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How long do side effects of prednisone last: How to Manage Prednisone Withdrawal

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How to Manage Prednisone Withdrawal

How and when do you stop taking prednisone, a steroid to treat inflammation? Even if you have side effects from the medication, don’t stop cold turkey or cut back the dose on your own if you’ve been on it more than a few weeks. You could go into steroid withdrawal, which can have severe symptoms.

It’s safer to taper off prednisone. Your doctor will gradually lower your dose. Tapering helps prevent withdrawal and stop your inflammation from coming back.

As you taper, you may notice subtle symptoms. Let your doctor know if you do. They’ll watch you carefully and adjust your prednisone taper dose if needed.

What Are Prednisone Withdrawal Symptoms?

Prednisone withdrawal may cause symptoms like:

Withdrawal could also lead to serious psychological symptoms like depression, anxiety, mood swings, mania, or delirium.

What Causes Withdrawal?

Your adrenal glands make a steroid called cortisol that’s similar to prednisone. Your body needs cortisol to function.

When you take prednisone for more than a few weeks, your adrenal glands make way less cortisol. If you stop prednisone or taper too quickly, your body won’t have enough of the steroid it needs. Your withdrawal symptoms are due to that sudden steroid shortage.

Why Taper Steroids?

When you taper off prednisone, your adrenal glands have time to catch up and make normal levels of cortisol. This could take weeks or even months, depending on how long you took the medication or how high your dose was.

Even a tapered dose of prednisone helps prevent inflammation, which is why you took the steroid in the first place. The doctor will give you a schedule to gradually lower your dose. Follow it carefully. They’ll let you know when it’s safe to stop prednisone altogether.

How Long Will Withdrawal Symptoms Last?

It’s normal to feel some mild symptoms for about a week or two as you taper off prednisone. Don’t take any OTC pain medicine or prescription drugs without asking your doctor first.

Psychological withdrawal symptoms could last for 2 to 8 weeks. The doctor may give you blood tests to check your cortisol levels as you taper off prednisone. You may need to taper off more slowly or go back to your regular dose if you have severe symptoms.

How to Manage Withdrawal Symptoms

Take these steps to help control withdrawal symptoms:

  • Exercise. If you feel up to it, a slow walk or some stretches may help your aches and pain. Muscles and joints stiffen up if you don’t move them for too long. Gentle yoga or warm-water pool exercise may help, too.
  • Physical therapy. The doctor can prescribe physical therapy to treat pain and teach you safe ways to move your body.
  • Meditation and counseling. Meditation may help calm anxiety and center your mind. Talk to a therapist, family member, or friend about your feelings to help you feel that you’re not alone.

Can You Speed Up the Process?

Wondering if you can get off steroids faster? Maybe. If you’ve only taken prednisone for 3 weeks or less, you might not have to taper. The doctor will let you know. If you’ve been on steroids for more than a year, it may take 2 months to taper off.

Don’t try to speed up the taper on your own. Your adrenal glands need time to ramp up their cortisol production.

Can Tapering Cause a Flare?

Your symptoms may be a return of inflammation, not withdrawal. Tapering too quickly can cause a flare to happen.

If your disease flares, you may need to go back to a higher steroid dose for a short time to get the inflammation under control.

8 Prednisone Side Effects + How to Minimize Them – Health Essentials from Cleveland Clinic

Whether you’re attacked by poison ivy or have inflammatory bowel disease symptoms that affect your quality of life, taking prednisone can be a game-changer. But there’s a catch: Prednisone is known for a host of side effects that range from annoying to intolerable.

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“By teaming up with your doctor and practicing good old-fashioned self-care, you can minimize or even eliminate prednisone side effects,” says family medicine doctor Donald Ford, MD.

What is prednisone?

Prednisone is a strong anti-inflammatory steroid and jack-of-all-trades that is prescribed to treat conditions such as:

  • Poison ivy.
  • Sore throat.
  • Inflammation in different parts of
    the body.
  • Inflammatory arthritic conditions,
    such as rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica.
  • IBD, including Crohn’s disease and
    ulcerative colitis.

Prednisone mimics cortisol, your body’s “fight-or-flight” hormone. Cortisol’s many responsibilities include keeping inflammation at bay. “When we use prednisone as a treatment, we’re usually trying to either reduce inflammation directly or moderate the body’s inflammatory response,” says Dr. Ford.

How to counteract prednisone side effects

Compromised immune system

Turns out, prednisone’s greatest asset is also its
greatest weakness. The very action that makes prednisone so effective — its
ability to mute the immune system and relieve symptoms — can also lead to an increased
risk of illness and infection, since your body’s defenses are low.

What you can do: Practice healthy
lifestyle habits, including getting enough sleep and eating healthfully. “Treat
yourself well,” Dr. Ford says. “Anything you can do to stay healthy is going to
benefit you and reduce some of the problems associated with prednisone.”

Fluid retention

Fluid retention is one of prednisone’s most famous
side effects. “‘Moon face’ is common, which is swelling in the face that can
occur after you’ve been on steroids for a long time,” Dr. Ford notes. “You can also
get swelling in the legs and midsection.”

What you can do: “Prednisone alters how the body processes salt, so staying on a
low-salt diet can help to some degree,” he says. “And exercise can help keep
excess weight off.”

Hyperactivity

While prednisone is not a stimulant, it can make you
feel more alert or jittery. “It doesn’t really interrupt sleep, but some
patients find it keeps them awake when they don’t want to be,” Dr. Ford says.

What you can do: “If it’s possible, we
recommend you take your whole dose in the morning,” he recommends. “Then hopefully,
that sense of extra alertness will dissipate by bedtime.”

Stomach upset

Prednisone may cause gastrointestinal symptoms when you
take it on an empty stomach.

What you can do: This one is pretty
simple: Take your dose with food.

High blood sugar

If you typically have normal blood sugar levels, file
this side effect under no big deal. But if you’re one of the millions of
Americans with diabetes, this is something to watch out for.

What you can do: If you have diabetes, double
down on controlling and monitoring your blood sugar. And if you get your
prednisone and diabetes medications from different doctors, make sure they’re
aware of each other.

These healthy habits can affect your sugar levels, too:

  • Use strategies (such as
    meditation) to cope with and reduce stress.
  • Eat more fruits, vegetables, whole
    grains, and low-fat or skim milk and cheeses.
  • Be active — shoot for exercise
    most days of the week.
  • Get adequate rest (ideally seven
    to nine hours each night).
High white blood cell count

Curiously enough, prednisone raises white blood cell
counts on lab tests, Dr. Ford says. These are immunity cells that protect you
from disease. “What’s happening is that prednisone releases white blood cells from
your tissues into your bloodstream. The number goes up on a blood test, because
the cells have ‘moved’ there. But the actual white blood cell count is not
increasing, so it’s most likely fine.”

What you can do: Take a breath, and stay calm. You
don’t need to do anything (for once!)

Bone density loss

Long-term steroid use (longer than a month) can lead to loss of bone density, which also ups your risk for bone fractures. Some patients lose as much as 10% to 20% of their bone mass in the first six months of treatment.

What you can do: Talk with your doctor about your personal risk. “We typically start screening for bone density at age 65. But if somebody is younger and on chronic prednisone, then we would do bone density tests earlier and begin osteoporosis treatment if necessary.”

Symptoms related to mood

Mood issues may be connected to prednisone’s penchant for making you feel energized. “You may get that initial revved-engine feeling followed by a down,” notes Dr. Ford. “Long-term, we don’t think it causes depression, but it can certainly make your mood more volatile.”

What you can do: Your doctor can change your dose or add another medication to counteract any effects on your mood. And keep loved ones in the loop so they can give you any extra support you need.

How prednisone dosage impacts side effects

Most steroid side effects only occur when people take prednisone
long-term. For non-chronic issues, you might take it only for a couple of
weeks.

“We also try to start you on a high dose and then
rapidly lower it, which also minimizes side effects,” Dr. Ford explains. “That
way, you get the benefit of a strong anti-inflammatory burst to settle down the
reaction. Then the prednisone stays in your system long enough at lower levels so
the whole reaction can turn itself off.”

For longer-term prescriptions, doctors may taper down dosages gradually to get them as low as possible without the return of symptoms. “We typically aim for a dose that’s about 5 to 7 milligrams a day,” says Dr. Ford.

“We’re trying to roughly match how much cortisol the body produces, though many patients will be on a higher or lower dose than that.

The right prednisone
dosage helps your body fire on all cylinders and reduces potential side
effects. But if you hit a symptom sweet spot, it doesn’t mean you no longer
need to take it.

“Don’t stop taking prednisone without checking with your doctor
first,” Dr. Ford cautions. “Stopping it suddenly will likely bring back the
symptoms we’re trying to control.”

Prednisone Side Effects | Common and Serious Side Effects

Medical providers have been prescribing corticosteroid drugs such as prednisone since the late 1950s to treat a variety of ailments caused by inflammation and over-active immune systems. Because prednisone works by altering many different processes in the body, including the immune system, it causes a wide variety of side effects. Some of these side effects are unavoidable.

There have been 87,545 reports of adverse events reported to the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) from 1968 to 2020 for Rayos (brand name, delayed release prednisone), Prednisone Intensol (oral liquid) and generic prednisone.

Fact

FDA received 87,545 reports of adverse events related to Rayos, Prednisone Intensol and generic prednisone from 1968 to 2020.

Of those reports, 77,738 were serious, including 14,121 deaths. In 2019 alone, there were 17,068 reported side effects. FAERS reports are voluntary and not gathered during a clinical trial, so there is no way for the FDA to verify that prednisone caused the effects.

The side effects and how serious they are vary depending on a person’s age, how healthy they are and other medications they are taking. Women are also more likely to experience prednisone side effects than men.

Despite the long list of side effects associated with prednisone and other corticosteroids, many people take them and have minor or no side effects, according to Dr. Theodore R. Fields of the Hospital for Special Surgery. There are also precautions people can take to manage or reduce side effects.

Common Side Effects

Common side effects of prednisone tend to be milder, especially with lower doses and short-term use. They may last a few days to a few weeks. This isn’t a complete list of side effects. If side effects last for a long time or get worse, patients should talk to their pharmacist or medical provider.

People with acute conditions such as asthma flare ups, allergic reactions or a flare up of chronic obstructive pulmonary disease (COPD) may take prednisone short-term.


Common prednisone side effects include:

  • Acne

  • Blurred vision

  • Changes in behavior or mood

  • Elevated blood pressure levels

  • Elevated blood sugar levels

  • Fluid retention

  • Headache

  • Nausea

  • Restlessness and inability to stay still (akathisia)

  • Sleep problems

  • Thinning skin

  • Vomiting

  • Weight gain

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Serious Side Effects

More serious side effects can occur with larger prednisone doses and long-term treatment. People who have chronic inflammatory conditions such as rheumatoid arthritis, asthma, COPD, inflammatory bowel disease or osteoarthritis are more likely to receive prednisone long-term — for several months or years. People who need to suppress the immune system for a long period of time, such as after a transplant, may also receive prednisone long-term.

In addition to allergic reactions such as hives or trouble breathing, prednisone can affect the bones, muscles, adrenal glands, cardiovascular system, skin, eyes, gastrointestinal system and even mental health.

In some cases, people may be able to counteract prednisone side effects by adjusting diet, taking supplements or exercising.

Allergic Reaction

An allergic reaction to prednisone can be serious. If you have any of these symptoms, contact your medical provider or emergency room right away.

  • Hives

  • Skin rash

  • Swelling of the face, lips or tongue

  • Difficulty breathing

  • Itching

Bone and Muscle Problems

Up to 40 percent of people taking long-term prednisone experience bone loss that leads to a fracture, according to an article by Dr. Muhammad Yasir and colleagues in the U.S. Library of Medicine. Most people lose bone mass within the first six to 12 months of therapy.

To counteract this side effect, medical providers may recommend a calcium supplement, vitamin D supplement, weight bearing exercise or bone-saving medications such as Fosamax or Binosto (alendronate), Boniva (ibandronate) or Actonel or Atelvia (risedronate).

In addition, patients may experience osteonecrosis — death of bone tissue that happens when there is reduced blood flow to the joints. This often manifests as hip and knee pain, but it can become severe and may require surgery.

Prednisone also affects the muscles and can cause muscle weakness in the legs and arms. In severe cases, patients may be hospitalized. Stopping treatment and performing exercises usually reverses this side effect.

High Blood Sugar and Shifting Body Fat

Taking prednisone can cause an increase in fasting blood sugar. This can be especially serious in people with Type 2 diabetes. Patients should make sure they get their blood sugar tested and monitored while taking prednisone. After stopping treatment, blood sugar metabolism usually returns to normal.

Prednisone and other corticosteroids are the main cause of redistribution of body fat called Cushing syndrome. This can develop early in the dosing regimen and manifests as a buffalo hump behind the neck, a round “moon face” and gathering of fat in the abdomen. Children also have skin changes and hypertension.

Prednisone can affect several hormones, including cortisol. Prolonged hormone suppression can cause adrenal gland atrophy (wasting away) which leads to adrenal insufficiency.


Symptoms of adrenal insufficiency include:

  • Abdominal pain

  • Anorexia or weight loss

  • Body pains

  • Diarrhea

  • Fatigue

  • Fever

  • Headache in the morning

  • Nausea

  • Poor growth and weight gain in children

  • Psychiatric symptoms

Increased Risk of Infection

Taking prednisone can increase a person’s chance of getting mild to serious, life-threatening infections. Larger doses increase the risk, especially doses for immunosuppression. Older age and taking other drugs that also suppress the immune system increase the risk. Doses of 10 mg or lower pose the least risk.

Cardiovascular Problems

Prednisone can cause irregularities in potassium, calcium and phosphate levels. This may lead to high blood pressure, heart-beat irregularities, edema (swelling) and weight gain.

People on medium-high doses of prednisone may suffer premature atherosclerosis — buildup of cholesterol in the arteries. Over time, this can obstruct blow flow or lead to blood clots.

Medical providers may recommend a low salt diet or diuretics (water pills) to help combat fluid accumulation and control blood pressure. Eating a low cholesterol diet and getting exercise may also help with atherosclerosis.

Skin Problems

Even at low doses, prednisone can cause skin problems. These include skin thinning, acne, hirsutism (excess hair growth), hair thinning, face redness, stripe-like marks on the skin (stria) and impaired wound healing.

Eye Problems

Blurred vision is the most common eye problem with prednisone use, and it’s not typically a serious issue. But the risk of cataracts in both eyes is high in patients who take more than 10 mg of prednisone daily for longer than a year.

The drug increases pressure in the eye that might lead to glaucoma. The pressure may subside after stopping treatment, but the damage to the optic nerve may be permanent.

People who start having vision changes should see an ophthalmologist to see what treatments may help counteract vision side effects.

Gastrointestinal Side Effects

People using prednisone have an increased risk of gastric ulcer formation, gastritis and GI bleeding. The risk is four times greater when prednisone and an NSAID, such as ibuprofen, are used together.

Other gastrointestinal side effects include fatty liver and pancreatitis.

Mental Health Side Effects

Early on in treatment (within several days), prednisone may increase feelings of well-being, anxiety, hypomania or mild euphoria. With long-term therapy, however, patients may develop depression. Psychosis, referred to as corticosteroid-induced psychosis, can occur at doses of 20 mg or more per day with long-term use.

About 1.3 percent of psychosis cases occurred in patients taking 40 mg or lower, while 18.4 percent occurred in patients taking 80 mg daily. Patients with a history of mental health issues and female gender are at greater risk.

Mental health symptoms start within three to four days after starting therapy, but they can occur at any time. Some people have symptoms, including depression, after stopping therapy.

In children receiving prednisone for acute lymphoblastic leukemia (ALL), prednisone may cause behavioral symptoms including aggression, insomnia, mood fluctuations, depression, manic behavior and euphoria. Most children no longer experience these symptoms after they stop therapy.

Side Effects in Women vs.

Men

Overall, women are at greater risk of side effects from prednisone than men. They are more likely to resist increases in dosages because of side effects. Women also reported more intolerable side effects than men.


Side effects reported more often in women than men include:

  • Weight gain

  • Increased appetite

  • Changed appearance

  • Moon face

  • Prominent scar

  • Increased hair loss

  • Gingival hyperplasia (gum swelling)

  • Mood swing

  • Depression

  • Fatigue

  • Poor concentration

  • Headache

  • Sleeplessness

  • Palpitations

Warnings and Precautions

Tell your doctor or pharmacist if you’re allergic to prednisone or have other types of medication allergies. Also be sure to tell your doctor about all medications, vitamins and herbal supplements you take because prednisone could interact with them.


Tell your doctor if you have any of the following conditions:

  • Congestive heart failure or heart failure

  • Edema

  • Glaucoma or cataracts

  • High blood pressure that is not well controlled

  • History or mental illness

  • Infections

  • Osteoporosis or low bone density

  • Peptic ulcer disease

  • Type 2 diabetes

Prednisone and Vaccines

Do not get live or attenuated live vaccines if you are on high doses of prednisone that suppress the immune system. Prednisone may cause organisms in the vaccines to replicate (grow) and this may cause infections.

People taking prednisone have weakened immune systems and should also be careful around people with diseases including smallpox, chicken pox or measles.

Seniors, Children and Pregnant Women

Seniors are at greater risk for prednisone-induced side effects and this is usually dose related. The lowest effective dose should always be used.

In seniors, bone loss and osteoporosis are the most frequently reported side effects. Bone loss is more likely to occur at the beginning of treatment and may recover after stopping treatment. Taking medications such as Fosamax or Binosto (alendronate), Boniva (ibandronate) or Actonel or Atelvia (risedronate) may slow bone loss.

Children experience the same side effects as adults, but prednisone may stunt their growth even with low doses.

Pregnant women should use prednisone with caution. The risk of birth defects and low birth weight increases when pregnant women take the drug during the third trimester. Prednisone may pass to an infant though breast milk and may harm the baby.

Prednisone and COVID-19

A recent editorial in the Journal of Clinical Endocrinology & Metabolism by Dr. Paul M. Stewart and colleagues found that patients who take prednisone or other glucocorticoid drugs are at high risk for developing complications if infected with COVID-19.

Because prednisone decreases a person’s ability to fight off infections, the body is unable to mount an adequate response to the virus, according to researchers.

Prednisone withdrawal: Symptoms, treatment, and duration

Prednisone withdrawal occurs when a person stops taking prednisone abruptly or reduces their dose too quickly. Symptoms of prednisone withdrawal can include body aches, mood swings, and extreme fatigue.

Prednisone is a corticosteroid that doctors prescribe to treat swelling and inflammation. It relieves swelling, itching, and redness by suppressing the immune system.

A doctor may prescribe prednisone for numerous conditions, including:

When doctors prescribe prednisone, they will generally specify a dose that gradually tapers down over several days to prevent prednisone withdrawal.

Share on PinterestPrednisone causes the body to reduce the amount of cortisol it makes.
Image credit: NLM, 2011

Prednisone is a synthetic steroid similar to cortisol, a hormone that the adrenal glands produce. Some people refer to cortisol as the stress hormone.

However, cortisol does much more than controlling stress. The body also uses cortisol to regulate the heart rate and blood pressure.

Without medication, the body naturally maintains a consistent level of cortisol.

However, when a person takes prednisone, particularly when the course of treatment is more than a few weeks in length, the body reduces the amount of cortisol that it makes.

When a person then stops taking prednisone, the body cannot immediately produce enough cortisol to make up for the missing drug. It may take several days or weeks before cortisol production levels return to normal.

While the adrenal glands make most of the body’s cortisol, many different types of cell in the body have cortisol receptors. This means that cortisol can affect many functions in the body, including:

  • blood sugar control
  • metabolism
  • blood pressure
  • memory
  • reducing inflammation

When the body is not producing enough cortisol to compensate for the missing prednisone, a person can experience a range of symptoms until the body readjusts.

Symptoms of prednisone withdrawal can include:

  • body aches
  • mood swings
  • weakness
  • extreme fatigue
  • dizziness or lightheadedness
  • joint pain
  • loss of appetite
  • nausea

Symptoms can vary in intensity and may last anywhere from a few days to several months after discontinuing the drug.

The severity and duration of withdrawal symptoms usually correlate with the length of time that a person was taking prednisone, as well as the size of their regular dose.

People who are using prednisone should check with their doctor before stopping or reducing their dose.

Anyone experiencing any symptoms of prednisone withdrawal after reducing the dose or stopping the medication should consult a doctor.

The doctor may adjust the taper schedule and recommend ways to manage the withdrawal symptoms.

Treatment for prednisone withdrawal focuses on managing the symptoms and controlling the body’s cortisol production.

Some lifestyle modifications that can help people to manage prednisone withdrawal include:

  • getting enough sleep
  • avoiding stress
  • abstaining from caffeine and alcohol
  • eating a varied and nutritious diet

However, in some cases, these lifestyle modifications may not be enough to help a person who has severe prednisone withdrawal symptoms.

People with severe symptoms should consult a doctor immediately. The doctor may need to readjust their tapering plan or treat any health complications.

To help prevent prednisone withdrawal, a person can take the following precautions while using prednisone and during the taper period afterward:

  • Sticking to the recommended dosage and not taking more than the doctor prescribed.
  • Tapering the dose according to the doctor’s instructions.
  • Avoiding stopping prednisone treatment suddenly.

Most people will recover fully from prednisone withdrawal once their body begins producing enough cortisol again.

The duration of symptomatic withdrawal will vary according to the dosage of prednisone that the person was taking and the length of the course of treatment.

Generally, people who were on a lower dose for a shorter period will have less severe symptoms. They may also recover from prednisone withdrawal more quickly, or they may not experience any withdrawal symptoms at all.

Prednisone and other corticosteroids: Balance the risks and benefits

Prednisone and other corticosteroids

Weigh the benefits and risks of corticosteroids, such as prednisone, when choosing a medication.

By Mayo Clinic Staff

Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, inflammatory bowel disease and asthma. But these drugs also carry a risk of various side effects.

How do corticosteroids work?

When prescribed in doses that exceed your body’s usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis, asthma or skin rashes.

Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues.

How are corticosteroids used?

Corticosteroid drugs are used to treat rheumatoid arthritis, inflammatory bowel disease (IBD), asthma, allergies and many other conditions. These drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients. Corticosteroids also treat Addison’s disease, a relatively rare condition where the adrenal glands aren’t able to produce even the minimum amount of corticosteroid that the body needs.

Corticosteroids are administered in many different ways, depending on the condition being treated:

  • By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as rheumatoid arthritis and lupus.
  • By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies.
  • In the form of eyedrops. This form helps treat swelling after eye surgery.
  • Topically. Creams and ointments can help heal many skin conditions.
  • By injection. This form is often used to treat muscle and joint signs and symptoms, such as the pain and inflammation of tendinitis.

What side effects can corticosteroids cause?

Corticosteroids carry a risk of side effects, some of which can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact.

Side effects of oral corticosteroids

Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects. Side effects depend on the dose of medication you receive and may include:

  • Fluid retention, causing swelling in your lower legs
  • High blood pressure
  • Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium
  • Upset stomach
  • Weight gain, with fat deposits in your abdomen, your face and the back of your neck

When taking oral corticosteroids longer term, you may experience:

  • Elevated pressure in the eyes (glaucoma)
  • Clouding of the lens in one or both eyes (cataracts)
  • A round face (moon face)
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
  • Thinning bones (osteoporosis) and fractures
  • Suppressed adrenal gland hormone production that may result in a variety of signs and symptoms, including severe fatigue, loss of appetite, nausea and muscle weakness
  • Thin skin, bruising and slower wound healing

Side effects of inhaled corticosteroids

When using an inhaled corticosteroid, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

  • Fungal infection in the mouth (oral thrush)
  • Hoarseness

If you gargle and rinse your mouth with water — don’t swallow — after each puff on your corticosteroid inhaler, you may be able to avoid mouth and throat irritation. Some researchers have speculated that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma.

Side effects of topical corticosteroids

Topical corticosteroids can lead to thin skin, red skin lesions and acne.

Side effects of injected corticosteroids

Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient’s situation.

Reduce your risk of corticosteroid side effects

To get the most benefit from corticosteroid medications with the least amount of risk:

  • Ask your doctor about trying lower doses or intermittent dosing. Newer forms of corticosteroids come in various strengths and lengths of action. Ask your doctor about using low-dose, short-term medications or taking oral corticosteroids every other day instead of daily.
  • Talk to your doctor about switching to nonoral forms of corticosteroids. Inhaled corticosteroids for asthma, for example, reach lung surfaces directly, reducing the rest of your body’s exposure to them and leading to fewer side effects.
  • Ask your doctor if you should take calcium and vitamin D supplements. Long-term corticosteroid therapy may cause thinning bones (osteoporosis). Talk with your doctor about taking calcium and vitamin D supplements to help protect your bones.
  • Take care when discontinuing therapy. If you take oral corticosteroids for a long time, your adrenal glands may produce less of their natural steroid hormones. To give your adrenal glands time to recover this function, your doctor may reduce your dosage gradually. If the dosage is reduced too quickly, your adrenal glands may not have time to recover and you may experience fatigue, body aches and lightheadedness.
  • Wear a medical alert bracelet. This or similar identification is recommended if you’ve been using corticosteroids for a long time.
  • See your doctor regularly. If you’re taking long-term corticosteroid therapy, see your doctor regularly to check for side effects.

Weigh the risks and benefits of corticosteroids

Corticosteroids may cause a range of side effects. But they may also relieve the inflammation, pain and discomfort of many different diseases and conditions. Talk with your doctor to help you better understand the risks and benefits of corticosteroids and make informed choices about your health.

Dec. 16, 2020

Show references

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  4. Saag KG, et al. Major side effects of inhaled glucocorticoids. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
  5. Roberts WN, et al. Joint aspiration or injection in adults: Complications. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2020.
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Prednisone: MedlinePlus Drug Information

Prednisone comes as a tablet, delayed-release tablet, as a solution (liquid), and as a concentrated solution to take by mouth. Prednisone is usually taken with food one to four times a day or once every other day. Your doctor will probably tell you to take your dose(s) of prednisone at certain time(s) of day every day. Your personal dosing schedule will depend on your condition and on how you respond to treatment. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prednisone exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor.

If you are taking the concentrated solution, use the specially marked dropper that comes with the medication to measure your dose. You may mix the concentrated solution with juice, other flavored liquids, or soft foods such as applesauce.

Swallow the delayed-release tablet whole; do not chew or crush it.

Your doctor may change your dose of prednisone often during your treatment to be sure that you are always taking the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, infection, or a severe asthma attack. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment.

If you are taking prednisone to treat a long-lasting disease, the medication may help control your condition but will not cure it. Continue to take prednisone even if you feel well. Do not stop taking prednisone without talking to your doctor. If you suddenly stop taking prednisone, your body may not have enough natural steroids to function normally. This may cause symptoms such as extreme tiredness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt. Call your doctor if you experience these or other unusual symptoms while you are taking decreasing doses of prednisone or after you stop taking the medication.

A Breakdown of The Pros and Cons and Prednisone

If you visit the doctor from time to time for anything other than a routine checkup, it’s likely that at some point you’ve received a prescription for a type of drug called corticosteroids. These are commonly prescribed in the US, and they are used in almost every medical specialty.

In a study of short-term corticosteroid use, researchers at the University of Michigan found that one in five American adults with commercial health insurance had been prescribed a median of six days of corticosteroids at least once over a three-year period.

While its importance is undeniable, you should know corticosteroids such as prednisone come with downsides — a long list of side effects and interactions with numerous other medications. Corticosteroid use is a common reason people are admitted to hospitals due to drug-related adverse events.

Benefits of Prednisone

One of the most widely used corticosteroids is prednisone, a “manufactured hormone similar to the natural hormone, cortisone, produced by humans,” according to Norman P. Tomaka, BSPharm, MS, a media liaison for the American Pharmacists Association and consultant pharmacist and healthcare risk manager based in Melbourne, Fla.

“Prednisone is an anti-inflammatory drug that reduces the body’s immune response in order to manage many different health conditions, including breathing problems, severe allergies, inflamed skin, serious eye swelling, serious arthritis, bowel disorders, blood disorders,  certain cancers, and multiple sclerosis flares,” said Tomaka. Researchers are investigating the potential use of corticosteroids during the late phases of infection in patients with COVID-19, with mixed results so far, including some research showing steroids may increase mortality in the disease. 

 

Depending on the condition, the drug is used on a short- or long-term basis, and it can be taken in several ways, including pill or liquid form. Along with the extensive number of ailments that it may relieve, there are lots of benefits associated with prednisone treatment when prescribed appropriately. For example, it is a rapid-acting medication, meaning it gets to work quickly once taken. It can also be adapted to a “variety of dosing schedules tapered to the patient’s specific condition and length of treatment,” Tomaka explained.

Risks of Prednisone 

More serious side effects, such as an increased risk of infections, psychological effects, weakening of bones, and bone fractures are associated with longer-term use.

Mixing corticosteroids such as prednisone and anticoagulant medicines (e.g., heparin, warfarin, dabigatran, apixaban and rivaroxaban) can make anticoagulants less effective. Also, combining NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, diclofenac, and naproxen with corticosteroids increases your risk of developing stomach ulcers and internal bleeding.

When used short-term, prednisone is generally well-tolerated, and when side effects do occur in this scenario, they usually clear up quickly after treatment ends. Even with short-term use, however, some people do experience side effects such as fluid retention, weight gain, fatigue, increased blood sugar, stomach irritation, irritability and increased alertness and hunger. A July 2020 study in the Annals of Internal Medicine found that taking corticosteroids for as short a period as three days may increase the risk for serious adverse events. The researchers found that rates of gastrointestinal bleeding, sepsis (widespread inflammation commonly triggered by a bacterial infection), and heart failure significantly increased within five to 30 days after treatment began.

In the University of Michigan study mentioned above, there was a major increase — by up to five times — in rates of several adverse events, particularly sepsis, venous thromboembolism (a blood clot in a deep vein) and bone fracture, in patients who were on corticosteroids for a short time. These issues occurred even at low doses, and the higher risk of adverse effects lingered even weeks or months after patients stopped taking the drug.

You should also be aware there is the potential for psychological side effects. Prednisone affects areas of the brain that manage the regulation of different neurotransmitters, including serotonin and dopamine — both of which can impact mood.

When fitness instructor Gabriela Correa suddenly developed a red, itchy rash over most of her body, her dermatologist prescribed a one-week course of prednisone. After a few days of taking it, however, Correa felt noticeably more anxious — she was “freaking out for no reason,” as she put it — and had trouble falling and staying asleep. She called her doc, who advised her to stop taking prednisone. Fortunately, most of the rash had already cleared up by then, so no further treatment was needed, and she did not experience any additional problems related to the medication.

When prednisone is used on a long-term basis for the treatment of a serious medical condition, patients should be monitored for negative effects that may include a reduced ability to fight infection, reduced wound healing, softening of bones, skin discoloration, increased sweating, mood swings and behavioral changes, digestion problems, muscle weakening, glaucoma and decreased sex drive.

People on long-term corticosteroid therapy are considered to be at high risk for COVID-19. In a 2020 report in The Journal of Clinical Endocrinology & Metabolism, experts note that patients taking corticosteroids may be more susceptible to COVID-19 due to the immunosuppressive effects of the steroids. In addition, problems caused by the underlying disease the drugs are prescribed for or immunosuppressive actions of other drugs prescribed in conjunction with the steroids may also contribute to higher susceptibility to COVID-19. 

Staying Safe

If your healthcare provider recommends prednisone, Tomaka offers the following tips about how to avoid side effects:

  • Before starting prednisone, be sure to communicate with your prescriber regarding the details of your past medical history and all medications you are taking or have taken recently.
  • Do not take more than the dose prescribed.
  • Take the medication at the time of day directed by the prescriber.
  • Take each dose with food or milk to prevent stomach irritation.
  • Avoid alcohol and other irritating foods and beverages while taking prednisone.
  • Finish your course of treatment as instructed by the prescriber.

There are certain signs that might point to a more serious problem that requires more immediate attention. If you develop any of the following symptoms, you should promptly call your healthcare provider for immediate guidance:

  • Any blood in your stool.
  • Nausea and/or vomiting.
  • Constipation or diarrhea.
  • Chest pain.
  • Visual disturbances.
  • Serious swelling in your ankles and/or feet.
  • New infection or wounds.
  • Fever.
  • Increased or decreased blood pressure.
  • Serious behavioral disturbances, such as hallucinations or delusions.

“Most patients benefit from short-term prednisone treatment, while others require low-dose maintenance therapy with medical supervision and routine lab work,” Tomaka said. “Depending on the condition treated, the benefit of using prednisone may outweigh the risks.”

Research is underway to develop safer alternatives to prednisone. For example, an experimental drug called vamorolone improved muscle function in a 2019 study of boys with Duchenne muscular dystrophy, a disease characterized by progressive muscle weakness and wasting, primarily affecting young boys and often treated with prednisone. Boys treated with vamorolone experience fewer adverse events, including less weight gain, bone loss and insulin resistance, compared to boys treated with prednisone.

Closely following prescription instructions, clearly communicating with your provider about your health and medication history, and keeping an eye out for signs of a negative reaction can help you reap the intended benefits of prednisone while minimizing its many potential risks.

90,000 Prednisolone – what you need to know while taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisolone that is considered an obligatory and necessary drug of the first choice in the treatment of a disease (for example, nephrotic syndrome about which you can read here).

It’s not about the drug itself and what diseases it should be prescribed for, but our information block about what doctors usually forget when prescribing prednisolone. Usually, children come for a consultation while taking prednisone in combination with asparkam. Believe me, hypokalemia (a decrease in the level of potassium in the blood) and therefore prescribe asparks is not the most frequent complication when prescribing prednisolone.

In our practice of the department, almost 90% of patients receiving this drug are observed with a diagnosis of nephrotic syndrome.

Prednisolone is prescribed for a long time (the full course of therapy until the drug is discontinued can last 6-12 months), additional drugs must be prescribed to prevent the side effects of prednisolone. It is:

  1. In order to protect the mucous membrane of the upper gastrointestinal tract (esophagus, stomach, duodenum), against the background of prednisolone there may be indigestion, nausea, vomiting and more serious complications such as a steroid ulcer. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e.e. Protection of the stomach in a literal translation). These are antacids (eg Maalox, fosfalugel, etc.), H + pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
  2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone loss) can develop, which ultimately leads to bone fractures.But this condition can also be prevented, it is necessary to take calcium and Vitamin D preparations. The dose of drugs is also selected individually.

What else you need to pay attention to:

  1. Compulsory blood pressure monitoring
  2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.
  3. Check blood glucose levels when taking prednisone for very long periods of time.
  4. Mental health status. Children very often become capricious, sometimes even aggressive. This condition goes away on its own after discontinuation of the drug.
  5. Watch your weight and diet. On the background of taking prednisolone, appetite is greatly increased. However, as a parent, you can control your child’s nutrition by limiting the intake of easily digestible carbohydrates.
  6. In order to control and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by means of EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes. It is imperative to consult your doctor.

If you have any questions on this topic or have any suggestions, we are happy to answer questions and accept your suggestions.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

DEPO-Medrol; Medrol; P-Care D40 [DSC]; P-Care D80 [DSC]; ReadySharp methylPREDNISolone [DSC]; SOLU-Medrol

Trade names: Canada

Depo-Medrol; Medrol; SOLU-medrol; Solu-MEDROL; Uni-Med

What is this drug used for?

  • Used to treat a variety of health problems including allergy symptoms, bronchial asthma, adrenal disorders, blood disorders, skin rashes and edema.This is not a complete list of health problems this drug is used to treat. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

All forms of issue:

  • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
  • If you have any of the following health problems: fungal or malarial infection that affects the brain.
  • For herpes eye infection.
  • In case of damage to the optic nerve.

Injection (if injected into muscle):

  • If you have idiopathic thrombocytopenic purpura (ITP).

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking. Do not start or stop taking any medication or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

All forms of issue:

  • Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
  • Perform blood tests as directed by your doctor. Please consult your doctor.
  • This drug may affect the results of allergic skin tests. Your doctor or laboratory worker should be told that you are taking this drug.
  • You may be at increased risk of developing an infection. Wash your hands often. Try not to come into contact with carriers of the infection, incl. with people with colds or flu.
  • If any signs of infection appear, such as fever, chills, flu-like symptoms, very severe sore throat, ear or sinus pain, cough, increased or discolored sputum production, pain when urinating, ulceration in the mouth or non-healing wounds, see a doctor immediately.
  • People who take steroid drugs like this drug can have very bad and sometimes fatal chickenpox or rubella.If you have never had chickenpox or rubella, avoid contact with people who have these diseases. If you come into contact with someone with chickenpox or rubella, consult your doctor.
  • This drug suppresses the body’s production of steroid hormones. Tell your doctor if you have a fever, infection, surgery, or injury. The body’s normal response to such stressful situations can change. You may need to increase your steroid dose.
  • Prolonged use increases the likelihood of developing cataracts or glaucoma. Consult your doctor.
  • Long-term use of this drug may cause fragility of bones (osteoporosis). If you have an increased risk of increased bone fragility or have questions, talk to your doctor.
  • Consult a physician prior to any vaccination. Using some vaccines with this drug may increase the chance of infection or make the vaccine less effective.
  • If you have high blood sugar (diabetes), your blood sugar should be checked regularly.
  • Consult a physician before drinking alcohol.
  • Liver problems have rarely happened with this drug. Sometimes these cases were fatal. Call your doctor right away if you have signs of liver problems such as dark urine, tiredness, lack of appetite, nausea or abdominal pain, discolored stools, vomiting, yellowing of the skin or eyes.
  • If you are 65 years of age or older, use this drug with caution. You may have more side effects.
  • In some cases, the drug may affect the growth rate in children and adolescents. They may need to check their growth rate regularly. Consult your doctor.
  • Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

Injection:

  • Very serious health problems have been observed with the introduction of similar drugs into the spinal column (epidural).These included paralysis, loss of vision, stroke, and sometimes death. It is not known if drugs like this drug are safe and effective when injected into the spinal column. These drugs are not approved for this use. Consult your doctor.
  • Some preparations contain benzyl alcohol. These drugs should not be given to newborns or infants. If you want to know if this drug contains benzyl alcohol, talk to your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
  • Signs of Cushing’s disease such as weight gain in the upper back or abdomen, moon face, severe headache, or slow healing.
  • Signs of adrenal dysfunction such as severe nausea and vomiting, severe dizziness or loss of consciousness, muscle weakness, feeling very tired, mood changes, lack of appetite, or weight loss.
  • Signs of low potassium, such as muscle pain or weakness, muscle cramps, or a feeling of an irregular heartbeat.
  • Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
  • Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
  • Shortness of breath, sudden weight gain, or swelling of the arms or legs.
  • Difficulty urinating or change in the amount of urine excreted.
  • Changes in the skin (acne, stretch marks, slow healing, hair growth).
  • Pain or pressure in the chest.
  • Rapid, slow heartbeat, or irregular heartbeat.
  • Menstrual irregularities.
  • Pain in bones or joints.
  • Change in vision.
  • The appearance or aggravation of mental disorders, mood swings or changes in behavior.
  • Convulsions.
  • Unusual burning, numbness, or tingling sensations.
  • Any unexplained bruising or bleeding.
  • Severe abdominal pain.
  • Black, tarry, or bloody stools.
  • Vomiting of blood or vomit in the form of coffee grounds.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects.Call your doctor or get medical help if these or any other side effects bother you or do not go away:

  • Nausea or vomiting.
  • Sleep disorders.
  • Anxiety.
  • Excessive sweating.
  • Headache.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

Pills:

  • Take in the morning if you are taking this drug once a day.
  • Take with food.
  • Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

Injection:

All forms of issue:

  • If you missed a dose or recently stopped using this drug and have symptoms such as severe fatigue, weakness, tremors, tachycardia, confusion, sweating, or dizziness, tell your doctor.
  • If you have taken this drug for several weeks, consult your doctor before stopping it. It may be best to gradually stop taking this medication.
  • Check eye pressure regularly if taking this medicine for a long time. Consult your doctor.
  • Get a bone density test as directed by your doctor. Consult your doctor.
  • You may need to reduce your salt intake and take additional potassium.Consult your doctor.

What should I do if a dose of a drug is missed?

Pills:

  • Take the missed dose as soon as you can.
  • If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
  • Do not take 2 doses at the same time or an additional dose.

Injection:

  • Call your doctor for further instructions.

How do I store and / or discard this drug?

Pills:

  • Store at room temperature in a dry place. Do not store in the bathroom.

Injection:

  • If you need to store this drug at home, ask your doctor, nurse, or pharmacist for information about how it is stored.

All forms of issue:

  • Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your health does not improve or even worsens, see your doctor.
  • You should not give your medicine to anyone and take other people’s medicines.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.Please consult your doctor for complete information on the possible risks and benefits of taking this drug.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

90,000 Prednisolone 5 mg No. 30 tab.

Instructions for medical use

of medicinal product

Prednisolone Nycomed

Trade name

Prednisolone Nycomed

International non-proprietary name

PREVISOLON

DRUGS FORMASTER

TAGS

VEGETABLE

TAGS

VEGLES

PREDISOLON 5 MG,

AUXILIARY SUBSTANCES: MAGNESIUM STEARATE, TALC, CORN STARCH, LACTOSE MONOHYDRATE, STARCH PRESELATINIZED.

DESCRIPTION
TABLETS WHITE, ROUND SHAPE, FLAT ON BOTH SIDES WITH BEVELED EDGES, WITH “PD” AND “5.0” ENGRAVES AND RISK BETWEEN THEM.

PHARMACOTHERAPEUTIC GROUP

CORTICOSTEROIDS FOR SYSTEMIC USE. GLUCOCORTICOIDS. PREDISOLON. CODE

ATX H02AV06 Pharmacological properties Pharmacokinetics

INTAKE:
prednisolone When ingestion rapidly and completely absorbed from the gastrointestinal tract (the presence of up to 85% of the dose), bioavailability, lower at higher doses.THE MAXIMUM CONCENTRATIONS IN BLOOD PLASMA ARE REACHED AFTER 1-2 HOURS. HOWEVER, THE MAXIMUM BIOLOGICAL EFFECT IS ACHIEVED SIGNIFICANTLY LATER (AS A RULE, NOT EARLIER AFTER 4-8 HOURS).
Eating food slows down the achievement of the maximum concentration of predisolone in blood plasma, but does not affect the general bioavailability.

DISTRIBUTION:
AS A RULE, THE BINDING OF PRENISOLONE IS 90-95%, WHICH OCCURS PREVENTLY WITH THE CORTICOSTEROID-BINDING GLOBULIN (TRANSCORTINO NAVAL)
ONLY 5-10% OF PREDISOLONE ARE IN AN UNCONNECTED FORM AND BIOLOGICALLY ACTIVE.

METABOLISM:
PRENIZOLONE IS THE MAIN ACTIVE METABOLITE OF PRENIZOLONE. PREDISOLONE METABOLIZES FIRST OF ALL IN THE LIVER; 25% IS EXTRACTED IN AN UNCHANGEED FORM THROUGH THE KIDNEY.

ELIMINATION:
BIOLOGICAL SEMI-EXPIRATION IS 18-36 HOURS. THE PERIOD OF SEMI-REMOVAL FROM BLOOD PLASMA IS 2 – 4 HOURS, WHICH IS REDUCED BY MEDICINAL PREPARATIONS INDUCING LIVER ENZYMES.

PHARMACOKINETICS IN SPECIAL GROUPS OF PATIENTS:

IN PATIENTS WITH SEVERE LIVER DISEASES (HEPATITIS, CIRROSIS). FREE ACTIVE FRACTION CAN BE SIGNIFICANTLY INCREASED IN PATIENTS WITH LIVER DISEASES ASSOCIATED WITH HYPOALBUMINEMIA. PATIENTS WITH SEVERE LIVER DISORDERS MAY ALSO DECREASE BIOAVAILABILITY.

PHARMACODYNAMICS:

PRENISOLONE 5MG IN TABLETS IS A CORTICOSTEROID WITH GLUCOCORTICOID, ANTI-INFLAMMATORY, AND ALSO MINERALO-CORTICOID ACTIVITY AT LEAST.LIKE OTHER CORTICOSTEROIDS, PREDISOLONE NIKOMED INDUCTS SEVERAL MECHANISMS, INCLUDING ANTI-INFLAMMATORY ACTIVITY, IMMUNOSUPPRESSIVE PROPERTIES, AND ANTIPROLIFERATIVE EFFECTS. OTHER MECHANISMS INCLUDE INFLUENCE ON CARBOHYDRATE METABOLISM, FAT DISTRIBUTION, HEMATOLOGICAL PARAMETERS, CALCIUM EXTRACTION, GROWTH, MOOD AND SUPPRESSION OF THE HYPOTHALAMIC-HYPOPHYSICAL ADRENAL SYMPTOMS. THE THRESHOLD DOSE FOR THE DEVELOPMENT OF CUSHING SYNDROME IS 7.5 MG / DAY.

1. ANTI-INFLAMMATORY EFFECT IS ACHIEVED BY DECREASING THE FORMATION AND DECREASING ACTIVITY OF INFLAMMATION MEDIATORS (QUININE, HISTAMINE, LIPOSOMAL ENZYMES, PROSTAGLANDINENOUS AND VOCHALENOVATEL).PREDISOLONE REDUCES CELL MIGRATION INTO THE AFFECTED AREAS, REDUCES VASCULAR EXPANSION AND INCREASED VASCULAR PERMEABILITY IN THESE ZONES. VASCULAR EFFECT REDUCES VASCULAR PERMEABILITY DUE TO WHAT THE MOTION OF BLOOD SERUM THROUGH THE VESSELS WALLS INTO THE INTERCELERAL SPACES DECREASES AND AS A CONSEQUENCE, DECREASES THE SEQUENCE.

2. IMMUNOSUPPRESSIVES properties reduce RESPONSE TO DELAYED HYPERSENSITIVITY REACTIONS AND IMMEDIATE types (Types III and IV) BY INHIBITION TOXIC antigen-antibody complexes, which cause allergic vasculitis in the vessel wall skin as well as by inhibiting lymphokines, target cells, and macrophages (CAUSING ALLERGIC CONTACT DERMATITIS IN JOINT ACTION).

3. The antiproliferative effect reduces inflammation, expression of crusting on the skin formed as a result HIGH POLIFERATIVNOY activity of white blood cells – lymphocytes and excessive formation of fine capillaries in the superficial skin layer, the dermatological diseases (such as psoriasis).

INDICATIONS
Pharmacodynamic Therapy

– RHEUMATIC DISEASES INCLUDING collagenosis

– allergic diseases (hay fever, bronchial asthma, urticaria, drug allergies)

– respiratory diseases: chronic bronchitis (administered with antibiotic treatment)

– lung fibrosis, SARKAIDOZ

– ULCERATIVE ileitis / COLITIS

– proliferative glomerulonephritis (lipoid nephrosis) nephrotic syndrome

– acute severe dermatoses (pemphigus vulgaris, erythrodermic, Syndrome Lyell)

– thrombocytopenic purpura, chronic LIMFADENOZ with autoimmune PHENOMENOMA (HEMOLYTIC ANEMIA, THROMBOPENIA)

– TUMORS (USED IN COMBINATION WITH CHEMOTHERAPY)

SUBSTITUTIONAL THERAPY

– PRIMARY INSUFFICIENCY CHNIKOV (ADDISON’S DISEASE) AND HYPOPITUITARISM (SHIKHAN’S SYNDROME)

METHOD OF APPLICATION AND DOSES

AT THE BEGINNING OF THERAPY, ANY CORTICOSTEROID SHOULD BE CONSIDERED WITH A DRUG.THE INITIAL DOSE MUST BE RIGHT TO ACHIEVE THE DESIRED THERAPEUTIC EFFECT AND WILL DEPEND ON THE CLINICAL RESPONSE. PERIODICALLY IT IS NECESSARY TO EVALUATE THIS DOSE, BECAUSE THE EXPRESSION OF THE MAIN DISEASE MAY CHANGE, OR COMPLICATIONS MAY DEVELOP DURING THERAPY. THE DOSE SHOULD BE GRADUALLY REDUCED TO THE MINIMUM VALUE TO PROVIDE AND MAINTAIN A SATISFACTORY CLINICAL RESPONSE TO TREATMENT. MAY BE REQUIRED TO INCREASE DOSE DURING LONG-TERM THERAPY OR IN CASE OF EXCERVATION OF THE MAIN DISEASE.

IF THE LONG-TERM THERAPY WITH PRENISOLONE (NORMALLY MORE THAN 3 WEEKS) MUST BE DISCONTINUED, THE CANCELLATION MUST BE CARRIED OUT GRADUALLY AND STEP BY STEP TO AVOID THE “CANCELLATION SYNDROME”. ABSTRACT CUTTING THERAPY CAN BE FATAL. DOSE SHOULD BE REDUCED OVER WEEKS OR EVEN MONTHS DEPENDING ON THE DOSE VALUE, DURATION OF THERAPY, THE MAIN DISEASE OF THE PATIENT AND THE INDIVIDUAL RESPONSE OF THE PATIENT TO TREATMENT. UNLIKELY THAT abrupt withdrawal of treatment with prednisolone Nicomedia spends less than 3 weeks, WILL result in a clinically significant suppression of the hypothalamic-pituitary-adrenal system in most patients, but consider that the reaction to corticosteroids and tolerability of their withdrawal can vary widely.SO, IT IS NECESSARY TO CONSIDER THE QUESTION OF A GRADUAL REDUCTION OF THE DOSE WHEN DISCONTINUING THE MEDICINE AFTER SHORT COURSES OR WHEN TAKING HIGHER DOSES AND IN PATIENTS WITH OTHER PHYSICAL FACTORS OF ROSVOROS.

THE DOSING MODE WITH A GRADUAL DOSE REDUCTION SHOULD BE SELECTED INDIVIDUALLY. THE MOST OF PATIENTS WELL RESOLVE A DOSE REDUCTION OF PRENIZOLONE NIKOMED BY 2.5 MG EVERY 3-7 DAYS UNTIL THE DOSE OF PREDISOLONE NIKOMED 5-10 MG / DAY. HIGHER DOSES SHOULD BE REDUCED GRADUALLY OVER 9-12 MONTHS.

WITH A GRADUAL DOSE REDUCTION, THE EVENING DOSE SHOULD BE MISSED FIRST, AND THEN THE DOSES THAT SHOULD BE TAKEN AT NOON, AFTER DINNER OR EVENING, THEN THERE IS THAT IS THEREFORE. LONG PERIODIC TREATMENT WITH GLUCOCORTICOID THERAPY (1 DOSE EVERY DAY IN THE MORNING) HAS BEEN EFFICIENT DUE TO THE ABSENCE OF ADRENAL CORK SUPPRESSION.

METHOD OF APPLICATION: TAKE INSIDE TOGETHER WITH A SMALL AMOUNT OF LIQUID AFTER A FOOD.

ADULTS: NORMAL DOSE RANGES FROM 5 TO 60 MILLIGRAMS / DAY DEPENDING ON THE DISEASE TREATED FOR. IN GENERAL, THE ENTIRE DAILY DOSE SHOULD BE TAKEN BETWEEN 6 AM AND 8 AM IN THE MORNING. (CIRCADIC THERAPY – DAILY SECRETARY RHYTHMS SHOULD BE CONSIDERED WHEN PRESCRIBING).

SUBSTITUTIONAL THERAPY: THE RECOMMENDED INITIAL DOSE IS 5 MG, TAKEN GENTLY IN THE MORNING AND EVENING.

DOSES FOR SPECIFIC GROUPS OF PATIENTS

DOSAGE IN PATIENTS WITH HYPOTHYROSIS: IN PATIENTS WITH HYPOTHYROSIS, DOSE REDUCTION MAY BE REQUIRED.

DOSAGE IN PATIENTS WITH LIVER IMPAIRMENT: PATIENTS WITH LIVER IMPAIRMENT are MORE PROBABLE TO DEVELOP SEVERE ADVERSE REACTIONS DUE TO DECREASED MUFFICIENCY. DOSE ADJUSTMENT MAY BE NECESSARY.

DOSAGE IN PATIENTS WITH RENAL FAILURE: IN PATIENTS WITH RENAL FAILURE, DOSE ADJUSTMENT IS NOT REQUIRED.

DOSAGE IN ELDERLY PATIENTS: DOSE CORRECTION IS NOT REQUIRED, HOWEVER, IT SHOULD BE CONSIDERED THAT LONG-TERM ADMINISTRATION OF CORTICOSTEROIDS IN ELDERLY PATIENTS MAY CAUSE EXCERNATIVE EXCERNATION OF SACHES

DOSES FOR CHILDREN: NO EXPERIENCE IN CHILDREN. CHILDREN ARE CONSIDERED ESPECIALLY AT RISK IN RELATION TO DELAYED GROWTH, THEREFORE THE INDICATION FOR USE OF THE PREPARATION REQUIRES A PARTICULARLY STRICT ASSESSMENT OF THE CONDITION OF CHILDREN.
IN CHILDREN DURING GROWTH, TREATMENT SHOULD BE BASICALLY PERIODIC OR INTERRUPTED. A GRADUAL DOSE REDUCTION TO A DOSE PROVIDING A SATISFACTORY CLINICAL RESPONSE AND CAUSING THE MINIMUM SIDE EFFECTS IS NECESSARY.

ANTI-INFLAMMATORY OR IMMUNOSUPPRESSIVE EFFECTS: USUALLY THE DOSE OF PREDISOLONE IS 0.1-2 MG / KG / DAY.THE DOSE CAN BE BROKENED INTO 1-4 DEPOSITS PER DAY. THE LOWEST EFFECTIVE DOSE IS USUALLY DETERMINED BY CLINICAL RESPONSE.

EXCERVATION OF BRONCHIAL ASTHMA: USUALLY THE DOSE OF PREDISOLONE IS 1-2 MG / KG / DAY; THIS DOSE CAN BE BROKEN IN 1-2 TAKES / DAYS WITHIN 3-5 DAYS.

SUBSTITUTION THERAPY: REGULAR DOSE IS 4 TO 5 MG / m2 / DAY.

NEPHROTIC SYNDROME: THE NORMAL DOSE IS 2 MG / KG / DAY (MAXIMUM DOSE 60-80 MG / DAY), WHICH IS GIVEN IN 2-4 TAKES.

SIDE EFFECTS
VERY FREQUENTLY (> 1/10), FREQUENTLY (> 1/100, <1/10), RARE (> 1/1000, <1/100), RARE (> 1/10000, <1 / 1000), VERY RARE (<1/10000), UNKNOWN (CANNOT BE ASSESSED BASED ON AVAILABLE DATA).

IN GENERAL, THE FREQUENCY OF DEVELOPMENT OF THE FORECASTED SIDE EFFECTS, INCLUDING SUPPRESSION OF THE HYPOTHALAMO-HYPOPHYSICAL-ADRENAL SYSTEM, DEPENDS ON THE DOSE, TIME OF ADMISSION AND DURATION. SIDE EFFECTS MAY BE REDUCED TO A MINIMUM IF USE THE LOWEST EFFECTIVE DOSE FOR THE MINIMUM PERIOD OF TIME.

LOT

– increased susceptibility to infection, aggravation without infection, activation of latent infection and masking symptoms of infection (due to immunosuppressive and anti-inflammatory effects prednisolone)

– reduction in the number of eosinophils and lymphocytes

– MASKING or exacerbation of existing disease

– Adrenal insufficiency (starting with SUPPRESSION WORK hypothalamus and ends TRUE atrophy of the adrenal cortex) at constant use of oral prednisone withdrawal symptoms due to insufficient adrenal (headache, nausea, dizziness, anorexia, fatigue, emotional instability, apathy, and an inadequate response to a stressful situation) “STEROID DIABETES MELLITUS” WITH LOW SENSITIVITY TO INSULIN, INCREASED BLOOD SUGAR LEVEL IN PATIENTS ALREADY SUFFERING WITH DIABETES MELLITUS (100%), DELAYED GROWTH IN CHILDREN LTATE impaired secretion of growth hormone, and reduced susceptibility to HIM

– increased intraocular pressure (up to 40% of patients treated with oral medication), cataract (30% of patients UNDER LONG-TERM oral treatment drug)

– lung abscess (12%)

– Oral candidiasis, particularly in cancer patients (33%)

– fungal infections of mucous membranes (30%)

– Osteoporosis causes pain, back pain, limited mobility, acute pain, vertebral crush fractures and loss of height, fractures of long BONE (25% long-term treatment of oral preparations), myopathy (10%) IN THE TREATMENT OF HIGH-DOSE

Frequently

– increased number of leukocytes and platelets

– Cushing’s syndrome, including changes CHARACTER fat deposition (moon face, truncal obesity, ” Bull’s Hump “) WHEN Continuous use of oral doses above the physiological (typically more than 50 mg per day), hypokalemia DUE sodium retention and excretion of potassium, amenorrhea in women of childbearing age, high cholesterol, triglycerides and lipoprotein AT treatment with high doses taken by mouth, increased appetite and weight gain

– euphoria, depression, psychosis (induced by corticosteroids)

– Hypertension (due to sodium retention, which leads to fluid retention), worsening of congestive heart failure (due to delay sodium)

– increased risk of developing tuberculosis

– increased symptoms and Increased risk of gastrointestinal perforation, colitis, ileitis, diverticulitis

– stretch marks, acne-like rash, bruising, dermatitis, ecchymosis, facial erythema, atrophy, hirsutism, slow wound healing, increased sweating, telangiectasia and thinning of the skin, Masking or worsening of existing diseases LEATHER

– increasing the frequency of nighttime urination

infrequently

– ALLERGIC REACTIONS

– diabetes (<1%) IN THE TREATMENT OF SMALL oral doses, increased cholesterol, triglycerides and lipoprotein IN THE TREATMENT OF LOW oral doses

– insomnia, mood swings, changes in personality, mania and hallucinations

– respiratory muscle myopathy

– gastric ulcer or duodenal ulcer while receiving acetylsalicylic acid or nonsteroidal antiinflammatory drugs (NSAIDs), gastrointestinal bleeding (0.5%) GASTROINTESTINAL PERFORATIONS

– ASEPTIC BONE TISSUE NECROSIS

– URINARY STONES DUE TO INCREASED EXCRETION OF CALCIUM AND PHOSPHATE

RARE RARE RICE

TROPOSTA

– Bani BLOOD

– changes in thyroid function

– possibility of extending the COMA in cerebral malaria, cognitive disorders (eg, poor memory), dementia, epidural lipomatosis

– HIGH RISK OF DESTRUCTION cornea WITH SIMULTANEOUS herpetic infection of the eye (due to masking this infection), glaucoma (with prolonged oral treatment drug)

VERY RARE

– ketoacidosis and hyperosmolar coma, manifestations of latent hyperparathyroidism, propensity to porphyria, the syndrome of tumor lysis, inappropriate secretion of sex hormones (DISORDERS of menstruation, hirsutism, impotence)

– MANIFESTATION OF LATENT EPILEPSY, Pseudotumor of the Brain (BENEFITS INTRACRANIAL HYPERTENSION WITH SYMPTOMS SUCH AS HEADACHE, BLUE VISION AND VISUAL IMPAIRMENT

Cardiomyopathy with risk reduction of cardiac activity, arrythmias due to hypokalemia, vascular collapse

– Pancreatitis (AFTER A LONG treatment with high doses)

– epidermal necrolysis, Stevens-Johnson syndrome

– Achilles tendinopathy and patellar tendons

NOT KNOWN

– an increased risk of atherosclerosis and thrombosis, vasculitis (MAY ALSO OCCUR AS A withdrawal syndrome after prolonged therapy)

– ulcers and esophageal candidiasis

– muscular atrophy, a disease tendons, tendinitis, tendon rupture

– delayed wound healing, eating disorders

NOTE:
WITH AN EXCESSIVE RAPID DOSE REDUCTION AFTER PROLONGED TREATMENT PROBLEMS MAY DEVELOP MUSCLE AND JOINT PAIN, FEVER, RHINITIS, CONJUNCTIVITIS AND WEIGHT LOSS.

CONTRAINDICATIONS

prednisolone NYCOMED contraindicated in the following conditions / disorders:

– hypersensitivity to prednisone NYCOMED or any auxiliary substances in preparations

– systemic mycosis

– vaccination with live viral or bacterial vaccine is contraindicated DURING immunosuppression corticosteroids (not a full immune response may allow a live attenuated vaccine caused infectious diseases)

during prolonged therapy:

– ULCERS 12 duodenal ulcer

– stomach ulcers

– severe forms of osteoporosis

– HEAVY myopathy (EXCEPT myasthenia gravis )

– PSYCHIATRIC ANAMNESIS

– ACUTE VIRAL INFECTIONS (SHEALING HERPES, SIMPLE HERPES, FLARE POISON)

– Chronic active hepatitis (C HBS AG-positive)

GLAUCOMA – Poliomyelitis

– LYMPHADENITIS after vaccination with BCG

– pre- and post-vaccination period (8 weeks before and 2 weeks post vaccination)

MEDICINAL INTERACTION CORTICOID EFFECT IS DECLINED BY THE APPLICATION OF CYP3A4 INDUCTORS SUCH AS RIFAMPICIN, PHENYTOIN, PRIMIDON, BARBITURATES, CARBAMAZEPINE AND AMINOGLUTHETHYMIDE.
THE CORTICOID EFFECT IS INCREASED WITH THE APPLICATION OF SUBSTANCES BLOCKING CYP3A4: (KETOCONAZOL, RITONAVIR), ERYTHROMYCIN, TROLEANDROMYCIN.

