaconazole and prednisone should be coadministered with caution due to an increased potential for adverse events.
Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of prednisone. Further, both prednisone and posaconazole are substrates of the drug efflux protein, P-glycoprotein, which when administered together may increase the absorption or decrease the clearance of the other drug.
This complex interaction may cause alterations in the plasma concentrations of both posaconazole and prednisone, ultimately resulting in an increased risk of adverse events. Potassium Phosphate; Sodium Phosphate: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
Potassium-sparing diuretics: Minor The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone. Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy.
Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. Pramlintide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Prilocaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Primidone: Moderate Coadministration may result in decreased exposure to prednisone. Promethazine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Propranolol: Moderate Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Concurrent use may increase risk of hypoglycemia because of loss of the counter-regulatory cortisol response. Propranolol; Hydrochlorothiazide, HCTZ: Moderate Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Propylthiouracil, PTU: Moderate The metabolism of corticosteroids is increased in hyperthyroidism and decreased in hypothyroidism. Dosage adjustments may be necessary when initiating, changing or discontinuing thyroid hormones or antithyroid agents.
Purine analogs: Minor Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. Pyridostigmine: Moderate Concomitant use of anticholinesterase agents. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. Quinapril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Quinolones: Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids. Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. Rapacuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Repaglinide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Rifampin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifampin; a dosage increase may be necessary.
Rifapentine: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifapentine; a dosage increase may be necessary.
Rilonacept: Moderate Patients receiving immunosuppressives along with rilonacept may be at a greater risk of developing an infection. Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Rituximab: Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy.
Rituximab; Hyaluronidase: Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. Rocuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Salicylates: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Salsalate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Saquinavir: Major Saquinavir may inhibit CYP3A4 metabolism of prednisone, resulting in increased plasma prednisone concentrations and reduced serum cortisol concentrations. There have been reports of clinically significant drug interactions in patients receiving ritonavir with other corticosteroids, resulting in systemic corticosteroid effects including Cushing syndrome and adrenal suppression.
Similar results are expected with saquinavir. Consider using an alternative treatment to prednisone, such as a corticosteroid not metabolized by CYP3A4 i. If corticosteroid therapy is to be discontinued, consider tapering the dose over a period of time to decrease the potential for withdrawal. Sargramostim, GM-CSF: Major Avoid the concomitant use of sargramostim and systemic corticosteroid agents due to the risk of additive myeloproliferative effects. If coadministration of these drugs is required, frequently monitor patients for clinical and laboratory signs of excess myeloproliferative effects e.
Sargramostim is a recombinant human granulocyte-macrophage colony-stimulating factor that works by promoting proliferation and differentiation of hematopoietic progenitor cells.
❾-50%}Prednisone Tablets (prednisone) dose, indications, adverse effects, interactions from localhost
For example, if your dose is 40mg daily, your doctor may tell you to take 8 tablets 8 x 5mg all at the same time. Take prednisolone with breakfast so it does not upset your stomach. Taking prednisolone in the morning also means it's less likely to affect your sleep. If your prednisolone tablets are labelled as "enteric coated" or "gastro resistant", you can take these with or without food but make sure to swallow them whole.
Do not take indigestion medicines 2 hours before or after taking enteric coated or gastro resistant tablets. Sometimes, your doctor may advise you to take prednisolone on alternate days only. You may need to take it for longer, even for many years or the rest of your life. If you miss a dose of prednisolone, take it as soon as you remember. If you do not remember until the following day, skip the missed dose and take the next one at the usual time.
If you forget doses often, it may help to set an alarm to remind you. Maintenance doses for chronic conditions are usually 10 to 20 mg PO once daily or 20 mg to 40 mg PO every other day. The treatment combination demonstrated superior results over colchicine alone in the treatment of primary amyloidosis. A multicenter, randomized, controlled trial confirmed that this shorter duration of low dose prednisone is equivalent to using 40 mg of prednisone for a longer duration i. Data from studies indicate that systemic glucocorticoids shorten recovery time; improve lung function FEV-1 , improve oxygenation, and reduce the risk of early relapse, treatment failure, and the length of hospitalization.
Taper dose over at least 6 weeks. There is variation in the literature with regard to dosage regimens. Prednisone 0. Use of IV methylprednisolone for a few days may precede oral corticosteroid use. While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value. Higher quality data are needed to establish the benefits vs. Experts generally agree that patients who have neurologic deficits should receive a corticosteroid; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation.
Topically applied corticosteroids are as effective as systemic corticosteroids for anterior ocular inflammation. Common regimens from high-quality clinical trials include a prednisone or prednisolone dose of 60 mg PO per day for 5 days, followed by a 5-day taper or 25 mg PO twice daily for 10 days , in combination with appropriate antiviral treatment.
A prednisone dose of mg PO administered in descending doses over 10 days has also been used with efficacy. The American Academy of Neurology notes that for new-onset Bell's palsy, steroids are effective in increasing the probability of complete facial functional recovery according to data derived from class I high quality studies.
The optimal dose of prednisone for infantile spasms has not been determined. Based on the evidence currently available, the American Academy of Neurology and the Child Neurology Society's practice parameters for the treatment of infantile spasms state that there is insufficient evidence that oral corticosteroids are effective in the treatment of infantile spasms.
There are limited data available for the treatment of refractory seizure types in pediatric patients. The optimal dose of prednisone for adjunctive therapy of seizure disorders has not been determined. Doses of 0. One case series of 28 pediatric patients ages 2 to 10 years suggests that prednisone therapy may be an effective adjunct treatment for intractable generalized epilepsy.
Treatment was most beneficial in those with absence seizures and early Lennox-Gastaut syndrome. In another retrospective case series, 32 mentally retarded children received various steroids for intractable epilepsy.
Eight of those, ages 9 months to 6 years, received prednisone at varying doses and duration 0. All 3 patients who responded had complex partial seizures. Of those 3 patients, 2 relapsed in less than 1 month after prednisone discontinuation. Infants and children with infantile spasms and children with other types of non-specified intractable seizures were included in the analysis.
The mean age of patients in the non-specified intractable seizures group was Prednisone was reported to be ineffective in all 30 patients with other seizure types. A corticosteroid taper may be considered. One study used prednisone 0. Guidelines state corticosteroid avoidance, early corticosteroid weaning, or very low dose maintenance corticosteroid therapy are all acceptable therapeutic approaches.
When corticosteroids are used, if no rejection episodes in the past 6 months have occurred and significant corticosteroid side effects are present, attempt corticosteroid weaning. Corticosteroid withdrawal can be successfully achieved 3 to 6 months after transplantation in many patients such as older patients, non-multiparous women, and those without circulating anti-HLA antibodies or rejection history.
Patients received aspirin mg orally daily during thalidomide therapy. The use of granulocyte colony-stimulation factor was permitted as indicated. The progression-free survival time evaluated via an independent review facility was significantly improved in patients with CDexpressing systemic anaplastic large-cell lymphoma sALCL or PTCL who received brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone CHP compared with cyclophosphamide, doxorubicin, vincristine, and prednisone CHOP The progression-free survival PFS time evaluated via an independent review facility was significantly improved in patients with CDexpressing sALCL or peripheral T-cell lymphoma who received brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone CHP compared with cyclophosphamide, doxorubicin, vincristine, and prednisone CHOP A suggested taper is 40 mg PO twice daily on days 1 to 5; then 40 mg PO once daily on days 6 to 10; then 20 mg PO once daily on days 11 to Start therapy as early as possible and within 72 hours after starting specific PCP therapy.
Recommended for patients with moderate to severe infection, defined by a PaO2 less than 70 mmHg at room air or an alveolar-arterial DO2 gradient of 35 mmHg or more. The benefits of starting corticosteroids after 72 hours are unclear. Recommended for patients with moderate to severe infection, defined by a PaO2 less than 70 mmHg at room air or an alveolar-arterial DO2 gradient more than 35 mmHg. Corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease, and on patient response.
There is no absolute maximum dosage. Specific guidelines for dosage adjustments in hepatic impairment are not available; prednisone is converted to prednisolone, the active moiety, by the liver. The use of oral prednisolone instead of oral prednisone may be preferred in patients with significant hepatic dysfunction see Prednisolone monograph ; doses are equivalent i. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
Immediate-release tablet: If given once daily or every other day, administer in the morning to coincide with the body's normal cortisol secretion. Delayed-release tablet Rayos : Administer the delayed-release tablets once daily by having the patient swallow them whole; do not break, divide or chew.
When deciding the administration time for the delayed-release tablets, consider the pharmacokinetics and the disease or condition being treated. Prednisone is released from the tablet beginning approximately 4 hours after intake of the first dose. Oral solution or syrup: Administer using a calibrated measuring device for accurate measurement of the dose. Generic: - Protect from moisture - Store at controlled room temperature between 68 and 77 degrees F Deltasone: - Store at controlled room temperature between 68 and 77 degrees F Predone: - Store at controlled room temperature between 68 and 77 degrees F RAYOS: - Protect from light - Protect from moisture - Store at 77 degrees F; excursions permitted to degrees F Sterapred: - Store at controlled room temperature between 68 and 77 degrees F Sterapred DS: - Protect from moisture - Store at controlled room temperature between 68 and 77 degrees F.
Prednisone is contraindicated in patients with a hypersensitivity to prednisone or to any components of the formulation. Rare instances of anaphylactoid reactions have occurred in patients receiving corticosteroid therapy. Although true corticosteroid hypersensitivity is rare, it is possible, though also rare, that such patients will display cross-hypersensitivity to other corticosteroids.
It is advisable that patients who have a hypersensitivity reaction to any corticosteroid undergo skin testing, which, although not a conclusive predictor, may help to determine if hypersensitivity to another corticosteroid exists. Such patients should be carefully monitored during and following the administration of any corticosteroid. Patients receiving high-dose systemic corticosteroid therapy, such as prednisone, for any period of time are at risk to develop immunosuppression; patients receiving moderate dosages of systemic corticosteroids for short periods or low doses for prolonged periods also may be at risk.
When given in combination with other immunosuppressive agents, there is a risk of significant immunosuppression. Corticosteroids may increase the risks related to infections with any pathogen, including viral, bacterial, fungal, protozoan, or helminth infection.
The degree to which the dose, route and duration of corticosteroid administration correlates with the specific risks of infection is not well characterized, however, with increasing doses of corticosteroids, the rate of occurrence of infectious complications increases.
Corticosteroids may also mask some signs of current infection. Although the FDA-approved product labeling states that corticosteroids are contraindicated in patients with systemic fungal infections, most clinicians believe that systemic corticosteroids can be administered to these patients as long as appropriate therapy is administered simultaneously. Avoid use of prednisone in patients with a fungal infection or bacterial infection that is not adequately controlled with anti-infective agents.
Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids. Rule out infection with latent or active amebiasis before initiating corticosteroid therapy in patients who have spent time in the tropics or who have unexplained diarrhea. Use corticosteroids with caution in patients with known or suspected Strongyloides threadworm infestation as the immunosuppressive effects may lead to disseminated infection, severe enterocolitis, and sepsis.
Cases of severe and disseminated strongyloidiasis have been reported following use of corticosteroids in combination with tocilizumab to treat patients with coronavirus disease COVID Before giving these drugs together to patients from strongyloidiasis endemic areas, consider administering ivermectin as prophylactic treatment.
Reserve systemic corticosteroid therapy in active tuberculosis for patients with fulminating or disseminated disease and only in conjunction with appropriate antituberculosis therapy.
Reactivation of tuberculosis may occur in patients with latent tuberculosis or tuberculin reactivity; close observation for disease reactivation is needed if corticosteroids are indicated in such patients. Furthermore, chemoprophylaxis is advised if prolonged corticosteroid therapy is needed. Advise patients receiving immunosuppressive doses of systemic corticosteroids to avoid exposure to persons with a viral infection i.
Instruct patients to get immediate medical advice if exposure occurs. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin may be indicated.
If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin may be indicated. Avoid the use of corticosteroids in active ocular herpes infection due to the risk of corneal perforation.
Corticosteroids should not be used in cerebral malaria. As glucocorticoids can produce or aggravate Cushing's syndrome, glucocorticoids should be avoided in patients with Cushing's disease unless when needed to correct hypocortisolism that may occur during use of treatments for the condition. Acute adrenal insufficiency and even death may occur following abrupt discontinuation of systemic therapy.
