Prednisolone overdose consequences. Side effects when using prednisolone

Included in the preparations

Interaction:

Salicylates - increase the likelihood of bleeding.

Diuretics - disturbances of electrolyte metabolism.

Hypoglycemic drugs - reduce the rate of decrease in blood glucose levels.

Cardiac glycosides - risk of glycoside intoxication.

Rifampicin - weakening of the effect of rifampicin.

Antihypertensive drugs - reducing their effectiveness.

Rifampicin, barbiturates and - decreased effect of the drug.

Reduced effect of the drug when taken together with somatropin, antacids (decreased absorption).

Increased effect of the drug when taken simultaneously with estrogen-containing oral contraceptives.

Acetylsalicylic acid - reduces the concentration of salicylates in the blood.

Antipsychotics - risk of developing cataracts.

M-anticholinergics, nitrates - increase intraocular pressure.

special instructions:

During treatment, observation by an ophthalmologist, monitoring of blood pressure and water-electrolyte balance, and peripheral blood patterns are necessary.

For psoriasis, take under strict medical supervision.

At diabetes mellitus Use only for absolute indications.

Influence on the ability to drive vehicles and operate machinery.

Instructions

Prednisolone is a hormonal medication that is commonly used for acute illnesses and life-threatening conditions. When is it prescribed to children and in what form is it used? How does this medication work on a child’s body, and what side effects may occur in a child when treated with Prednisolone?

Release form

Prednisolone is manufactured by several companies, and sometimes there is a word next to the name of the medication indicating the manufacturer (for example, Prednisolone Nycomed). The drug is presented in the following types.

• Pills. They are usually flat-cylindrical and white in color, and one pack contains from 10 to 120 tablets (most often polymer bottles of 100 pieces are produced).
• Ointment, which is used for external processing. This is a thick white mass placed in aluminum tubes in quantities of 10 g or 15 g.
• Ampoules with solution, which can be injected into a muscle or injected into a vein. Such ampoules contain 1 or 2 ml of a clear solution. The liquid is colorless, yellowish or yellow-greenish. One package includes 3, 5 or more ampoules.

Prednisolone is not available in suppositories, drops, capsules, syrup or other forms.

Compound

All dosage forms of the drug contain prednisolone as the main ingredient. It is presented in the following dosages:

• in 1 tablet – 1 mg or 5 mg;
• in 1 ml of solution for injection - 15 mg or 30 mg in the form of sodium phosphate;
• in 1 gram of ointment – ​​5 mg.

Excipients in different forms and medicines for different manufacturers differ, so the exact composition should be found in the instructions or on the packaging of a particular medication.

Operating principle

Prednisolone is a synthetic hormone from the group of glucocorticosteroids and acts similarly to hormonal compounds that are produced in the adrenal glands.

This substance:

• relieves shock and prevents death in shock;
• quickly and effectively eliminates the inflammatory process, regardless of its severity and location;
• suppresses exudation - active release of fluid from inflamed tissues;
• stops the development of an allergic reaction and eliminates allergy symptoms such as rash, swelling, itching and others;
• stops the active proliferation of cells at the site of damage, thereby preventing the appearance of scars;
• suppresses the immune system.

All these effects of Prednisolone develop very quickly, and the effect of the drug itself is very strong, so it is used in life-threatening situations or in cases where other medications have been ineffective. If there is a possibility of replacing such a medicine with other drugs, it should be used.

Prednisolone also has the following properties:

• stimulation of protein breakdown in tissues and bloodstream, as well as the synthesis of protein molecules in liver cells;
• increased blood glucose levels;
• retention of Na+ and water, which causes swelling;
• increased excitability of nerve cells in the brain;
• reducing potassium absorption in the gastrointestinal tract and stimulating its excretion from the body;
• redistribution of fat reserves with an increase in its amount in the upper body;
• lowering the threshold for convulsive readiness;
• inhibition of the production of glucocorticoids, as well as FSH and TSH.

Such effects of the drug are not therapeutic, but must be taken into account, since they are the ones that cause side effects.