GASTROINTESTINAL TRACT ORGANS AND METABOLISM

HYPOGLYCEMIC PREPARATIONS

PRENISOLONE NIKOMED PREVENTS THE EFFECT OF HYPOGLYCEMIC PREPARATIONS OF PURCHASES. ADVERSE EFFECT: INCREASED RISK OF HYPERGLYCEMIA.

CARDIOVASCULAR PRODUCTS

POTASSIUM EXTRACTING DIURETICS (THIAZIDES, FUROSEMIDE, ETC.

EFFECT OF ADDITIONAL LOSS OF POTASSIUM IN THE KIDNEY. ADVERSE EFFECT: INCREASED RISK OF HYPOCALYEMIA AND CONSEQUENTED CARDIAC ARRHYTHMIAS.

CARDIAC GLYCOSIDES

GLYCOSIDE EFFECT DUE TO POTASSIUM DEFICIENCY.

ANGIOTENSIN-CONVERSING ENZYME (ACE) INHIBITORS

INCREASED RISK OF BLOOD FORMULA CHANGE.

ANTIHYPERTENSIVE

REDUCTION OF ALREADY REDUCED BLOOD PRESSURE.

HORMONES FOR SYSTEMIC APPLICATION

ORAL CONTRACEPTIVES

THE LEVEL OF PREDISOLONE IN THE BLOOD SERUM CAN INCREASE DUE TO ITS REDUCED METABOLISM.ADVERSE EFFECT: INCREASED RISK OF DEVELOPMENT OF SIDE EFFECTS OF CORTICOSTEROIDS. EXCESSIVE USE OF GLUCOCORTICOIDS CAN SUPPRESS THE EFFECT OF SOMATOTROPINE, WHICH INCREASES GROWTH.

ANTIMICROBIAL AGENTS

RIFAMPICIN

INCREASED METABOLISM OF PREDISOLONE. ADVERSE EFFECT: REDUCED EFFICIENCY OF PRENIZOLON.

AMPHOTHERICIN B

EFFECT OF ADDITIONAL LOSS OF POTASSIUM IN THE KIDNEY. ADVERSE EFFECT: INCREASED RISK OF HYPOCALYEMIA AND CONSEQUENTED CARDIAC ARRHYTHMIAS.

FLUOROQUINOLONES

ADVERSE EFFECT: INCREASED RISK OF RUPTURE OF TENDONS.

KETOCONAZOLE

ADVERSE EFFECT: MAY INCREASE THE EFFECTS OF PREDISOLONE.

MEANS FOR THE MUSCLE, JOINT AND BONE SYSTEM

ACETYL SALICYLIC ACID (ACK)

IT IS KNOWN THAT ACETYL SALICYLIC ACID IRRITATES THE VENTRICULAR, MAY BE PRESENTED THE MECHANISM IS NOT KNOWN. AN INCREASED CLEARANCE OF ACETYL SALICYLIC ACID DUE TO EXPOSURE OF PREDISOLONE HAS BEEN REPORTED.THERE IS AN INCREASED RISK OF DEVELOPMENT OF GASTROINTESTINAL BLEEDING AND ULTRA, AS WELL AS A RISK OF DECREASING THE EFFICIENCY OF ACETYL SALICYLIC ACID. IN THIS WAY, SALICILATE SIDE EFFECTS WILL BE MANIFESTED WHEN PREDISOLONE IS DISCONTINUED.

NON-STEROID ANTI-INFLAMMATORY DRUGS (NSAIDs)

NSAIDs IRRITATE THE STOMACH, AND PRESOLONE CAN MASK THESE ADVERSE EFFECTS. ADVERSE EFFECT: INCREASED RISK OF GASTROINTESTINAL BLEEDING AND ULTRA FORMATION.

NON-DEPOLARIZING MUSCLE RELAXANTS

ADVERSE EFFECT: LONG-TERM RELAXATION OF MUSCLES.

CENTRAL NERVOUS SYSTEM

BARBITURATES

BARBITURATES STIMULATE LIVER ENZYMES AND INCREASE METABOLISM OF PREDISOLONE. ADVERSE EFFECT: REDUCED EFFICIENCY OF PRENIZOLON.

PHENYTOIN AND PHOSPHENYTOIN

INCREASED METABOLISM OF PRENISOLONE IN THE LIVER. ADVERSE EFFECT: REDUCED EFFICIENCY OF PRENIZOLON.

QUETIAPIN

INDUCTION OF P450-MEDIATED METABOLISM OF QUETIAPINE INDUCED BY CORTICOSTEROIDS. ADVERSE EFFECT: REDUCTION OF THE LEVEL OF QUETIAPIN IN THE BLOOD SERUM.

INCREASED QUETIAPINE DOSE MAY BE REQUIRED TO MAINTAIN SCHIZOPHRENIA SYMPTOMS CONTROL.

BUPROPION

SIMULTANEOUS USE TOGETHER WITH SYSTEMIC GLUCOCORTICOIDS CAN INCREASE THE RISK OF DEVELOPMENT OF SEIZURES.

IMMUNODEPRESSANTS

METOTREXAT

MECHANISM UNKNOWN. STRENGTHENING THE ACTION OF THE PRESOLONE.

CYCLOSPORIN

PREVISOLONE CAN INCREASE THE LEVEL OF CYCLOSPORIN IN BLOOD PLASMA.

EFFECTS ON LABORATORY TESTS AND STUDIES

SKIN REACTIONS TO ALLERGIC TESTS MAY BE SUPPRESSED.THE REDUCTION OF THYROTROPIC HORMONE (TSH) INCREASES.

OTHER AGENTS

VACCINES

REDUCED IMMUNE RESPONSE GIVES THE POSSIBILITY OF INFECTIONS CAUSED BY LIVE VACCINES, AND CAN ALSO DECREASE IN EFFICIENCY.
THERE IS AN INCREASED RISK OF GENERALIZED, POTENTIALLY LIFE-THREATENING INFECTIONS WHEN VACCINED WITH LIVE VACCINES.

EPHEDRINE

THE METABOLISM OF GLUCOCORTICOIDS MAY BE ACCELERATED AND, CONSEQUENTLY, THEIR EFFICIENCY MAY DECREASE.

LEAKABLE AND BETA SYMPATOMETICS

INCREASE IN POTASSIUM LOSS.

CHLOROQUINE, HYDROXYCHLOROQUINE, MEFLOQUINE

INCREASED RISK OF MYOPATHIES, CARDIOMYOPATHIES

CUMARIN DERIVATIVES

REDUCTION OF THE DEVIOSINE OF THEIR PRE-EFFECTIVENESS OF THE EFFECT.

THEOPHYLLIN

UNWANTED EFFECT: INCREASED CLEARANCE DURING TREATMENT WITH PREDISOLONE.

CYCLOPHOSPHAMIDE

SINGLE DOSES OF PREDISOLONE CAN INHIBIT THE ACTIVATION OF CYCLOPHOSPHAMIDE, BUT THE LEVEL OF ACTIVATION INCREASES AFTER PROLONGED USE.

THALIDOMIDE

CAN INCREASE THE EFFECT OF PRENISOLONE.

PRASQUANTEL

POSSIBLE REDUCTION OF PRASQUANTEL CONCENTRATION IN BLOOD DUE TO CORTICOSTEROIDS.

ATROPINE

ADVERSE EFFECT: INCREASED INTRAOCULAR PRESSURE IS POSSIBLE WHEN ADMINISTRATED WITH PREDISOLONE.

LICRICE

INHIBITION OF CORTICOSTEROID METABOLISM BY LICRICE. ADVERSE EFFECT: INCREASED RISK OF CORTICOSTEROID SIDE EFFECTS.

SPECIAL INSTRUCTIONS

– Patients with certain physical problems, such as fever, trauma or surgery, during treatment may take time CORRECTION OF DAILY corticoid DOSE

– the risk of disease tendons, tendinitis or tendon rupture will increase with the simultaneous use of fluoroquinolones and corticosteroids

– Long-term use should be accompanied by examination by an ophthalmologist every three months

– Long-term use may be associated with rapid progression of Kaposi’s sarcoma

– EXCEPT replacement therapy corticosteroids do not possess curative, A palliative effect thanks to its anti-inflammatory and immunosuppressive properties …LONG-TERM RECEPTION, DEPENDING ON THE DOSE AND DURATION OF TREATMENT, IS ASSOCIATED WITH AN INCREASED FREQUENCY OF ADVERSE EFFECTS. Patients who are receiving long-term corticosteroid therapy system actions, must be supervised in order to identify SUPPRESSION hypothalamic-pituitary-adrenal (HPA) axis (adrenal insufficiency), Cushing’s syndrome, hyperglycemia, and glucosuria

– after long-term corticosteroid therapy, treatment should be withdrawn SOFT TO PREVENT “CANCELLATION SYNDROME”.ADRENOCORTICAL INSUFFICIENCY MAY LAST FOR MONTHS AFTER STOPPING CORTICOSTEROID TREATMENT, AND DURING STRESS PERIODS (SURGICAL SURGERY, DISEASE) MAY REQUIRE NECESSARY. Risk of adrenal insufficiency can be reduced prescribing THROUGH THE DAY instead of daily doses administered

– in connection with anti-inflammatory and immunosuppressive EFFECTS Corticosteroids THEIR used in doses higher than necessary for replacement therapy, susceptibility to infections, exacerbate AVAILABLE INFECTION DISEASES AND ACTIVATION OF LATENT INFECTIONS.ANTI-INFLAMMATORY EFFECT MAY LEAD TO MASKING SYMPTOMS UNTIL THE PERIOD, UNTIL THE INFECTIOUS DISEASE PROVES TO THE RELATED STAGE. IF NEW INFECTIONS ARISE DURING TREATMENT, THE FACT SHOULD BE CONSIDERED THAT IT WILL BE IMPOSSIBLE TO LOCALIZE SUCH INFECTION

– IN PATIENTS WITH LATENT TESUME TUBERCULES TUBERCULES. SUCH PATIENTS SHOULD BE CAREFULLY OBSERVED FOR TB REACTIVATION AND IF LONG-TERM CORTICOSTEROID TREATMENT IS REQUIRED, ANTITUBERCULOSIS CHEMOTHERAPY MAY BE INDICATED.The use of corticosteroids in patients with active tuberculosis should be restricted to cases LIKE exacerbation or dissemination of TB if their use to treat diseases PLANNED together with a suitable anti-tuberculosis therapy

– Systemic corticosteroid therapy may increase the risk of severe or lethal infection in persons exposed VIRAL DISEASES SUCH AS CHICKEN POISON OR MEASLES (PATIENTS SHOULD BE WARNED TO AVOID SUCH RISK AND TO CONTACT A DOCTOR IMMEDIATELY IF IT IS PRESENT).CORTICOSTEROIDS CAN PROMOTE BACTERIAL AND FUNGAL INFECTIONS (CANDIDA INFECTIONS). CORTICOIDS CAN ACTIVATE LATENT AMEOBIC INFECTIONS, SO IT IS VERY IMPORTANT TO REMOVE THEM BEFORE STARTING CORTICOID THERAPY

– PREDISOLONE INCREASES GLUCONEOGENESIS. APPROXIMATELY 20% OF PATIENTS TREATED WITH HIGH DOSES OF STEROIDS DEVELOP BENEFITS “STEROID DIABETES” WITH LOW INSULIN SENSITIVITY AND LOW RENAL GLUCOSIS. THE CONDITION IS REVERSIBLE WHEN CANCELLATION OF THERAPY.IN CONFIRMED DIABETES MELLITUS TREATMENT WITH CORTICOSTEROIDS USUALLY IMPROVES BALANCE, WHICH MAY BE COMPENSATED BY CORRECTING THE DOSE OF INSULIN

– LONG-LONG LONGER CAPACITAL Prednisone reduces the level of calcium and phosphate, which affects the level of vitamin D, thereby causing a dose-dependent reduction LEVEL osteocalcin in serum (Protein bone matrix, which correlates with bone formation)

– THERAPY prednisolone within weeks cause children RISK DEVELOPMENT growth retardation associated with a reduction in growth hormone secretion and reduce PERIPHERAL sensitivity to this hormone

– corticosteroids can cause mental disorders, including euphoria, insomnia, mood swings, personality changes, depression and psychotic tendencies

– Long corticosteroids SYSTEM OF MAY CAUSE A POSTER SUBCAPSULAR CATARACT AND GLAUCOMA (DUE TO INCREASED INTRACULAR PRESSURE), AS WELL AS AN INCREASED RISK OF EYE INFECTION.OPHTHALMOLOGICAL EXAMINATION AND TREATMENT IN CASE OF GLAUCOMA, ULTRA AND CORNEAL INJURY MUST BE SHOWN. PATIENTS WITH HERPETIC INFECTION HAVE AN INCREASED RISK OF DEVELOPING CORNEAL INJURY, BECAUSE PREDISOLONE CAN MASK THE INFECTION.

