Prednisone

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[edit] BRAND NAMES

[edit] STRUCTURE

Prednisone.jpg

[edit] MECHANISM OF ACTION

  • Decreases inflammation
  • Supression of immune system

[edit] INDICATIONS

  • As an anti-inflammatory or immunosuppressive agent for certain allergic, dermatologic, gastrointestinal, hematologic, ophthalmologic, nervous system, renal, respiratory, rheumatologic, specific infectious diseases, organ transplantation, autoimmune disease
  • Treatment of certain endocrine conditions: Congenital adrenal hyperplasia, Hypercalcemia of malignancy, Nonsuppurative thyroiditis, Primary or secondary adrenocortical insufficiency.
  • Chemotherapy adjunct (Acute leukemia, Aggressive lymphomas)

[edit] DOSAGE

  • Individualize dosing based on disease severity and patient response.
  • Take orally with food
  • Advoid abrupt withdrawal with long-term therapy

[edit] CONTRAINDICATIONS

  • Serious infections, except Tuberculous meningitis
  • Systemic fungal infections
  • Varicella

[edit] WARNINGS AND PRECAUTIONS

  • Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia: Monitor patients for these conditions with chronic use. Taper doses gradually for withdrawal after chronic use.
  • Infections: Increased susceptibility to new infection and increased risk of exacerbation, dissemination, or reactivation of latent infection.
  • Elevated blood pressure, salt and water retention, and hypokalemia: Monitor blood pressure and sodium, potassium serum levels
  • GI perforation: increased risk in patients with certain GI disorders (e.g. Peptic ulcer)
  • Behavioral and mood disturbances: Corticosteroids use may be associated with central nervous system effects ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
  • Decreases in bone density: Monitor bone density in patients receiving long term corticosteroid therapy.
  • Ophthalmic effects: May include cataracts, infections, and glaucoma. Monitor intraocular pressure if corticosteroid therapy is continued for more than 6 weeks.
  • Live or live attenuated vaccines: Do not administer to patients receiving immunosuppressive doses of corticosteroids.
  • Negative effects on growth and development: Monitor pediatric patients on long-term corticosteroid therapy.
  • Use in pregnancy: Fetal harm can occur with first trimester use. Apprise women of potential harm to fetus.

[edit] INTERACTIONS

  • Warfarin: Co-administration of corticosteroids and warfarin usually results in inhibition of response to warfarin
  • Antidiabetic agents: May increase blood glucose concentrations. Dose adjustments of antidiabetic agents may be required.
  • CYP3A4 inducers and CYP3A4 inhibitors: May, respectively, increase or decrease clearance of corticosteroids, necessitating dose adjustment.
  • Cyclosporine: Increase in activity of both, cyclosporine and corticosteroid when administered concurrently. Convulsions have been reported with concurrent use.
  • NSAIDs including aspirin and salicylates: Increased risk of gastrointestinal side effects

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category D (US). Prednisolone can cause fetal harm when used in pregnancy. Prednisone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

[edit] SIDE EFFECTS

Common adverse reactions for corticosteroids include fluid retention, hyperglycemia, hypertension, behavioral and mood changes, increased appetite, weight gain, impaired wound healing

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES