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Pregnancy Category: C
ClassificationTherapeutic: anti inflammatories steroidal
Used systemically and locally in a wide variety of chronic diseases including:
- Autoimmune disorders.
In pharmacologic doses, suppresses inflammation and the normal immune response.
Has numerous intense metabolic effects (see Adverse Reactions and Side Effects).
Suppresses adrenal function at chronic doses of 5 mg/day.
Replaces endogenous cortisol in deficiency states.
Has minimal mineralocorticoid activity.
Suppression of inflammation and modification of the normal immune response.
Absorption: Well absorbed after oral administration.
Distribution: Widely distributed; crosses the placenta and probably enters breast milk.
Metabolism and Excretion: Converted by the liver to prednisolone, which is then metabolized by the liver.
Half-life: 3.4–3.8 hr (plasma), 18–36 hr (tissue); adrenal suppression lasts 1.25–1.5 days.
Time/action profile (anti-inflammatory activity)
Contraindicated in: Active untreated infections (may be used in patients being treated for tuberculous meningitis); Some products contain alcohol and should be avoided in patients with known intolerance; Lactation: Avoid chronic use.
Use Cautiously in: Chronic treatment (leads to adrenal suppression; use lowest possible dose for shortest period of time); Pediatric: Chronic use will result in ↓ growth; use lowest possible dose for shortest period of time; Stress (surgery, infections); supplemental doses may be needed; Potential infections may mask signs (fever, inflammation); Obstetric: Safety not established.
Adverse Reactions/Side EffectsAdverse reactions/side effects are much more common with high-dose/long-term therapy
Central nervous system
- depression (most frequent)
- euphoria (most frequent)
- ↑ intracranial pressure (children only)
- personality changes
Ear, Eye, Nose, Throat
- ↑ intraocular pressure
- hypertension (most frequent)
- peptic ulceration (life-threatening)
- anorexia (most frequent)
- nausea (most frequent)
- acne (most frequent)
- ↓ wound healing (most frequent)
- ecchymoses (most frequent)
- fragility (most frequent)
- hirsutism (most frequent)
- petechiae (most frequent)
- adrenal suppression (most frequent)
Fluid and Electrolyte
- fluid retention (long-term high doses)
- hypokalemic alkalosis
- thromboembolism (life-threatening)
- weight gain
- weight loss
- muscle wasting (most frequent)
- osteoporosis (most frequent)
- avascular necrosis of joints
- muscle pain
- cushingoid appearance (moon face, buffalo hump) (most frequent)
- ↑ susceptibility to infection
Drug-Drug interactionAdditive hypokalemia withthiazide and loopdiuretics, amphotericin B, piperacillin, or ticarcillin.Hypokalemia may ↑ risk of digoxin toxicity.May ↑ requirement for insulins ororal hypoglycemic agents.Phenytoin,phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness.Oral contraceptives may ↓ metabolism.↑ risk of adverse GI effects with NSAIDs (including aspirin).At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ the risk of adverse reactions from live virus vaccines.May ↑ risk of tendon rupture fromfluoroquinolones.
Oral (Adults) Most uses—5–60 mg/day as a single dose or in divided doses (delayed-release tablets should be administered once daily). Multiple sclerosis—200 mg/day for 1 wk, then 80 mg every other day for 1 mo. Adjunctive therapy of Pneumocystis jirovecii pneumonia in AIDS patients—40 mg twice daily for 5 days, then 40 mg once daily for 5 days, then 20 mg once daily for 10 days.
Oral (Children) Nephrotic syndrome—2 mg/kg/day initially given in 1–3 divided doses (maximum 80 mg/day; delayed-release tablets should be administered once daily) until urine is protein free for 4–6 weeks. Maintenance dose of 2 mg/kg/day every other day in the morning, gradually taper off after 4–6 weeks. Asthma exacerbation—1 mg/kg q 6 hr for 48 hr, then 1–2 mg/kg/day (maximum 60 mg/day) in divided doses twice daily.
Availability (generic available)
Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg
Delayed-release tablets: 1 mg, 2 mg, 5 mg
Oral solution: 1 mg/mL, 5 mg/mL
- Indicated for many conditions. Assess involved systems before and periodically during therapy.
- Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy.
- Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur.
- Pediatric: Children should have periodic evaluations of growth.
- Lab Test Considerations: Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May decrease WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations.
- Guaiac-test stools. Promptly report presence of guaiac-positive stools.
- May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I.
- Suppress reactions to allergy skin tests.
- Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.
Potential Nursing DiagnosesRisk for infection (Side Effects)
Disturbed body image (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
- Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
- Oral: Administer with meals to minimize GI irritation.
- Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing.
- Use calibrated measuring device to ensure accurate dosage of liquid forms.
- Swallow delayed-release tablets whole; do not crush, break, or chew.
- Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
- Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
- Caution patient to avoid vaccinations without first consulting health care professional.
- Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
- Advise patient to notify health care professional of medication regimen before treatment or surgery.
- Discuss possible effects on body image. Explore coping mechanisms.
- Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
- Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history.
- Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
- Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see ). Alcohol should be avoided during therapy.
- Decrease in presenting symptoms with minimal systemic side effects.
- Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
- Management of symptoms in adrenal insufficiency.
a trademark for a glucocorticoid (predniSONE).