Indications

Prednisolone ointment is prescribed for eczema, atopic dermatitis, contact dermatitis, toxicerma, psoriasis and other skin diseases. In addition, this form is prescribed for tendovaginitis, bursitis and keloid scars.

At what age is it prescribed?

There are no age restrictions for treating children with Prednisolone, but due to the fact that such a medication can negatively affect growth processes in childhood, this hormone is prescribed only if there are serious indications and only under medical supervision.

In addition, it is important not to forget that such a remedy is used only for acute conditions and they always try to prescribe it in the minimum dose and for the shortest possible period.

Contraindications

If Prednisolone is prescribed to a child for health reasons, then there is only one contraindication for its use - intolerance to such a medicine. However, many diseases require increased attention from a doctor when prescribing Prednisolone. Such diseases include various gastrointestinal pathologies, infections (chickenpox, measles, herpes, tuberculosis, etc.), endocrine diseases, severe liver pathologies, glaucoma, and so on.

If a child has a serious illness, the issue of using Prednisolone is decided individually.

Side effects

During treatment with Prednisolone injections or tablets, various negative effects may be observed, For example:

• vomiting or nausea;
• decreased adrenal activity;
• decreased glucose tolerance;
• development of Itsenko-Cushing syndrome;
• change in appetite;
• development of diabetes mellitus (called steroid diabetes);
• the appearance of erosive esophagitis, bleeding from the wall of the stomach or intestines, as well as steroid ulcers of the gastrointestinal tract;
• growth slowdown;
• delayed sexual development;
• irregular heartbeat, increased blood pressure, bradycardia;
• bloating;
• mental disorders such as depression or paranoia;
• increase in intracranial or intraocular pressure;
• headaches or insomnia;
• increased sweating;

Side effects

• weight gain;
• eye infection (secondary);
• the appearance of peripheral edema;
• weakness, fatigue, muscle pain and other symptoms of hypokalemia;
• the appearance of stretch marks or acne;
• allergic reactions in the form of skin rash, itching or other symptoms;
• exacerbation of infectious diseases;
• withdrawal syndrome.

The use of ointment can provoke the appearance of “stars”, skin itching, excessive dryness, acne, burning and other skin problems.

If a large area of ​​skin is treated with this Prednisolone, the effects of treatment will be similar to the side effects from injections or taking pills.

Instructions for use

The form of the medication, the required dosage and duration of use of Prednisolone are determined by the doctor, taking into account many factors, including the diagnosis, the patient’s condition, the age of the child, and his weight in kilograms. Prednisolone for injection can be administered intravenously either as a bolus or through a dropper (the medicine must be diluted with saline). It is intravenous injections that are used in acute conditions when immediate assistance is required.

If injections into a vein are not possible, the medicine is administered intramuscularly, and if the condition improves, the injections are replaced with tablets. If the drug is prescribed for a long period, it should be discontinued gradually, reducing the daily dose. The longer the treatment was carried out, the slower the medicine was discontinued.

Prednisolone tablets are most often given once at 6-8 am, since it is at this time that glucocorticoids are released in the human body. If the dosage is very large, it can be divided into several doses. In this case, the medication is given in a larger dose in the morning, and the remaining amount is taken at 12 o’clock. Taking Prednisolone tablets is recommended during meals or immediately after meals. The medicine is taken with a small volume of liquid.

Overdose

If the dose of the drug is too high, blood pressure increases, swelling appears and other side effects increase. In such a situation, it is important to seek medical help immediately.

Interaction with other drugs

When treating with Prednisolone, it is important to take into account the use of any other medications, since this hormone is not recommended to be combined with many other medications, so as not to provoke side effects or increase them. Among the drugs that should not be used with Prednisolone are diuretics, cardiac glycosides, phenobarbital, paracetamol, anticoagulants, isoniazid, vitamin D, antacids and other drugs.

In addition, Prednisolone is incompatible with antiviral vaccines, therefore a certain period must pass between vaccination and the use of glucocorticoid.

Terms of sale and storage

All dosage forms of Prednisolone are sold by prescription. The price of 100 tablets of 5 mg, depending on the manufacturer, varies from 50 to 115 rubles. One tube of ointment containing 15 g of the drug costs an average of 25-30 rubles.