In addition, a withdrawal syndrome unrelated to adrenocortical insufficiency may occur following sudden discontinuation of corticosteroid therapy. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels. Withdraw prolonged systemic corticosteroid therapy greater than 2 weeks gradually. HPA suppression can last for up to 12 months following cessation of systemic chronic therapy.
Recovery of HPA axis function is generally prompt and complete upon discontinuation of short-term or topical corticosteroid therapy. Like all corticosteroids, prednisone therapy may impair immune and adrenocortical function. HPA-suppressed patients may need supplemental corticosteroid treatment during periods of physiologic stress, such as surgery, acute blood loss, or infectious conditions, even after the corticosteroid has been discontinued.
Patients should advise the attending physician of the corticosteroid they have received within the last 12 months, and the disease for which they were being treated. Identification cards which include the name of the patient's disease, the currently administered type and dose of corticosteroid, and the patient's physician should be carried with the patient at all times.
Corticosteroid therapy, including prednisone therapy, has been associated with left ventricular free-wall rupture in patients with recent myocardial infarction, and should therefore be used cautiously in these patients. As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal disease or insufficiency.
Systemic corticosteroids, such as prednisone, may decrease glucose tolerance, produce hyperglycemia, and aggravate or precipitate diabetes mellitus. Metabolic clearance of corticosteroids is decreased in hypothyroidism and increased in hyperthyroidism. Changes in thyroid disease status of a patient may necessitate adjustment in dosage. Systemic corticosteroids should be used with caution in patients with active or latent peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since steroids may increase the risk of a gastrointestinal GI perforation.
Signs of peritoneal irritation following GI perforation in patients receiving corticosteroids may be minimal or absent. Corticosteroids should not be used in patients where there is a possibility of impending GI perforation, abscess, or pyogenic infection. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with severe hepatic disease with cirrhosis.
An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with neuromuscular disease disorders e.
This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years. Use with caution in patients with glaucoma; prednisone can cause increased intraocular pressure with possible damage to the optic nerves.
If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored. Use of corticosteroids may produce posterior subcapsular cataracts and may enhance the establishment of secondary ocular infection due to bacteria, fungi or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes.
Corticosteroids should not be used in active ocular herpes simplex because of possible corneal perforation. Existing emotional instability or psychosis may be aggravated by corticosteroids.
Psychiatric derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychosis. Use prednisone with caution in patients with a seizure disorder; systemic steroids can lower the seizure threshold. Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i.
This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteopenia or osteoporosis at any age.
Growth and development of pediatric patients on prolonged corticosteroid therapy should be carefully observed. Special consideration should be given to patients at increased risk of osteoporosis e.
Consider interventions to reduce bone loss or treat glucocorticoid-induced osteoporosis in affected patients. To minimize the risk of glucocortoicoid-induced bone loss, the smallest possible effective dosage and duration should be used. Current recommendations suggest that all interventions be initiated in any patient in whom glucocorticoid therapy with at least the equivalent of 5 mg of prednisone for at least 3 months is anticipated. Prednisone has been used in infants, children, and adolescents; however, consider pediatric-specific issues before initiating treatment.
Safety and efficacy have not been established for the use of corticosteroids in neonates. Adverse effects in newborns have included complications of treatment such as gastrointestinal bleeding, intestinal perforation, hyperglycemia, and hypertension. The potential for growth inhibition in any pediatric patient should be monitored during prolonged therapy, and the potential for growth effects should be weighed against the clinical benefit obtained and the availability of other treatment alternatives.
Administration of corticosteroids to pediatric patients should be limited to the least amount compatible with an effective therapeutic regimen. Further, children receiving corticosteroids are immunosuppressed, and are therefore more susceptible to infection.
Normally innocuous infections can become fatal in these children, and care should be taken to avoid exposure to these diseases. Published studies provide evidence of efficacy and safety in pediatric patients for the treatment of nephrotic syndrome pediatric patients more than 2 years of age , and aggressive lymphomas and leukemias patients greater than 1 month of age.
