What are the main ocular side effects of corticosteroids. How do steroids affect intraocular pressure and cataract formation. Why is caution needed when prescribing steroids for ocular conditions. What are the risk factors for steroid-induced glaucoma.

Understanding Corticosteroids and Their Ocular Impact

Corticosteroids are powerful anti-inflammatory medications used to treat a wide range of conditions, including various ocular disorders. While highly effective, these drugs come with a significant risk of side effects, particularly when used long-term. In ophthalmology, steroids play a crucial role in managing inflammatory, autoimmune, and infectious eye diseases. However, their use requires careful consideration due to potential ocular complications.

The efficacy of corticosteroids stems from their ability to alter gene expression throughout the body, particularly downregulating inflammatory pathways. This mechanism of action, while beneficial for treating inflammation, can lead to unintended consequences in ocular tissues.

Steroid-Induced Glaucoma: A Serious Concern

One of the most significant ocular side effects of corticosteroids is steroid-induced glaucoma. This condition occurs when steroid use leads to an increase in intraocular pressure (IOP), potentially causing damage to the optic nerve and resulting in progressive, permanent vision loss.

Mechanism of Steroid-Induced Glaucoma

How do steroids cause an increase in IOP? Corticosteroids increase the expression of ocular extracellular matrix proteins, which in turn increases resistance to aqueous humor outflow from the eye. This mechanism leads to a buildup of pressure within the eye, potentially damaging the optic nerve over time.

Risk Factors for Steroid-Induced Glaucoma

Several factors can increase an individual’s susceptibility to steroid-induced glaucoma:

• Pre-existing primary open-angle glaucoma
• History of increased IOP with previous steroid administration
• Type 1 diabetes diagnosis
• Very young or very old age
• Duration and potency of steroid use

Are certain individuals more prone to developing steroid-induced glaucoma? Yes, those with the risk factors mentioned above are at higher risk and should be closely monitored when using corticosteroids.

Cataract Formation: An Accelerated Process

Long-term corticosteroid use is associated with accelerated cataract development, particularly posterior subcapsular cataracts. These cataracts form in the back of the lens and can significantly impact vision quality.

Mechanism of Steroid-Induced Cataracts

While the exact mechanism is not fully understood, it is believed that steroids induce changes in gene transcription within lens epithelial cells. This alteration in cellular function leads to the premature formation of cataracts, particularly in the posterior subcapsular region of the lens.

Can steroid-induced cataracts be reversed? Unfortunately, once cataracts form, they cannot be reversed. However, they can be surgically removed and replaced with an artificial lens, restoring vision in most cases.

Delayed Wound Healing and Increased Infection Risk

Corticosteroids, while effective in reducing inflammation, can also impair the body’s natural healing processes and immune responses. This dual effect can lead to delayed wound healing and an increased susceptibility to infections in ocular tissues.

Impact on Corneal Healing

The cornea, the clear front surface of the eye, is particularly vulnerable to the effects of steroids on wound healing. Delayed corneal epithelial healing can increase the risk of infection and potentially lead to more serious complications.

Contraindications in Certain Infections

Are there situations where steroid use is absolutely contraindicated in eye conditions? Yes, in cases of certain corneal infections, particularly herpetic keratitis, steroid use is strictly contraindicated as it can exacerbate the infection and lead to severe corneal damage.

Balancing Efficacy and Risk in Ocular Steroid Use

Given the potential for serious side effects, the use of corticosteroids in ophthalmology requires careful consideration and monitoring. Physicians must weigh the benefits of steroid treatment against the risks of ocular complications.

Monitoring Protocols

Patients on long-term steroid therapy should undergo regular ophthalmological evaluations to monitor for changes in IOP, cataract formation, and other ocular side effects. These evaluations typically include:

1. Regular IOP measurements
2. Slit-lamp examinations to assess for cataract formation
3. Funduscopic examinations to evaluate optic nerve health
4. Visual acuity testing

Alternative Treatment Considerations

In cases where the risk of ocular side effects is high, or when side effects begin to manifest, physicians should consider alternative treatment options. These may include non-steroidal anti-inflammatory drugs (NSAIDs), immunomodulators, or other targeted therapies depending on the underlying condition.

Steroid Administration Routes and Ocular Side Effects

It’s important to note that all routes of steroid administration can potentially lead to ocular side effects. This includes oral, topical, injected, and inhaled steroids.

Topical Ocular Steroids

While topical ocular steroids may seem to pose a lower risk due to their localized application, they can still lead to significant ocular side effects, particularly when used long-term or in high doses. The risk of steroid-induced glaucoma and cataract formation remains a concern with topical ocular steroid use.

Systemic Steroids

Systemic steroids, whether oral or injected, can affect ocular tissues through their systemic distribution. Patients on long-term systemic steroid therapy for non-ocular conditions should still be monitored for potential ocular side effects.

Does the risk of ocular side effects vary with different steroid administration routes? While all routes can potentially cause ocular side effects, topical ocular steroids and high-dose systemic steroids generally pose the highest risk for complications like steroid-induced glaucoma and cataracts.

Managing Ocular Side Effects of Corticosteroids

When ocular side effects of corticosteroid use are detected, prompt management is crucial to prevent permanent damage to vision and ocular structures.

Managing Steroid-Induced Glaucoma

The management of steroid-induced glaucoma typically involves:

• Discontinuation or reduction of steroid use when possible
• Initiation of IOP-lowering medications
• Regular monitoring of IOP and optic nerve health
• In severe cases, surgical intervention may be necessary

Addressing Steroid-Induced Cataracts

For steroid-induced cataracts, management options include:

• Regular monitoring of cataract progression
• Consideration of cataract surgery when vision is significantly impacted
• Exploring alternative treatments to reduce or eliminate steroid use

Can the effects of steroid-induced ocular side effects be reversed? While some effects, such as elevated IOP, may be reversible upon discontinuation of steroids, others, like cataract formation, are permanent and may require surgical intervention.

Future Directions in Ocular Steroid Therapy

Research in the field of ocular pharmacology continues to explore ways to harness the benefits of corticosteroids while minimizing their side effects. Some promising areas of investigation include:

Selective Glucocorticoid Receptor Agonists

These compounds aim to provide the anti-inflammatory benefits of steroids with a reduced side effect profile by selectively targeting specific glucocorticoid receptor pathways.

Novel Drug Delivery Systems

Advancements in drug delivery technologies, such as sustained-release implants and nanoparticle formulations, may allow for more targeted and controlled steroid delivery to ocular tissues, potentially reducing systemic exposure and side effects.

Combination Therapies

Exploring combinations of steroids with other anti-inflammatory or immunomodulatory agents may allow for lower steroid doses while maintaining therapeutic efficacy.

Will future developments eliminate the risk of ocular side effects from steroid use? While complete elimination of side effects is unlikely, ongoing research aims to significantly reduce risks and improve the safety profile of ocular steroid therapy.

In conclusion, while corticosteroids remain a vital tool in managing various ocular conditions, their use must be carefully balanced against the risk of potentially serious ocular side effects. Regular monitoring, patient education, and consideration of alternative therapies when appropriate are essential components of responsible steroid use in ophthalmology. As research continues to advance our understanding of steroid mechanisms and develop novel therapeutic approaches, the hope is that future treatments will offer the benefits of corticosteroids with a reduced risk of ocular complications.

Moran CORE | Ocular Side-Effects of Corticosteroids

Home / Basic Ophthalmology Review / Ocular Adverse Effects of Systemic Medications

Title: Ocular Side-Effects of Corticosteroids

Author(s): Sahil Aggarwal, MS4, University of California, Irvine School of Medicine; Brian Ta, MS4, University of Utah School of Medicine

Photographer: James Gilman, CRA, FOPS, Moran Eye Center Date: 07/2018

Keywords/Main Subjects:

CORE Category: Medical Student Education Outline > II. Anatomical Approach to Eye Disease > Ocular Adverse Effects of Systemic Medications > 1. Oral/topical/injected/inhaled Steroids

 BACKGROUND

From local skin reactions to systemic autoimmune disorders, corticosteroids are an essential treatment modality for a wide spectrum of disease processes. However, as efficacious as they are therapeutically, they are heavily polluted with side effects. Patients chronically taking steroids often exhibit signs of metabolic syndrome, with elevated blood sugar, hypertension, and rapid weight gain. Additional adverse effects include easy bruising, osteoporosis, and emotional disturbances.¹

In ophthalmology, steroids are predominantly used for treating inflammatory, autoimmune, and infectious diseases. They are often the first-line therapy in otherwise blinding conditions such as uveitis (inflammation of the uvea, or the pigmented layer of the eye including the iris, ciliary body and choroid) and giant cell arteritis.

There are several ocular side effects that are important to consider when prescribing steroids.² It is important to note that all methods of steroid administration, including oral, topical, and inhalation, increase the risk for ocular side effects.³ Because of these risks, steroids must be used with caution and only when necessary.

MECHANISM OF ACTION

Corticosteroids exert their efficacy by altering the way genes are expressed throughout the body. In particular, gene products that are involved in inflammatory pathways are down-regulated, reducing the activity of inflammatory cells.⁴ Specific cascades affected by steroids include cytokine production and the arachidonic acid pathway, reducing the body’s ability to regulate inflammation.⁴ While inhibition of inflammatory cascades is vital to steroids’ treatment efficacy, the down-regulation of the immune system can lead to increased risk of infection.

OCULAR SIDE EFFECTS

There are four important ocular side effects of corticosteroids: steroid-induced glaucoma, cataract formation, delayed wound healing, and increased susceptibility to infection.

 Glaucoma

Figure 1: A fundus photo of the optic nerve showing increased cupping, a risk factor for glaucoma.

 Glaucoma is a condition in which there is damage to the optic nerve, often related to elevated intraocular pressure (IOP). The result of this damage is a progressive, permanent vision loss. Steroid use can cause an increase in IOP by increasing the expression of ocular extracellular matrix proteins, thus increasing resistance to the outflow of aqueous from the eye.⁵ The risk of steroid-induced glaucoma depends on the duration of use and potency of the steroids themselves as well as the individual’s baseline risk for glaucoma.^6-8 The risks factors that have been identified to place someone at risk for a steroid-induced increase in IOP include: pre-existing primary open angle glaucoma, a history of increased IOP with previous steroid administration, a diagnosis of Type 1 diabetes, or those who are very young or very old.⁹ Patients who are taking steroids long-term should be regularly evaluated by ophthalmology for IOP changes, and consideration for non-steroid medications should always be made.

 Cataracts

Figure 2. Example of a posterior subcapsular cataract, the type of cataract that often forms from chronic steroid use. Photographer: James Gilman, CRA, FOPS, Moran Eye Center11

Cataracts are a common finding in aging adults and are safely removed and replaced with an artificial lens during cataract surgery. Long-term steroid use is associated with an accelerated development of cataracts. While the mechanism of cataract development in this setting is not well understood, it is thought to involve steroid-induced changes in gene transcription within lens epithelial cells.¹⁰ Classically, the type of cataract associated with steroid use is called a posterior subcapsular cataract, which forms in the back of the lens (Figure 1).¹¹ Patients on steroids who are experiencing reduced vision should be evaluated by an ophthalmologist.

Delayed Wound Healing and Risk of Infection

Figure 3: Fluorescein staining of a dendritic ulcer, pathognomonic for herpetic keratitis.   This is a type of corneal ulcer where steroids are absolutely contraindicated due to the risk of worsening the infection.

Steroids are often used in conjunction with topical antibiotics in ocular infections such as corneal ulcers. However, previous research has identified that steroids inhibit growth factors critical in wound healing.¹² Similarly, without co-treatment with antibiotics, local ocular infections that are treated with steroids may become worse, especially viral infections such as herpetic keratitis.¹² While local steroid therapy is valuable in infections of the eye, owing to their ability to reduce inflammation and scarring, these benefits must be weighed against the risk of recurrent infection and poor wound healing and require the close monitoring of an eye specialist.

 CONCLUSION

Corticosteroids are vitally important in treating several systemic and local inflammatory or autoimmune conditions. While therapy is associated with side effects, including steroid-induced glaucoma, cataracts, poor wound healing, and progressing infections, these effects can be mitigated with attentive monitoring. ¹³ Non-ophthalmologists should strongly consider referring any patient on prolonged systemic steroids to an eye-care specialist for monitoring for glaucoma and cataracts.  The decision to prescribe topical steroids can be complex and should involve an ophthalmologist.

 REFERENCES

1. Buchman AL. Side effects of corticosteroid therapy. J Clin Gastroenterol 2001;33:289–94.
2. Renfro L, Snow JS. Ocular effects of topical and systemic steroids. Dermatol Clin
1992;10:505–12.
3. Daniel BS, Orchard D. Ocular side-effects of topical corticosteroids: what a dermatologist
needs to know. Australas J Dermatol 2015;56:164–9.
4. Comstock TL, DeCory HH. Advances in Corticosteroid Therapy for Ocular Inflammation:
Loteprednol Etabonate. Int J Inflam 2012;2012.
5. Phulke S, Kaushik S, Kaur S, et al. Steroid-induced Glaucoma: An Avoidable Irreversible
Blindness. J Curr Glaucoma Pract 2017;11:67–72.
6. Francois J. Cortisone et tension oculaire. Ann D’Oculist 1954; 187: 805.
7. Cantrill HL, Palmberg, Zink HA, Waltman SR, Podos SM, Becker B. Comparison of in
vitro potency of corticosteroids with ability to raise intraocular pressure. Am J
Ophthalmol 1975; 79: 1012–1017.
8. Francois J. Corticosteroid glaucoma. Ann Ophthalmol 1977; 9: 1075–1080.
9. Goñi FJ, Stalmans I, Denis P, et al. Elevated Intraocular Pressure After Intravitreal Steroid
Injection in Diabetic Macular Edema: Monitoring and Management. Ophthalmol Ther
2016;5:47–61.
10. James ER. The etiology of steroid cataract. J Ocul Pharmacol Ther 2007;23:403–20.
11. Moran CORE | Cataracts. http://morancore.utah.edu/medical-student-education-
outline/cataracts/ (accessed 28 Jul 2018).
12. Srinivasan M, Mascarenhas J, Rajaraman R, et al. The Steroids for Corneal Ulcers Trial.
Arch Ophthalmol 2012;130.
13. Abelson MB, Butrus S. Corticosteroids in ophthalmic practice. Chapter 23. In: Albert DM et
al., eds. Albert & Jakobiec’s Principles and Practice of Ophthalmology, 3rd ed.
Philadelphia: Saunders Elsevier; 2008.

