PREDNISONE

(pred'ni-sone)
Apo-Prednisone , Deltasone, Meticorten, Orasone, Panasol, Prednicen-M, Sterapred,
Winpred
Classifications: hormones and synthetic substitutes; adrenal corticosteroid; glucocorticoid
Pregnancy Category: C

Availability
1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg tablets; 5 mg/5 mL, 5 mg/mL solution

Actions
Immediate-acting synthetic analog of hydrocortisone. Effect depends on
biotransformation to prednisolone, a conversion that may be impaired in patient with
liver dysfunction. Less mineralocorticoid activity than hydrocortisone, but sodium
retention and potassium depletion can occur.

Therapeutic Effects
Has antiinflammatory properties.

Uses
May be used as a single agent or conjunctively with antineoplastics in cancer therapy;
also used in treatment of myasthenia gravis and inflammatory conditions and as an
immunosuppressant.

Contraindications
Systemic fungal infections and known hypersensitivity.

Cautious Use
Patients with infections; nonspecific ulcerative colitis; diverticulitis; active or latent
peptic ulcer; renal insufficiency; hypertension; osteoporosis; myasthenia gravis. Safety
during pregnancy (category C) or lactation is not established.

Route & Dosage

Antiinflammatory
Adult: PO 5–60 mg/d in single or divided doses
Child: PO 0.1–0.15 mg/kg/d in single or divided doses

Acute Asthma
Child: PO <1 y, 1–2 mg/kg/d times 3–5 d or 10 mg q12h; 1–4 y, 20 mg q12h; 5–13 y, 30
mg q12h; >13 y, 40 mg q12h times 3–5 d

Administration
Oral

• Crush tablet and give with fluid of patient's choice if unable to swallow whole.
• Give at mealtimes or with a snack to reduce gastric irritation.
• Dose adjustment may be required if patient is subjected to severe stress (serious
infection, surgery, or injury) or if a remission or disease exacerbation occurs.
• Do not abruptly stop drug. Reduce dose gradually by scheduled decrements
(various regimens) to prevent withdrawal symptoms and permit adrenals to
recover from drug-induced partial atrophy.

Alternate-Day Therapy (ADT) for Patient on Long-term Therapy

• With ADT, the 48-h requirement for steroids is administered as a single dose
every other morning.
• Be aware that ADT minimizes adverse effects associated with long-term
treatment while maintaining the desired therapeutic effect.
• See prednisone for numerous additional nursing implications.

Adverse Effects ( 1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI:
Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound
healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures.
Endocrine: Cushingoid features, growth suppression in children, carbohydrate
intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis.
Metabolic: Hypokalemia.

Interactions
Drug: barbiturates, phenytoin, rifampin increase steroid metabolism—increased doses
of prednisone may be needed; amphotericin B, diuretics increase potassium loss;
ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in
patients with myasthenia gravis; may inhibit antibody response to vaccines, toxoids.
Pharmacokinetics
Absorption: Readily absorbed from GI tract. Peak: 1–2 h. Duration: 1–1.5 d. Distribution:
Crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver.
Elimination: Hypothalamus-pituitary axis suppression: 24–36 h; Excreted in urine. Half-
Life: 3.5 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

• Establish baseline and continuing data regarding BP, I&O ratio and pattern,
weight, and sleep pattern. Start flow chart as reference for planning individualized
pharmacotherapeutic patient care.
• Check and record BP during dose stabilization period at least 2 times daily.
Report an ascending pattern.
• Monitor patient for evidence of HPA axis suppression during long-term therapy
by determining plasma cortisol levels at weekly intervals.
• Lab tests: Obtain fasting blood glucose, serum electrolytes, and routine laboratory
studies at regular intervals during long-term steroid therapy.
• Be aware that older adult patients and patients with low serum albumin are
especially susceptible to adverse effects because of excess circulating free
glucocorticoids.
• Be alert to signs of hypocalcemia (see Appendix F). Patients with hypocalcemia
have increased requirements for pyridoxine (vitamin B6), vitamins C and D, and
folates.
• Be alert to possibility of masked infection and delayed healing (antiinflammatory
and immunosuppressive actions). Prednisone suppresses early classic signs of
inflammation. When patient is on an extended therapy regimen, incidence of oral
Candida infection is high. Inspect mouth daily for symptoms: white patches,
black furry tongue, painful membranes and tongue.
• Monitor bone density. Compression and spontaneous fractures of long bones and
vertebrae present hazards, particularly in long-term corticosteroid treatment of
rheumatoid arthritis or diabetes, in immobilized patients, and older adults.
• Be aware of previous history of psychotic tendencies. Watch for changes in mood
and behavior, emotional stability, sleep pattern, or psychomotor activity,
especially with long-term therapy, that may signal onset of recurrence. Report
symptoms to physician.
• If a patient is receiving aspirin concomitantly with a corticosteroid, salicylism
may be induced when the corticosteroid dosage is decreased or discontinued.
• Be aware that long-term corticosteroid therapy is ordinarily not interrupted when
patient undergoes major surgery, but dosage may be increased.
• Monitor for withdrawal syndrome (e.g., myalgia, fever, arthralgia, malaise) and
hypocorticism (e.g., anorexia, vomiting, nausea, fatigue, dizziness, hypotension,
 hypoglycemia, myalgia, arthralgia) with abrupt discontinuation of corticosteroids
after long-term therapy.

Patient & Family Education

• Take drug as prescribed and do not alter dosing regimen or stop medication
without consulting physician.
• Be aware that a slight weight gain with improved appetite is expected, but after
dosage is stabilized, a sudden slow but steady weight increase [2 kg (5 lb) per wk]
should be reported to physician.
• Avoid or minimize alcohol and caffeine may contribute to steroid-ulcer
development in long-term therapy.
• Report symptoms of GI distress to physician and do not self-medicate to find
relief.
• Do not use aspirin or other OTC drugs unless they are prescribed specifically by
the physician.
• Report slow healing, any vague feeling of being sick, or return of pretreatment
symptoms.
• Be fastidious about personal hygiene; give special attention to foot care, and be
particularly cautious about bruising or abrading the skin.
• Report persistent backache or chest pain (possible symptoms of vertebral or rib
fracture) that may occur with long-term therapy.
• Tell dentist or new physician about prednisone therapy.
• Carry medical information at all times. It needs to indicate medical diagnosis,
medication(s), physician's name(s), address(es), and telephone number(s).
• Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined: generic names in

bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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