Other indications for pediatric use of corticosteroids e. Indicated vaccination procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids as replacement therapy e.
Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered. However, the response to such vaccines may be diminished and cannot be predicted. In patients who have received high-dose, systemic corticosteroids for 2 weeks or longer, it is recommended to wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine.
If systemic corticosteroids such as prednisone must be used during pregnancy, the potential risks should be discussed with the patient. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. Based on findings from human and animal studies, corticosteroids can cause fetal harm when administered to a pregnant woman. Published epidemiological studies suggest a small but inconsistent increased risk of orofacial clefts with use of systemic corticosteroids during the first trimester.
Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring. Intrauterine growth restriction and decreased birth weight have also been reported with maternal use of systemic corticosteroids during pregnancy; however, the underlying maternal condition may also contribute to these risks. There are no adequate and well-controlled studies in pregnant women.
Corticosteroids distribute into breast milk, and the manufacturer states that in order to minimize infant exposure, the lowest dose should be prescribed to lactating women to achieve the desired clinical effect. Prednisone concentrations in breast milk are low, and no adverse effects have been reported in the breast-fed infant with maternal use of any corticosteroid during breast-feeding; prednisone is generally considered compatible to use during lactation. Published case reports of systemic prednisone use during pregnancy that indicate little risk to a nursing infant due to lack of reported side effects.
Prednisone is converted to prednisolone in vivo, and peak concentrations in human milk appear in about 1 hour after a dose; the total daily dose reaching the infant is approximately 0. Prednisolone and methylprednisolone have similar data available regarding systemic use during lactation.
High doses of corticosteroids administered to lactating women for long periods could potentially produce problems in the breastfed infant including growth and development and interfere with endogenous corticosteroid production. At higher daily prednisone doses, avoidance of breast-feeding during times of peak milk concentrations can help limit infant exposure; however, such adjustments are rarely necessary. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
Use systemic corticosteroids such as prednisone with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use. According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.
The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration. According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences.
Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression. Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients. Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection.
Acetaminophen; Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance. Acetaminophen; Aspirin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Acetaminophen; Aspirin; Diphenhydramine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide. Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH.
Acetohexamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment. Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance.
Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Albiglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Do not take more medication than you are told to take. Do not suddenly stop taking your medication because you may develop a severe reaction.
Your care team will tell you how much medication to take. Using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.
This medication may mask signs of infection. It can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others such as chickenpox, measles, flu. Consult your doctor if you have been exposed to an infection or for more details. Avoid contact with people who have recently received live vaccines such as flu vaccine inhaled through the nose.
This medication may slow down a child's growth if used for a long time. Consult the doctor or pharmacist for more details. See the doctor regularly so your child's height and growth can be checked. During pregnancy, prednisolone should be used only when clearly needed. It may rarely harm an unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for an extended period of time may have hormone problems.
This medication passes into breast milk. However, this drug is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. Drug interactions may change how your medications work or increase your risk for serious side effects.
This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Other medications can affect the removal of prednisolone from your body, which may affect how prednisolone works. Examples include estrogens, azole antifungals such as itraconazole , rifamycins such as rifabutin , St. John's wort, drugs used to treat seizures such as phenytoin , among others.
If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention usually milligrams a day , you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details. This product may interfere with certain lab tests such as skin tests. Make sure laboratory personnel and all your doctors know you use this drug.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call Otherwise, call a poison control center right away.
Send the page " " to a friend, relative, colleague or yourself. We do not record any personal information entered above. Commonly-prescribed oral corticosteroid with little mineralocorticoid activity; metabolized to prednisolone; prednisone is roughly 4 times as potent as hydrocortisone as a glucocorticoid Used in many conditions in adult and pediatric patients, including asthma, COPD, SLE, rheumatoid and psoriatic arthritis, prevention of transplant rejection, and many allergic, dermatologic, and inflammatory states If long-term therapy required, the lowest possible effective dose should be used.
For acute conditions, parenteral steroid therapy is recommended initially. NOTE: Hydrocortisone and cortisone are the preferred agents; prednisone has little to no mineralocorticoid properties.