Corticosteroids should be used with caution in the following conditions:

– gastro-intestinal diseases such as ulcerative colitis and diverticulitis at the possibility of perforation of the colon, abscess COLON OR OTHERWISE pyogenic infections, obstruction of the colon, EXPRESS fistulas, and sinus TRACTS, FRESH INTESTINAL ANASTOMOSIS AND LATENT PEPTIC ULTRA.Inflammatory properties Glucocorticoids can mask SIGNS gastrointestinal perforations and thus leads to a delay DIAGNOSTICS and, consequently, to potentially fatal

– High blood pressure or congestive cardio-vascular system (due to mineralocorticoid EFFECT prednisolone, which may lead to RETENTION OF LIQUID AND SALT)

– OSTEOPOROSIS (BECAUSE CORTICOSTEROIDS CAN INCREASE THE SYMPTOMS OF OSTEOPOROSIS)

– KNOWN AND PROSPECTED INFECTIONS

90,000 Last week, vaccination caused five serious adverse reactions | Estonia

A total of 382 adverse reactions were reported in Estonia last week for the Astra Zeneca vaccine, 43 for Pfizer / BioNTech and 10 for the Moderna vaccine.

These were mainly mild side effects. More serious adverse reactions were reported in five cases, but hospitalization was not required there either.

Pfizer / BioNTech Comirnaty vaccine – 43 reports

Of the 43 reports, 40 were associated with adverse reactions in women and three with adverse reactions in men. Serious reactions requiring treatment are described in three reports.

A 53-year-old woman developed an allergic reaction 5 minutes after the first dose of the vaccine, for which the woman was given injections of epinephrine and prednisone.The patient’s condition improved and she did not need hospitalization.

A 36-year-old woman, two minutes after the second dose of the vaccine, developed a stress reaction resembling an allergic reaction, which was treated with epinephrine, antihistamines and prednisone. The woman felt better and did not need hospitalization.

A 59-year-old woman developed a severe psychosomatic stress reaction 15 minutes after the first dose of the vaccine and was injected with diazepam and morphine.The patient’s condition improved and she did not need hospitalization.

Other reports reported mild adverse reactions, some of which lasted several days.

AstraZeneca vaccine – 382 reports

For the AstraZeneca vaccine, there were 300 reports of side effects in women and 82 reports of side effects in men. Serious reactions requiring treatment are described in two reports.

A 55-year-old woman developed nausea and intermittent vomiting 10 hours after the first dose of the vaccine and received metoclopramide and esomeprazole.The woman felt better and did not need hospitalization. In addition, she was diagnosed with a coronavirus infection.

A 38-year-old woman, two minutes after the first dose of the vaccine, began an exacerbation of asthma (severe cough, shortness of breath), she was given antihistamines, prednisolone, salbutamol, ranitidine. The patient got better and did not need hospitalization.

In other cases, mild reactions were recorded.

Studies show that there are fewer complaints after the second dose of the AstraZeneca vaccine than after the first dose.

Moderna vaccine – 10 messages

Of these, six were reported in women and four in men. There were no serious reactions, i.e. mild reactions have been reported: reactions at the injection site, fever and chills, headache and pain elsewhere (including pain in muscles, joints or bones, pain in the eyes, pain in the skin). In two cases, pain at the injection site lasted more than a week.

It is known that mRNA vaccines cause slightly more complaints after the second dose and these reactions can be more severe.

The general picture – side effects are 1%

According to the Health Board, 112,807 doses of COVID-19 vaccine were administered in Estonia between December 27 and the morning of February 22.

During this period, the Department of Medicines received 1209 reports of adverse reactions, which is 1% of all vaccines made.

Of these, 698 are for Pfizer / BioNTech’s Comirnaty vaccine, 13 are for Moderna and 426 are for AstraZeneca.

The doctor spoke about the side effects of dexamethasone

The anti-inflammatory drug dexamethasone, which has been shown to be effective against complications of COVID-19, has side effects such as an increased tendency to thrombosis and the ability to cause stomach ulcers. Therefore, only specialists should appoint it. Honored Doctor of Russia Mikhail Kagan told TASS about this.

Dexamethasone is a steroid drug with anti-inflammatory and immunosuppressive effects.It is used to treat rheumatoid diseases, asthma, allergies, chronic obstructive pulmonary disease and many other diseases. According to the results of the RECOVERY clinical study, which involved more than 6 thousand patients with coronavirus infection, dexamethasone reduced the mortality rate of patients with COVID-19 who were on mechanical ventilation by one third.

The head of the World Health Organization (WHO) then called these results a “scientific breakthrough.” However, the study has not yet been independently reviewed and published in any scientific journal.The authors promise to do so in the near future.

Why dexamethasone should be taken with caution

“[Side effects] are the same as for other drugs in this group – increased tendency to thrombosis, increased blood pressure, increased blood glucose, the ability to cause stomach ulcers, etc. This is a serious drug for serious situations with serious side effects Therefore, only an experienced doctor will understand what’s what, – said Kagan.

The doctor explained that the drug, according to preliminary results of the study, does not affect the virus itself, it only reduces the excessive inflammation that occurs in the body after infection.

As a prophylaxis and in the first week after infection with coronavirus, Kagan did not recommend using this drug, since it suppresses the immune system. “It can only help the virus,” the doctor explained.

In general, as Kagan explained, dexamethasone has been known to mankind since the 1960s and has long been registered for the treatment of autoimmune diseases in all countries, including the USSR and Russia. Traditional therapy for many autoimmune diseases is based on corticosteroids, such as systemic lupus erythematosus, glomerulonephritis, bronchial asthma, Kawasaki syndrome, autoimmune thrombocytopenic purpura and others.

It is logical to use corticosteroids for coronavirus infection, the doctor noted, but there were no unequivocal recommendations, since there was no evidence of the effectiveness of this drug against COVID-19 before. In addition, doctors are aware of the risks of using such steroids. At the same time, in the seventh version of the temporary methodological recommendations of the Ministry of Health “Prevention, diagnosis and treatment of a new coronavirus infection” dated June 3, there was a recommendation that this drug can be used in a severe course of the disease, Kagan noted.

“It should be noted that in the UK the dose of dexamethasone was used significantly lower than that recommended by our Ministry of Health – 6 mg per day (in domestic recommendations – 20 mg per day. I think that the British managed to find the optimal dose that already provides a positive effect and minimizes side effects). actions “, – concluded the doctor.

How clinical trials were conducted

More than 6.4 thousand people participated in the RECOVERY study, which began in March 2020.patients with coronavirus infection. Of these, 2.1 thousand people were randomly selected, who were given 6 mg of dexamethasone per day for ten days. The rest of the participants underwent the usual treatment in such cases.

The results showed that this immunosuppressant reduced the number of deaths among patients with severe forms of COVID-19: by a third among patients on ventilation and by 20% among those who needed supplemental oxygen.

Glucocorticoids – Nikavet Veterinary Clinic

Author: Yakimenko Anastasia Sergeevna (translated from English)

Glucocorticoids (GCs) have far-reaching pharmacological effects, which can vary significantly depending on the dosage and slightly depending on the type of GC prescribed (see.Pharmacological effects of glucocorticoids).


Pharmacological effects of glucocorticoids:

• Reduces the production of inflammatory mediators

• Attenuation of leukocyte phagocytosis, chemotaxis and antigen production

• Pronounced catabolic effect on metabolism, muscle mass and bone turnover

• Change in renal excretion of potassium, calcium and sodium

• Excitation of stress leukogram

• Serum induction of alkaline phosphatase

Prednisone, Prednisolone and Methylprednisolone

Prednisone is a prodrug of Prednisolone.In cats, oral prednisolone results in much higher plasma concentrations than the same dose of oral prednisolone. This may be due to poor bioavailability of prednisone in cats or its slow conversion to prednisone. For this reason, prednisone is the preferred HA for cats. Whereas dogs can convert both prednisone and prednisolone equally. Methylprednisolone is more effective than prednisolone in inhibiting lymphocyte proliferation in vitro in humans.But this data is not valid for dogs. Animal textbooks report that methylprednisolone has no mineralocorticoid effects compared to prednisolone, but there is no evidence for this. In fact, methylprednisolone activates the mineralocorticoids responsible for the renal tract, at least in rodents.

Dosage of Prednisol, Prednisolone and Methylprednisolone

The commonly used doses of HA have been extrapolated from previous human studies and supported by clinical experience in dogs and cats (Ref.empirical recommendations for glucocorticoid dosing). For physiological replacement, the recommended starting dose is 0.2 mg / kg orally once a day. The timing of manifestation is not important, at least in cats.

Doses exceeding the norm by about 3 times are recommended for stress (for example, hospitalization or surgery) in animals that have endogenous HA deficiency. This is supported by studies of the secretion of cortisol in dogs under experimental stress conditions.For anti-inflammatory effects, oral doses of 0.5 to 1.0 mg / kg per day for dogs and 1.0-2.0 mg / kg per day for cats are recommended; for immunosuppression, 2.0 mg / kg per day or 50 mg / m2 for dogs or up to 4.0 mg / kg per day for cats is suggested.

For large and giant dog breeds, use of no more than 50 mg / m2 (maximum dose 30-40 mg twice daily) is suggested by the author to reduce the incidence of serious side effects (eg muscle wasting, secondary infections). In obese cats, the dose of prednisolone should be administered based on an assessment of lean body mass, as the plasma concentration of prednisolone in obese cats is doubled compared to the same dosage per kg in normal cats.

Prednisolone is the preferred glucocorticoid for cats.

Positive and negative effects

Glucocorticoids commonly cause dose-dependent polyuria and polydipsia, muscle atrophy and alopecia in dogs. Cats are more resistant to many of the side effects of HA, possibly due to fewer and low affinity for HA receptors in the liver and skin. Acquired diabetes mellitus is a major complication of chronic HA treatment in cats and requires close clinical monitoring for polydipsia, weight loss, or glucosuria.Prednisone, prednisolone, and methylprednisolone have mineralocorticoid effects, and moderate to high doses should be avoided in patients with hypertension, heart failure, ascites, or hypokalemia. In addition, methylprednisolone acetate can cause acute plasma expansion and even congestive heart failure in cats, although this can be attributed to intercellular fluid changes rather than overall water retention. HAs typically induce serum alkaline phosphatase (ALP) activity in dogs, with alanine aminotransferase (ALT) inhibition.These changes are not clinically effective, unless the activity of ALT or ALP is exceeded, or hyperbilirubinemia is not present, which in itself suggests the presence of the disease.

ALP is not readily induced by HA in cats; small increases in alkaline phosphatase from baseline were reported when methylprednisolone acetate was given to the cat, but values ​​were within the range. Any increase in serum ALP beyond the reference range is clinically significant in cats, regardless of whether HA is present in their treatment.

Two weeks of treatment with an anti-inflammatory dosage of prednisone suppresses the hypothalamic-pituitary-adrenal system (HPA system). After one month of treatment, it may take 2 weeks for adrenal function to recover. Because of this, the patient should ideally be isolated from chronic HA at least 2-3 weeks prior to elective anesthesia or surgery, if possible; however, if negative consequences of discontinuation of treatment are possible, then each patient should be considered separately.

Dexamethasone

Dexamethasone is approximately 5 to 10 times more potent than prednisone for a duration of approximately 32 to 48 hours. Dexamethasone does not have mineralocorticoid activity due to the substituted methyl ring and does not contribute to the retention of salt and water.

Indications and dosing

Dexamethasone is the preferred GC for patients with hypertension, heart failure, hypoalbuminemia, edema, or ascites.Based on the increased potency of dexamethasone, dosages can be empirically determined by calculating the base doses of prednisone and dividing by 7 or 8 to obtain the equivalent dexamethasone dose.

Dexamethasone is also available in injectable form, which is useful for the administration of HA bypassing severe malabsorption in the treatment of protein-losing enteropathy or lymphangiectasia.

Positive and negative effects

Dexamethasone (0.55 mg / kg orally per day) is more diabetogenic in healthy cats than eight times the dose of prednisolone (4.4 mg / kg orally per day).This suggests that dexamethasone is at least 8 times more potent than prednisone for cats.

Dexamethasone is not suitable for alternative single-use therapy due to its long duration of action. For chronic tapering courses, dexamethasone may be substituted for prednisone or prednisolone at lower doses (eg, equivalent to 0.5 to 1.0 mg / kg oral prednisolone per day) or with a single alternative therapy.

Budesonide

Budesonide is a high initial dosage oral HA for humans.In dogs, budesonide is unlikely to increase liver enzyme activity or cause a stress leukogram.

Indications and Dosing

Budesonide is an alternative to prednisone or prednisolone for the treatment of inflammatory bowel disease and possibly inflammatory liver disease. This proves his focus on local effects; this makes it an attractive alternative in the treatment of inflammatory bowel disease, with equivalent efficacy to prednisone for dogs.

In dogs, budesonide is less likely to increase liver enzyme activity or cause a stress leukogram. Although the published empirical single dose is 3 mg / m2 per day, it can cause severe polyuria / polydipsia and breathing difficulties in some dogs and can completely suppress the HPA system. Reducing the starting dose (eg 1-2 mg / m2 or 1-2 mcg / 30 kg [dog]; 0.5-0.75 mg [cat]) may be better tolerated and may achieve clinical benefit.

Triamcinolone

The effectiveness of triamcinolone relative to prednisolone varies widely, from 10: 1 to 1: 1; however, in studies in cats with pruritic skin conditions, triamcinolone at one-seventh dose of methylprednisolone (0.18 mg / kg / day orally) showed comparable efficacy (1.41 mg / kg / day orally), suggesting that triamcinolone may be in 7 times more potent than methylprednisolone for cats. This study also showed a lower incidence of polydipsia in cats treated with triamcinolone compared with methylprednisolone, although the number of cats in the study was small.This conclusion is consistent with the understanding that triamcinolone, like dexamethasone, has a substitution ring and removes mineralocorticoid activity.

The potency and efficacy of oral triamcinolone cannot be compared with dexamethasone or prednisolone in dogs. Triamcinolone is more commonly used for long-term injectable use (Vetalog, bi-vetmedica.com) in dogs.

Long Action Injections

Long-acting HA injections provide sustained release by slow dissolution of acetonide and acetate preparations.These GCs are convenient for patients who find it difficult to administer drugs by mouth, but with prolonged use they can lead to suppression of the HPA system and functional insufficiency of the adrenal cortex in stressful situations. For example, triamcinolone acetonide (Vetalog, bi-vetmedica.com) lasts for weeks, and a single injection can suppress adrenal function in dogs for up to 4 weeks.

Like oral HA, these HA injections can lead to debilitating side effects that are more complicated due to the long duration of action.

Both triamcinolone acetonide and methylprednisolone acetate (Depomedrol, henryschein.com) can cause congestive heart failure in sensitive cats. This is due to an increase in plasma volume of up to 40% in cats during the first week after HA administration. This is secondary to osmotic shifts between cellular and plasma components.

These long-acting GCs should be avoided in patients with heart failure and should only be used with educated clients and close clinical monitoring of patients with murmurs.

Similarly, methylprednisolone acetate increases blood glucose levels in cats and can cause diabetes. Any cat treated with HA – especially with long-acting drugs – should be closely monitored for polydipsia, weight loss, glucosuria, or elevated serum fructosamine levels.

Bacteriuria without clinical signs develops in about 20-40% of dogs with chronic treatment with HA; females are more susceptible than males.Bacteriuria is visible even after a single treatment, and monitoring only urine sediment is unreliable because half of the positive cultures are absent in pyuria in dogs treated with HA. However, it is clear that people do not support treatment for asymptomatic bacteriuria, even in immunocompromised patients. Therefore, intermittent urine culture is probably not indicated in the treatment of dogs and cats with HA unless signs of urinary tract abnormality are found.

Source: https: // vk.com / doc180197187_438000583? hash = 7feb930d4e7f90b5bd & dl = dc9688e

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Clinical Study Infantile Spasms: Prednisolone, Vigabatrin – Clinical Trials Registry

Detailed Description

Background and rationale for the study:

Infantile spasms (IS) is a rare, catastrophic age-related epileptic syndrome with onset within the first 12 months of life. Clinically, the disorder is characterized by epileptic spasms, often accompanied by regression in development, and a characteristic interctal electroencephalography (EEG) called hypsarrhythmia, when all three of these characteristics are now commonly used the term “West syndrome”.The catastrophic nature of the disorder arises from the frequent consequences of severe global neurodevelopmental delay and medically refractory epilepsy.

The initial age of debut in 90% of cases occurs before 12 months of life, the peak occurs at 6 years. The incidence ranges from 2 to 3 per 10,000 live births with a life expectancy of 1.5 to 2 months. for 10,000 children. It is slightly more common in men, and a family history exists in 3-6% of cases. 1,2,3 The etiology of IS is conventionally divided into symptomatic and cryptogenic, depending on whether the underlying cause is known.Symptomatic AIs are diverse and can include focal or multifocal brain lesions, chromosomal abnormalities and genetic mutations, and congenital metabolic disorders. in about 20% of cases, an identifiable cause remains unknown, and they have been identified as cryptogenic.

The rate of spontaneous remission of IS in limited natural science studies is 30% .4,5 Although clinical spasms and typical EEG patterns disappear by 3-4 years, up to 60% of children with IS will develop other types of refractory seizures, including Lennox.Gastaut syndrome. Poor outcome of IS is primarily associated with etiology, however, delay in diagnosis and treatment6 and use of ineffective treatment methods EEG hypsarrhythmia is an example of epileptic encephalopathy, and there is evidence that longer epileptic encephalopathy contributes to delayed development and development of autism, especially in infants with Down syndrome and complex tuberous sclerosis (TBSC) .7,8 There are still significant differences in the management of IS today, as evidenced by the US Consensus Report and a recent survey of ongoing assessment and treatment of IS among its members ” Child ”Society of Neurologists (CNS).Most neurologists use adrenocorticotropic hormone (ACTH) as the first-line treatment of AI not induced by TSC and vigabatrin (VGB) as the first-line treatment for AI caused by TSC.9,10 American Academy of Neurology (AAN) 2004 and CNS practice parameter on the treatment of IS and the 2012 update. Evidence-based recommendations concluded that ACTH or VGB may be beneficial in the short term in treating IS, with ACTH being more effective than HBV, except in cases with TSC.11,12 The 2012 update also concluded that there was insufficient evidence to determine whether other forms of corticosteroids are as effective as ACTH. recommend other agents or combination therapy for short-term treatment of IS.

Although many conditions can cause IS, there are several hypotheses regarding the underlying mechanisms. The corticotropin releasing hormone (CRH) hypothesis is one of the most common.Elevated CRH can cause seizures and neuronal death in the hippocampus and amygdala. immature brains in animal studies. elevated CRH also causes desensitization of CRH receptors, which results in decreased ACTH release and results in decreased levels of ACTH in the cerebrospinal fluid (CSF). ACTH is likely to suppress excessive CRH production through a direct action on melanocortin receptors, causing an antiepileptic effect.13 Prednisolone is the primary a metabolite of a synthetic glucocorticoid, prednisone.Corticosteroids can reduce the excitability of the hippocampus in vitro, increase gamma-aminobutyric acid (GABA) and counteract 5-hydroxytryptophan.14 VGB is an irreversible enzyme-activated selective inhibitor of GABA transaminase: suppressing its catabolism increases the availability of GABA. in the synaptic cleft, increasing its inhibitory effect.15 Mammalian target The rapamycin pathway (mTOR) is a key signaling pathway that is not regulated in TSC. studies have shown that VGB partially inhibits mTOR pathway activity and glial proliferation.in in vitro knockout mice, and decreased activation of the mTOR pathway in cultured astrocytes from both knockout and control mice. This may explain the unique efficacy of VGB in TSC.16

At our facility, VGB is the first-line treatment of choice for all newly diagnosed IS. for its relative ease of use and fewer acute side effects compared to ACTH. concerns about retinal toxicity 17 require regular monitoring with electroretinograms (ERG) performed under sedation.18 In addition, changes on MRI associated with VGB are observed in 22-32% of cases. in children treated for IS, and although these changes are mostly asymptomatic and may disappear even when VGB continues, there are concerns that the changes reflect neurotoxic effects.19,20 For patients in whom VGB is ineffective, we use a 6-week course of synthetic ACTH. (Sinakten) is injected intramuscularly (i / m) every other day as a second-line agent. associated with significant side effects, including infections caused by immunosuppression, hypertension, weight gain, severe irritability, stomach irritation, hyperglycemia, electrolyte disturbances, cerebral atrophy, and behavior changes.

The UK Infantile Spasm Study (UKISS) has demonstrated the superiority of hormonal therapy over VGB to relieve spasms after 14 days in infants without TSC. The therapy group included patients receiving high doses of oral prednisolone and intramuscular ACTH. and the study showed that prednisolone was as effective as ACTH.21 Because this is the only Class 3 Study that provides evidence of oral prednisolone as a first-line treatment for IS, further prospective studies are needed.

Since 2010, SickKids has begun providing the option of either IM ACTH or high dose oral prednisolone as second-line therapy when a patient has failed VGB. A previous retrospective review of twenty IS patients who did not complete a 2-week course of VGB showed an 80% response (12/15) to ACTH and only 20% (1/5) to prednisone. The seemingly low response to prednisone may be related to an underlying etiology that made the condition immune to VGB in the first place.

Since the publication of the UKISS article, many institutions in the US and Australia have used oral prednisone instead of ACTH, in part due to the prohibitive cost of intramuscular ACTH ($ 70,000 per course for natural ACTH), but also its ease of use and reduced side effects profile compared with ACTH.23,24 A retrospective series of 17 newly diagnosed ISIs is presented. High doses of oral prednisolone as first-line therapy demonstrated a 100% clinical response in the cryptogenic group and 64% in the symptomatic group (without TSC).24 A retrospective series of 27 newly diagnosed ISs who received a high dose of prednisolone (8 mg / kg / day) with a maximum daily dose of 60 mg showed a response to prednisolone in 63% (17/27) within 2 weeks. 25

Choice the initial dose and 4-week treatment duration was based on previous studies that used a dose range of 4-8 mg / kg / day and 8 mg / kg / day, respectively, from 4-6 weeks of therapy. 21.23.24.25.

We decided to use the higher limit of the previously reported dose range to ensure maximum efficacy, with a shorter duration of 4 weeks of treatment to reduce the risk of drug side effects.

The recurrence rate of infantile spasms in retrospective studies ranged between 12-40%, the relapse time from 2 to 25 months. 24.25. We do not plan to use long term treatment. or intermittent intermittent treatment with prednisolone.

Prednisolone and HBV are oral medications that can be started immediately after the diagnosis of IS, accelerating treatment and shortening the delay in treatment. prednisolone may be more effective than HBV when used as first-line therapy in newly diagnosed IS patients without TSC.

and Objective: Objective – to compare the efficacy of prednisone and HBV as 1st line. short-term treatment of IS, assessed by clinical data and response to EEG after 2 weeks.

Hypothesis:

More patients on prednisolone therapy will have cessation of spasms and resolution. hypsarrhythmias for 2 weeks.

METHODS:

Study Design:

Single-center, prospective observational open-label trial using high-dose oral prednisolone as first-line treatment for newly diagnosed IS (non-tuberous sclerosis), followed up at 2 weeks of treatment, end of treatment, and then 5 months later.All patients undergo a thorough medical history, physical and neurological examination, metabolic, genetic, EEG and neuroimaging studies in accordance with the Hospital for Sick Children (HSC) guidelines for childhood spasms. 25 These patients will be compared with historical control data consisting of our IC cohort without TSC. patients from January 2010 to September 2013 who received VGB as first-line treatment passed the inclusion criteria and followed up for at least 6 months from the date of diagnosis and initiation of treatment.

Patients and their families are not required to participate in the study and will continue to receive assistance from their primary neurologists if they choose not to participate in the study.

Study Duration: The study duration for each patient is approximately 6 months. The total duration of training is estimated at 3 years.

Sample size: A sample of 70 patients in the VGB retrospective cohort and 35 patients. patients in a prospective cohort of prednisolone with a 2: 1 ratio should demonstrate a statistically significant difference in efficacy of 25% between prednisolone and Vigabatrin.

Patient group: children aged 2 to 24 months with clinical spasms and hypsarrhythmia or altered hypsarrhythmia on the initial EEG, referred to the outpatient neurology department of the Sickkids clinic.

Control group: historical control will consist of our cohort of patients with IS without TSC. from 2010-2013 who received VGB as first-line treatment and met the study inclusion criteria.

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