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prednisone
Apo-Prednisone†, Deltasone, Liquid Pred*, Meticorten, Orasone, Panafcort‡, Prednicen-M, Prednisone Intensol*, Sone‡, Sterapred, Winpred†

Pregnancy Risk Category C

How supplied
Tablets:
1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg
Tablets (film-coated):
5 mg
Oral solution:
5 mg/5 ml*, 5 mg/ml (concentrate)*
Syrup:
5 mg/5 ml*

Action
Not clearly defined. Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism.

Indications & dosage
Severe inflammation, immunosuppression--

Adults:
5 to 60 mg P.O. daily in single dose or as two to four divided doses. Maintenance dose given once daily or every other day. Dosage must be individualized.
Children:
0.14 to 2 mg/kg or 4 to 60 mg/
m2 daily P.O. in four divided doses.
Acute exacerbations of multiple sclerosis--

Adults:
200 mg P.O. daily for 7 days; then 80 mg P.O. every other day for 1 month.

Adverse reactions
CNS:
euphoria, insomnia, psychotic behavior, pseudotumor cerebri, vertigo, headache, paresthesia, seizures.
CV:
heart failure, hypertension, edema, arrhythmias, thrombophlebitis, thromboembolism.
EENT:
cataracts, glaucoma.
GI:
peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting.
GU:
menstrual irregularities.
Metabolic:
hypokalemia, hyperglycemia, and carbohydrate intolerance; increased serum cholesterol levels; decreased serum calcium levels; increased urine calcium levels.
Musculoskeletal:
growth suppression in children, muscle weakness, osteoporosis.
Skin:
hirsutism, delayed wound healing, acne, various skin eruptions.
Other:
cushingoid state (moonface, buffalo hump, central obesity ), susceptibility to infections, acute adrenal insufficiency after increased stress or abrupt withdrawal after long-term therapy.
After abrupt withdrawal:
rebound inflammation, fatigue, weakness, arthralgia, fever, dizziness, lethargy, depression, fainting, orthostatic hypotension, dyspnea, anorexia, hypoglycemia. After prolonged use, sudden withdrawal may be fatal.

Interactions
Drug-drug.
Aspirin, indomethacin, other NSAIDs: increased risk of GI distress and bleeding. Give together cautiously.
Barbiturates, phenytoin, rifampin:
decreased corticosteroid effect. Increase corticosteroid dosage, as ordered.
Oral anticoagulants:
altered dosage requirements. Monitor PT and INR closely.
Potassium-depleting drugs such as thiazide diuretics:
enhanced potassium-wasting effects of prednisone. Monitor serum potassium levels.
Salicylates:
decreased serum salicylate levels. Monitor for lack of salicylate effectiveness.
Skin-test antigens:
decreased response. Defer skin testing until therapy is completed.
Toxoids, vaccines:
decreased antibody response and increased risk of neurologic complications. Avoid concomitant use.

Effects on diagnostic tests
Drug suppresses reactions to skin tests, causes false-negative results in the nitroblue tetrazolium test for systemic bacterial infections, and decreases 131I uptake and protein-bound iodine levels in thyroid function tests.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with systemic fungal infections.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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