Side Effects, Symptoms, and More

Doctors prescribe corticosteroids to reduce inflammation in the body. These steroids are different from anabolic steroids, which are medications that are chemically similar to the male hormone testosterone. Corticosteroids stimulate the production of cortisol.

Anti-inflammatory steroids can affect your eyes and vision in different ways. As a general rule, the longer you take them or the higher the dose, the more likely side effects can occur.

The most concerning potential side effects of the eyes can be glaucoma and cataracts.

While steroids can cause side effects, doctors prescribe them for important reasons. Examples include treating immune disorders, cancer, or inflammatory conditions. A doctor will weigh the risks and benefits before prescribing them.

Some people may be more sensitive to steroids than others, including the effects on their eyes. People who are more likely to experience side effects of the eyes or vision include those who:

• have diabetes mellitus
• have a family history of open-angle glaucoma
• have a history of rheumatoid arthritis
• are very nearsighted

Older people are also more sensitive to the eye effects of steroids as well as children younger than 6 years old.

Duration

The longer a person takes steroids, the more at risk they are for complications.

A person’s eye pressure can increase after a few weeks of taking steroids. However, some people’s eye pressure may increase only an hour after taking steroids, according to one 2017 review.

Taking higher-dose steroids then tapering to a lower dose is less likely to cause cataracts than taking a lower steroid dose over a longer period of time, according to the American Academy of Ophthalmology. There are some exceptions, depending on why you’re taking the steroids.

If you take steroids in any form for more than two weeks, talk to your doctor about whether you should go to your eye doctor to monitor your eye pressure.

Pharmaceutical manufacturers make steroids in a variety of ways. All of them can affect a person’s vision. Examples include:

• eye drops
• inhalation, such as during breathing treatments and inhalers
• injections
• ointments
• pills

Doctors prescribe steroids for a variety of reasons. They often prescribe steroid eye drops to:

• reduce inflammation after eye surgery
• treat uveitis (eye inflammation)
• minimize damage to the eye after injury

Doctors may prescribe oral, inhaled, or topical steroids to minimize conditions such as:

• eczema
• atopic dermatitis
• asthma
• arthritis
• skin problems, such as rashes or allergic reactions

Taking steroids can raise your eye pressure. This is true for the many steroid forms.

Eye drops and oral medications are more likely to cause eye issues. Very high doses of inhaled steroids can also cause side effects in the eyes.

Cataracts

Taking steroids can cause a cataract type doctors call posterior subcapsular cataracts. It causes a small, cloudy area to form underneath the eye’s lens.

While cataracts are a known side effect for some people when taking steroids, they’re highly treatable.

If a person doesn’t take steroids for their eyes as directed, they can be at risk for more dangerous and less treatable side effects, such as ciliary body fibrosis maculopathy. Both of these conditions involve damage to parts of the eye.

Central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is a condition that causes fluid to build up under the retina. This can cause retinal detachment and problems seeing.

CSC is most common in young and middle-aged adults, according to the American Society of Retina Specialists.

If a doctor detects CSC early, stopping the steroids may be enough to help restore a person’s vision. There are other treatments available to treat those with chronic CSC problems.

Glaucoma

Taking steroids can cause steroid-induced glaucoma. While doctors don’t exactly know why this occurs, they have some theories.

For corticosteroids, they think that the medicines stop cells that “eat” debris in the eye cells. This leads to a buildup of debris in the aqueous material of the eye. The extra debris can make it harder for aqueous solutions to leave the eye, which increases eye pressure.

Talk to your doctor if you’re taking steroids and have the following eye problems:

Cataract symptoms

Cataract symptoms can include:

• blurry vision
• colors that seem faded
• double vision
• eyelid drooping
• “halo” or blurred effect around lights
• problems with peripheral (side) vision
• problems seeing at night

Central serous chorioretinopathy

This condition doesn’t always cause symptoms. However, you could experience some blurry vision in one or both eyes.