NOTE: Hydrocortisone is the preferred glucocorticoid in infants. Titrate to response. The usual range is 5 mg to 30 mg PO once daily. Renal transplant guidelines recommend a calcineurin inhibitor CNI such as tacrolimus and an antiproliferative agent such as mycophenolate plus or minus corticosteroids for initial prophylaxis.
In patients at low immunologic risk who receive induction therapy, corticosteroid discontinuation during first week after transplantation is suggested. Some evidence exists that steroids may be safely stopped in most patients after 3 to 12 months on combination therapy with a CNI and mycophenolate.
Data suggest that the risk of steroid withdrawal depends on the use of concomitant immunosuppressives, immunological risk, ethnicity, and time after transplantation. Once the prednisone taper is completed without a flare, the cyclosporine dose is tapered to alternate day dosing such that the patient is taking prednisone one day and cyclosporine the next day. Once patients reach their maximal response, therapy is continued for another 3 months and then tapered.
Multiple dosage regimens have been studied. Dosage requirements are variable though and should be individualized based on the response of the patient and tolerance to treatment. The American College of Gastroenterology states that corticosteroids are not effective for maintenance of medically-induced remission in Crohn's disease and should not be used for long-term treatment.
Corticosteroids for Crohn's disease are more effective for small-bowel involvement than for colonic involvement. Because of the potential complications of steroid use in this disease, steroids should be used selectively and in the lowest dose possible.
Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission. Total course of treatment may range from 3 to 10 days. Dosing in the afternoon at PM may be helpful for patients prone to nocturnal symptoms, with no increase in adrenal suppression.
Consider add-on low dose oral corticosteroids CS 7. Add CS only after exclusion of other contributory factors and consideration of other add-on treatments. In pediatric patients, the use of oral corticosteroids is usually limited to a few weeks until asthma control is improved and the patient can be stabilized on other, preferred treatments.
Increase by 5 mg every 2 to 3 days as needed. For chronic use, may change to every other day therapy. Usual dosage ranges from 5 to 30 mg PO once daily. Use the lowest effective dose usually less than 7.
American College of Rheumatology guidelines recommend 0. Taper the dose after a few weeks to the lowest effective dose that maintains control. Insufficient data exist to recommend a specific steroid taper because nephritis and extrarenal manifestations vary from patient to patient.
Some patients may require long-term therapy. If needed, the long-term maintenance dose is 0. In patients with severe skin reactions, higher initial doses e. Adjust until a satisfactory response is noted; taper as clinically indicated. High-dose corticosteroids are controversial; administration has been associated with decreased survival. Depending on the indication, the initial dose may be gradually tapered after 1 to 2 weeks and discontinued by 4 to 6 weeks, as guided by symptoms.
Oral corticosteroids are usually reserved for cases not responding to standard topical treatments. Use lowest effective dose. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine. Corticosteroid use in ARDS is controversial. The initial dosage may vary from 5 to 60 mg PO per day. Guidelines use a dose of 0. Taper to 0. Guidelines suggest use of prednisone with cyclophosphamide or azathioprine, and a minimum of 6 months duration.
Objective responses may not be noted until at least 3 months of therapy. Exact duration of treatment and need for long-term maintenance should be individualized to clinical response and tolerance of therapy.
Chronic doses of prednisone 15 mg to 20 mg PO once daily may be adequate as maintenance therapy. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Weight-based dosing: 0. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, as guided by symptoms.
Chemotherapy cycle is repeated every 57 days. Depending on indication, gradually taper the initial dose after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Guidelines recommend as adjunct therapy for meningitis.
Routine use outside of CNS involvement is not recommended; however, select patients may benefit. The National Institutes of Health NIH COVID treatment guidelines recommend prednisone as an alternative corticosteroid for hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation ECMO.
The NIH recommends 40 mg PO once daily or in 2 divided doses for up to 10 days or until hospital discharge whichever comes first. The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting prednisone. Treatment cycles may be repeated when the granulocyte and platelet counts returned to normal. Response may be gradual over several months. The optimal dosage of melphalan and prednisone plus thalidomide has not been clearly established and dosages have varied in randomized controlled trials.
In one study, previously untreated patients between 65 and 75 years of age received melphalan 0. Thalidomide was stopped after day 4 of the last cycle.
