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