Objects may seem smaller or farther away when you look at them with the eye that’s affected. Straight lines may look twisted or misshapen.

Glaucoma symptoms

One of the problems with taking steroids is that you don’t always have symptoms until the condition has progressed. Glaucoma is one example of this. Some glaucoma symptoms can include:

• blurry vision
• eye pain
• nausea
• problems seeing, especially in low light
• problems with peripheral (side) vision
• red eyes
• tunnel vision
• vomiting

For this reason, it’s important you visit your eye doctor at regular intervals, usually every six months. Your doctor can check your eye pressure and the general health of your eyes and diagnose any developing conditions early.

In addition to eye issues, chronic steroid use can also cause a number of other side effects. These include:

• delayed wound healing
• frequent infections
• osteoporosis and bones that break more easily
• thinning skin
• weight gain

If you have these symptoms, talk to your doctor. They may change your dosage, type of medication, or discontinue steroid use altogether.

Ideally, if you can taper or stop taking steroids, your symptoms will improve.

According to a 2017 review, a person’s eye pressure usually decreases within one to four weeks after they stop using steroids.

If you regularly take steroids, you’re at greater risk for infections. These include the flu and pneumonia. Always get a flu shot if you take steroids. Your doctor may also recommend getting the pneumonia shot.

Here are other ways you can improve your health when you take steroids:

• Drink plenty of water. Steroids can increase your retention of sodium, which can cause bloating. Drinking enough water on a daily basis can promote the body’s water release.
• Eat plenty of calcium. This can reduce osteoporosis and bone-thinning side effects. Examples of calcium-rich foods include:
  • cheese
  • milk
  • yogurt
  • spinach
• Exercise regularly. Taking steroids can change how your body deposits fat. By exercising, you can help maintain a healthy weight as well as healthy bones.
• Refrain from smoking. Smoking can thin the bones and increase your risk for bone-related side effects.
• Take your steroids in the morning, if possible. Steroids can make getting enough sleep difficult because you often feel more alert. Taking them in the morning can help you get sleep at night.

In addition to these tips, always talk to your doctor if you experience changes in your vision.

Sometimes it’s possible to take other medicines to relieve inflammation instead of steroids. Examples include taking nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen and naproxen sodium.

A variety of steroids are available on the market. Sometimes doctors can prescribe an alternate steroid option that doesn’t increase eye pressure as much.

Examples of these steroids include fluorometholone and loteprednol etabonate.

They can also serve as alternatives to steroids known to increase eye pressure. Those include:

• betamethasone
• dexamethasone
• prednisolone

Sometimes your doctor can reduce the steroid dose or have you take them every other day to reduce eye side effect risks.

In addition to these steroid alternatives, some doctors may taper or reduce steroid dosages in favor of medications known as immunomodulatory agents. Examples of these medicines include methotrexate and infliximab.

If you take any steroid type for more than two weeks, it’s a good idea to talk to your doctor about how the medication might affect your eyes.

Don’t ever stop taking steroids on your own without your doctor’s advice. Suddenly stopping taking steroids can cause side effects, such as:

• joint pain
• muscle tenderness
• fever
• fatigue

Some of the questions you may want to ask your doctor about taking steroids and eye changes include:

• Am I at higher risk for eye problems from steroids?
• Is there another drug I could take instead of steroids?
• Is this the lowest dose of this steroid that might work for me?

If your medical condition means you can’t stop taking steroids, your doctor may suggest preventive methods. This includes taking anti-glaucoma medicines (such as eye drops) to keep your eye pressure from getting too high.

Steroids are some of the most common medications doctors prescribe. Because many people take them for such a short amount of time, doctors aren’t usually worried about eye side effects.

However, if you take steroids for longer than two weeks, talk to your doctor about how you should monitor your vision. Your doctor may also recommend preventive techniques or prescribe alternative medications.

instructions for use, indications, composition, side effects

Ointment white.

Per tube: active ingredient – prednisolone – 50 mg;

excipients – glycerin, soft white paraffin, stearic acid, emulsifier No. 1, methyl parahydroxybenzoate, propyl parahydroxybenzoate, purified water.

Corticosteroids for external use in dermatology. Corticosteroids are weakly active (group I).

ATC code: D07AA03.

Prednisolone is a synthetic glucocorticosteroid, a drug for topical use. It has anti-inflammatory, anti-allergic, anti-edema effect. It inhibits the release of inflammatory mediators (histamine, prostaglandins, leukotrienes, lysosomal enzymes). Suppresses the skin inflammatory response, reduces vasodilation and increased vascular permeability in the focus of inflammation, reduces itching and pain at the site of application.

As part of the complex therapy of inflammatory and allergic diseases of the non-microbial skin. etiology: urticaria, eczema, allergic and seborrheic dermatitis, psoriasis, lupus erythematosus, erythroderma.

The ointment is applied in a thin layer to the affected areas of the skin, 1-3 times a day, gently rubbing. The duration of the course of treatment depends on the nature of the disease and the effectiveness of therapy, usually 6-14 days. Do not use the drug for longer than 14 days. It is necessary to stop treatment gradually, increasing the intervals between applications or switching to drugs that do not contain corticosteroids.

Children. When prescribing the drug to children older than 1 year, the total duration of treatment should be limited to 3-7 days and measures leading to increased absorption of corticosteroids (warming, fixing and occlusive dressings, diapers) should be excluded.

From the immune system: very rarely – allergic skin reactions (itching, rash, urticaria).

From the side of the skin and subcutaneous tissue: skin irritation (burning, redness), dry skin at the site of application of the ointment. With prolonged use: skin atrophy (sometimes irreversible), telangiectasia, striae, steroid acne, perioral dermatitis, purpura, changes in skin pigmentation, hypertrichosis, impaired wound healing, development of secondary skin infections.

On the part of the endocrine system: with prolonged use, use on large areas of the skin, application under occlusive dressings or in the area of ​​skin folds, hypercortisolism may develop (hyperglycemia, glucosuria, reversible inhibition of the function of the adrenal cortex, signs of Cushing’s syndrome), as a manifestation of the resorptive action of prednisolone .

In this case, the drug should be discontinued.

In children, due to the relatively larger surface of the skin, compared with body weight, the risk of decreased adrenal function is higher. Prolonged use of topical glucocorticosteroids may affect the growth and development of children.

If you experience any of the above side effects or any side effects not listed in this leaflet, seek medical advice.

Hypersensitivity to the components of the drug, Cushing’s syndrome, chickenpox, vaccination period, herpes simplex, wound or ulcerative lesions, bacterial or viral and fungal skin diseases, skin tuberculosis, skin manifestations of syphilis, skin tumors, acne vulgaris, acne rosacea, perioral dermatitis, children’s age up to 1 year, pregnancy, breastfeeding period.

Overdose may increase the manifestations of adverse reactions. With prolonged use of the drug in large doses, symptoms of hypercortisolism may appear. Symptoms: headache, increased blood pressure, heart failure, hyperglycemia, glucosuria.

In case of overdose symptoms, you should consult a doctor. Under the supervision of a doctor, a gradual withdrawal of the drug, symptomatic treatment is carried out. In severe cases, emergency medical attention is needed.

The drug should be prescribed in the smallest dosages and in the shortest possible time necessary. to achieve the desired therapeutic effect. If there is a history of indications of psychosis, high doses are prescribed under the strict supervision of a physician. With prolonged use of the drug, abrupt cancellation is dangerous. It is possible to exacerbate the disease and worsen the general condition of the patient. Therefore, the drug should be discontinued gradually. In the process of treatment, it is necessary to control the oculist, control blood pressure. Treatment should be carried out under the supervision of a physician. In order to reduce the development of adverse reactions, corticosteroids and nonsteroidal drugs should be alternated. The maximum allowable area of ​​skin treated with corticosteroids should not exceed 20% of the body surface. Corticosteroids should be used in short courses and only for the treatment of an exacerbation, but not for prevention. To prescribe prednisolone, one should take into account the daily secretory rhythm of glucocorticosteroids, the rhythm of the release of hormones of the adrenal cortex: in the morning, large doses are prescribed, in the afternoon – medium, in the evening – small. In the case of use in acne vulgaris or rosacea, an exacerbation of the disease is possible. Avoid getting the drug on the mucous membrane of the organs of vision. Caution should be used in immunodeficient states (including AIDS or HIV-infected). On the skin of the face, armpit and inguinal region, the drug is recommended to be used with caution, since its absorption increases and the risk of adverse reactions increases. Do not apply the drug to areas with atrophied skin.

As with other topical corticosteroids, prednisolone should not be applied to the skin around the eyes due to the risk of developing glaucoma or subcapsular cataracts.

Corticosteroids may mask the symptoms of an allergic reaction to any of the components of the drug.

In elderly patients, the drug should be used with caution, as they may be more sensitive to its effects due to thinning of the skin.

When using glucocorticoids, the risk of secondary skin infections increases. In case of infection, it is necessary to prescribe appropriate therapy with the use of antibacterial and / or antifungal drugs.

The drug should be used with caution in patients with psoriasis, since topical use of glucocorticoids can be dangerous due to the possibility of relapse of the disease, the development of tolerance, the risk of generalization of pustular psoriasis, the development of local or systemic toxicity due to impaired skin barrier function.