In another study, patients aged 75 years and older received melphalan 0. In cycles 1 through 4, bortezomib 1. In cycles 5 to 9, bortezomib 1. Dosage not established. The progression-free survival time was not significantly improved with carfilzomib, melphalan, and prednisone compared with bortezomib, melphalan, and prednisone in a randomized, phase 3 trial the CLARION trial ; additionally, serious and fatal adverse reactions occurred more often in the carfilzomib-containing arm.
There is not sufficient evidence to support the use of this drug combination for this indication. If side effects e. NOTE: The definitive treatment for median-nerve entrapment is surgery. Corticosteroids are temporary measures; patients who have intermittent pain and paresthesias without any fixed motor sensory deficits may respond to conservative therapy. Initially, 20 mg to 30 mg PO once daily has been recommended. Some experts give a combination of prednisone and azathioprine.
For maintenance, prednisone 5 mg to 15 mg PO once daily has been recommended. Doses for the various manifestations of SLE vary widely.
Maintenance doses are usually 10 to 20 mg PO once daily or 20 to 40 mg PO every other day. Initially, large doses e. Individualize dose and titrate to response. After symptoms controlled, decrease dose slowly every 5 to 7 days.
Maintenance doses for chronic conditions are usually 10 to 20 mg PO once daily or 20 mg to 40 mg PO every other day. The treatment combination demonstrated superior results over colchicine alone in the treatment of primary amyloidosis.
A multicenter, randomized, controlled trial confirmed that this shorter duration of low dose prednisone is equivalent to using 40 mg of prednisone for a longer duration i. Data from studies indicate that systemic glucocorticoids shorten recovery time; improve lung function FEV-1improve oxygenation, and reduce the risk of early relapse, treatment failure, and the length of hospitalization.
Taper dose over at least 6 weeks. There is variation in the literature with regard to dosage regimens. Prednisone 0. Use of IV methylprednisolone for a few days may precede oral corticosteroid use. While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value.
Higher quality data are needed to establish the benefits vs. Experts generally agree that patients who have neurologic deficits should receive a corticosteroid; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation.
Topically applied corticosteroids are as effective as systemic corticosteroids for anterior ocular inflammation. Common regimens from high-quality clinical trials include a prednisone or prednisolone dose of 60 mg PO per day for 5 days, followed by a 5-day taper or 25 mg PO twice daily for 10 daysin combination with appropriate antiviral treatment. A prednisone dose of mg PO administered in descending doses over 10 days has also been used with efficacy.
The American Academy of Neurology notes that for new-onset Bell's palsy, steroids are effective in increasing the probability of complete facial functional recovery according to data derived from class I high quality studies. The optimal dose of prednisone for infantile spasms has not been determined. Based on the evidence currently available, the American Academy of Neurology and the Child Neurology Society's practice parameters for the treatment of infantile spasms state that there is insufficient evidence that oral corticosteroids are effective in the treatment of infantile spasms.
There are limited data available for the treatment of refractory seizure types in pediatric patients.
This is a schedule for a day taper of prednisone. One tablet is Prednisone 10mg. For the first three days, take 4 tablets every morning with breakfast. For. Dexamethasone tablets USP, mg for oral administration. Each tablet contains anhydrous lactose, croscarmellose sodium, magnesium stearate. Prednisone 20mg. 10 tablets at Costco. Logo of Costco. Standard coupon. $ $12retail. Show coupon. Sign up & saveOne-time offer. Prednisone 40 mg wrapping 60 pills Prednisone is used to treat inflammatory conditions of your adrenal glands such as addisons disease, insect. Day 2: Administer 25 mg on day 2 as 5 mg (1 tablet) at breakfast, to taper until discontinuation over the next 6 to 12 months (Ref). For chronic use, may change to every other day therapy. When corticosteroids are used, if no rejection episodes in the past 6 months have occurred and significant corticosteroid side effects are present, attempt corticosteroid weaning. Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Patients should advise the attending physician of the corticosteroid they have received within the last 12 months, and the disease for which they were being treated. Tesamorelin: Moderate Use caution when coadministering tesamorelin with prednisone as their concurrent use may decrease the effectiveness of the steroids. The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. Oral solution or syrup: Administer using a calibrated measuring device for accurate measurement of the dose.The photos shown are samples only Not all photos of the drug may be displayed. Your medication may look different. If you have questions, ask your pharmacist. Generic name: Prednisolone - oral. Pronunciation pred-NISS-oh-lone. Prednisolone is a man-made form of a natural substance corticosteroid hormone made by the adrenal gland. It is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies.
It decreases your immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
Take this medication by mouth, with food or milk to prevent stomach upset, exactly as directed by your doctor. Follow the dosing schedule carefully. The dosage and length of treatment are based on your medical condition and response to treatment.
Your doctor may direct you to take prednisolone 1 to 4 times a day or take a single dose every other day. It may help to mark your calendar with reminders or use a pill box. If you are using the prednisolone dose pack, follow the dosing schedule on the package, unless directed otherwise by your doctor. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped.
Your dose may need to be gradually decreased. If you suddenly stop using this medication, you may have withdrawal symptoms such as weakness, weight loss, nausea, muscle pain, headache, tiredness, dizziness.
To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used prednisolone for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal. See also Precautions section. Nausea, heartburn, headache, dizziness, menstrual period changes, trouble sleeping, increased sweating, or acne may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Because this drug works by weakening the immune system, it may lower your ability to fight infections.
This may make you more likely to get a serious rarely fatal infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection such as cough, sore throat, fever, chills. Use of this medication for prolonged or repeated periods may result in oral thrush or a yeast infection. Contact your doctor if you notice white patches in your mouth or a change in vaginal discharge.
This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor.
Your doctor may need to adjust your diabetes medication, exercise program, or diet. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Call your doctor for medical advice about side effects. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at Before taking prednisolone, tell your doctor or pharmacist if you are allergic to it; or to prednisone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems.
Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of:. This drug may make you dizzy. Alcohol or marijuana cannabis can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely.
Limit alcoholic beverages. Talk to your doctor if you are using marijuana cannabis. This medicine may cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding. Consult your doctor or pharmacist for more information. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products.
Using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. If you will be using this medication for a long time, carry a warning card or medical ID bracelet that identifies your use of this medication.
This medication may mask signs of infection. It can make you more likely to get infections or may worsen any current infections. Avoid contact with people who have infections that may spread to others such as chickenpox, measles, flu. Consult your doctor if you have been exposed to an infection or for more details. Avoid contact with people who have recently received live vaccines such as flu vaccine inhaled through the nose. This medication may slow down a child's growth if used for a long time.
Consult the doctor or pharmacist for more details. See the doctor regularly so your child's height and growth can be checked. During pregnancy, prednisolone should be used only when clearly needed. It may rarely harm an unborn baby. Discuss the risks and benefits with your doctor. Infants born to mothers who have been using this medication for an extended period of time may have hormone problems. This medication passes into breast milk. However, this drug is unlikely to harm a nursing infant.
Consult your doctor before breast-feeding. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Other medications can affect the removal of prednisolone from your body, which may affect how prednisolone works. Examples include estrogens, azole antifungals such as itraconazole , rifamycins such as rifabutin , St. John's wort, drugs used to treat seizures such as phenytoin , among others. If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention usually milligrams a day , you should continue taking it unless your doctor instructs you otherwise.
Ask your doctor or pharmacist for more details. This product may interfere with certain lab tests such as skin tests.
Make sure laboratory personnel and all your doctors know you use this drug. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call Otherwise, call a poison control center right away. US residents can call their local poison control center at Canada residents can call a provincial poison control center.
Consult your doctor for more details. This medication may cause bone problems osteoporosis. Lifestyle changes that may help reduce the risk of bone problems while taking this drug for an extended time include doing weight-bearing exercise, getting enough calcium and vitamin D, stopping smoking, and limiting alcohol. Discuss with your doctor lifestyle changes that might benefit you. If you are taking this medication once daily and miss a dose, take it as soon as you remember.
If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. If you are taking this medication every other day, ask your doctor or pharmacist what you should do if you miss a dose. Store at room temperature away from light and moisture. Do not store in the bathroom.
Keep all medications away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
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