Corticosteroids can change the appearance of some skin lesions, making the diagnosis difficult.

Due to the content of parahydroxybenzoates in the composition after the use of the drug, the development of allergic reactions (including delayed ones) is possible.

In children older than one year, use with caution, under the supervision of a physician. It is necessary to limit the total duration of treatment and exclude activities leading to increased resorption and absorption of the drug. Do not use for the treatment of “diaper” dermatitis. Due to the fact that in children the ratio of area to body weight is greater than in adults, children are at greater risk of suppression of the function of the pituitary-adrenal system and the development of Cushing’s syndrome when using topical corticosteroids. With prolonged use of the drug in children, it is necessary to monitor body weight, height, and plasma cortisol levels.

The drug is contraindicated in pregnant women. Nursing mothers are advised to stop breastfeeding for the period of treatment.

Studies evaluating the effect on the ability to drive a car or work with machinery have not been conducted. Given the profile of adverse reactions of the drug, no effect on the speed of reaction when driving vehicles or working with other mechanisms is expected.

With topical application of prednisolone in the form of an ointment, drug interactions are not described. During the period of treatment, vaccination against smallpox or other types of immunization should not be carried out, especially with prolonged use of the drug on a large surface area of ​​​​the skin.

Store at temperatures between 8°C and 15°C.

Keep out of the reach of children.

2 years.

Do not use after the expiry date stated on the packaging.

10 g in tubes. Each tube, along with instructions for use, is placed in a pack.

On prescription.

Manufacturer

RUE “Belmedpreparaty”

Republic of Belarus, 220007, Minsk,

st. Fabriciusa, 30, t./f.: (+37517) 220 3716,

e-mail: [email protected]

Prednisolone: ​​Effects, Indications, Side Effects

Prednisolone belongs to the group of synthetic, that is, artificially obtained glucocorticoids. Glucocorticoids are hormones that release stored energy in the body and increase the body’s motivation. Colloquially, a group of glucocorticoids is called cortisone (medical spelling: cortisone). Prednisolone suppresses, as well as cortisone, the natural protective function – it acts in this way, immunosuppressive, anti-inflammatory (anti-inflammatory) and anti-allergic.

How does prednisone work?

Prednisolone prevents inflammatory cells from entering damaged tissue and induces an inflammatory response (often excessive and painful). In addition, prednisolone affects carbohydrate and lipid metabolism. In addition, it has many other effects on the body and, for example, also affects the connective tissue or salt and water balance.

See also

• examination
• surgery
• applications
• Correct Use
• Side Effects
• Important Notes
• Tax Regulations
• History
• More Interesting Facts About Prednisolone

When is Prednisolone Used?

The anti-inflammatory and anti-allergic effect of prednisolone is used among others in:

• Chronic polyarthritis (“rheumatic” inflammation of the joints) and other diseases of the rheumatic type
• inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Autoimmune diseases such as collagenosis or lupus erythematosus
• allergic shock
• allergic or inflammatory eye diseases
• Sudden hearing loss

ic lack of cortisone in the body, which may be due to with adrenal insufficiency (Addison’s disease).

Here’s how prednisolone is used

Prednisolone is usually systemic, ie for internal use. The active substance is available both in the form of tablets, which is the most common form of administration, and in the form of a solution for suppositories, infusions or injections, which is used in emergency therapy, in necessary high doses or in hospital treatment.

Prednisolone ointment, creams, drops or tinctures should also be used if used only locally.

Prednisone ophthalmic ointment is used for allergic conjunctivitis and other inflammatory eye conditions.

What are the side effects of prednisone?

Acute side effects of prednisolone include:

• increased susceptibility to infections due to immunodeficiency effect
• redistribution of body fat with possible increase in torso area (Stammfettsucht)
• Muscle tissue degradation and muscle weakness
• Changes in appetite, indigestion (eg inflammation of the stomach lining and stomach ulcers)

Other less common side effects of prednisone:

• Gray or green star
• High blood pressure
• Thinning of the skin
• Bone loss (osteoporosis)

Prednisolone eye ointment can also significantly reduce vision and responsiveness in traffic.

When using prednisolone, it should be noted that long-term use does not exceed the so-called ingestion threshold of 7.5 milligrams per day, since the risk of unwanted side effects increases significantly. A high dose of prednisone – about 1,000 milligrams a day – is only used for a few days of ongoing shock therapy.

Prednisolone and alcohol are not well tolerated, especially at high doses. Thus, the effect of prednisolone can be reduced. Many patients also report that they are less tolerant of alcohol while taking prednisone. At a high dose of prednisolone, the combination may cause severe hypoglycemia or hypoglycemia. Therefore, the general recommendation is not to take prednisolone and alcohol at the same time.

What should be considered when taking Prednisolone?

Since the effect of prednisolone is, among other things, to suppress the immune system, this drug should not be treated for acute viral infections (eg, chicken pox, herpes), prior to vaccination, or swollen lymph nodes.

In pre-existing diabetes mellitus, and in particular in hypertension that is difficult to control, treatment with prednisolone should be avoided as far as possible or under the supervision of a physician. Prednisolone also affects the patient’s mood and ability to concentrate. Therefore, they should not participate in traffic or operate machinery while taking high doses of prednisone.

During treatment with prednisone, iodine uptake by the thyroid gland may be reduced. Therefore, the level of the thyroid gland should be checked regularly. If possible, prednisolone should not be used during pregnancy and lactation, as the side effects of prednisolone can also be passed on to the baby.

In addition, interactions with other drugs may occur. Therefore, any treatment with cortisone prednisolone should be regularly checked by a doctor.

This is how you get medicines containing prednisolone

Medicines containing prednisolone are prescription drugs. The type and amount of dosage depends on the disease, severity and other individual factors. Especially in children, the preparation is precisely adapted to the size, age and body weight.

Since when is prednisolone known?

Prednisolone was developed in 1957 by the German pharmaceutical company Merck and brought to market. It quickly supplanted other cortisone products in use at the time due to its versatility and action profile, and has since become one of the best-selling drugs on the international market.

More interesting facts about Prednisolone

Side effects of prednisolone may be exacerbated by abrupt discontinuation after long-term treatment. In addition, the patient’s natural hormonal balance may be disrupted because the body stops its own production of cortisone during treatment. Therefore, prednisolone should be excluded. This means that prednisolone is reduced over a longer period of time in both daily and single doses before it can be permanently discontinued. For weight loss, prednisolone is not necessary for just a few days of therapy.

FAQ – 💬

❓ What is prednisone used for?

👉 Prednisolone is a synthetic glucocorticoid drug. It has anti-inflammatory, anti-allergic, immunosuppressive, anti-exudative and antipruritic effects. The immunosuppressive effect is associated with inhibition of the release of cytokines from lymphocytes and macrophages.

❓ What are the dangers of taking prednisolone?

👉 Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone thinning) can develop, which ultimately leads to bone fractures. But this condition can also be prevented by taking calcium and Vitamin D supplements.

❓ How does prednisone affect the body?

👉 PREDNISOLINE has an anti-shock, anti-allergic, anti-inflammatory effect. With prolonged use, it inhibits the synthesis and secretion of ACTH by the pituitary gland and, secondarily, the secretion of corticosteroids by the adrenal glands. After intravenous administration of , prednisolone binds to the blood plasma globulin – transcortin.

❓ What are the side effects of prednisone?

👉 Side effects : From the gastrointestinal tract: vomiting, pancreatitis, bleeding and perforation of the gastrointestinal tract, flatulence, hiccups, nausea, steroid gastric and duodenal ulcers, esophagitis, increased or decreased appetite, increased activity of liver enzymes .

❓ What diseases does prednisone treat?

👉 skin diseases: pemphigus, eczema, psoriasis, exfoliative dermatitis, atopic dermatitis, diffuse neurodermatitis, contact dermatitis (with damage to a large surface of the skin), toxidermia, seborrheic dermatitis, toxic epidermal necrolysis (Lyell’s syndrome), bullous dermatitis herpetiformis , malignant . ..

❓ When is prednisolone given?

👉 Prednisolone is used for emergency therapy in conditions requiring a rapid increase in the concentration of glucocorticosteroids in the body: shock (burn, traumatic, surgical, toxic, cardiogenic) – with the ineffectiveness of vasoconstrictors, plasma-substituting drugs and other symptomatic therapy; . ..

❓ What hormone is in Prednisolone?

👉 Hormonal drugs (including contraceptives) are also dangerous: since prednisone itself is a derivative of cortisol, it can enhance their effect.

❓ When is prednisolone prescribed?

👉 Use of substance Prednisolone resistant to other therapy; myocardial infarction; acute adrenal insufficiency; cirrhosis of the liver, acute hepatitis, acute hepatic and renal insufficiency; poisoning with caustic fluids (in order to reduce inflammation and prevent cicatricial narrowing).

❓ Why should prednisolone be taken with milk?

👉 These are NSAIDs butadion, indomethacin, diclofenac, etc., glucocorticosteroids prednisolone , dexamethasone and others, reserpine, the speed and completeness of absorption of which increases when interacting with milk , while forms milk protective film on the gastrointestinal mucosa and thus reducing the aggressive effect on it.

❓ How many days is prednisolone given?

👉 The duration of administration depends on the therapeutic effect, usually up to 6 days .