Store Prednisolone tablets at room temperature, and ampoules and ointment in a cool place. The shelf life, depending on the form, can be 2 years, 3 years or 5 years.

It should be specified on the packaging of the selected medication and do not use the medicine if the date has expired.

Prednisolone is synthetic glucocorticoid drug, which has all the advantages and disadvantages of drugs in this group. Its side effects increase with long-term use in high doses, so prednisolone They try to prescribe only in case of emergency and in short courses.

Side effects prednisolone from the side of metabolism and endocrine system

Prednisolone affects all types of metabolic processes. Under its influence, proteins are destroyed and their breakdown products are used by the body to produce .

With long-term use of prednisolone, protein deficiency occurs in the blood plasma. And since prednisolone in the blood plasma normally binds to proteins, when they are deficient, toxic free progesterone appears . When plasma protein is deficient, the growth and sexual development of children and adolescents is impaired.

The amount of glucose in the blood increases, which negatively affects patients with diabetes. It enhances the breakdown and at the same time the formation of fats, which are deposited in the tissues, creating excess weight and incorrect figure configuration. Mineral metabolism is disrupted due to the fact that potassium is removed from the body (myocardial contractility decreases) and calcium (osteoporosis is formed - thinning of the bones). Sodium and water are retained in the body - this causes edema.

On the part of the endocrine system, the function of the hypothalamic-pituitary-adrenal system is suppressed. This leads to dysfunction of the adrenal glands and the formation of Itsenko-Cushing syndrome, as well as to suppression of the secretion of gonadotropic hormones of the pituitary gland, disorders menstrual cycle and infertility in women and sexual dysfunction in men. Disorders of carbohydrate metabolism cause the development of steroid diabetes or manifestations of previously asymptomatic diabetes mellitus.

Side effects of prednisolone on the cardiovascular system

The body's loss of potassium affects the condition of the heart muscle (myocardium). This can lead to irregular heart rhythms and bradycardia (too slow heart rate, even to cardiac arrest). Impaired contractility of the heart can cause the development of symptoms of heart failure, when the heart cannot cope with the load and blood stagnates in the peripheral vessels. The process is further aggravated by the fact that sodium and water are retained in the body - this contributes to an increase in the volume of circulating blood and even greater stagnation.

At the same time, under the influence of prednisolone, a spasm occurs blood vessels and increased blood pressure, this creates the preconditions for even greater stagnation of blood and its increased coagulability, that is, a tendency to form blood clots. Thrombosis of coronary and cerebral vessels is the main cause of myocardial infarction and stroke. At the same time, in patients with acute myocardial infarction, while taking prednisolone, the focus of necrosis (tissue death) spreads and the formation of scar tissue slows down, which can lead to rupture of the heart muscle.

Side effects of prednisolone from the central nervous system and organs of vision

Metabolic disorders, spasm of blood vessels and increased volume of circulating blood lead to severe headaches, dizziness, increased intracranial pressure, agitation, insomnia, depression , disturbances of consciousness, psychosis, seizures.

On the part of the organ of vision, with long-term use of prednisolone, it is possible to develop cataracts, increased intraocular pressure, damage to the optic nerve, metabolic disorders in the cornea, and infection.

Side effects of prednisolone on other organs and systems

From the outside gastrointestinal tract Possible disturbances in appetite, nausea, vomiting, bloating, hiccups. Erosive and ulcerative lesions of the gastrointestinal tract and bleeding from this area, inflammation of the esophagus and pancreas occur, and sometimes transient liver dysfunction develops.

From the musculoskeletal system, osteoporosis may occur (it may be accompanied by fractures), bone growth disorders in children and adolescents, muscle weakness and decrease in muscle volume (muscle atrophy), rupture of muscle tendons and ligaments (they consist of connective tissue that becomes thinner under the influence of prednisolone).

On the skin with topical use of prednisolone and injection sites, pinpoint hemorrhages, areas of increased or decreased pigmentation, thinned skin (skin atrophy), stretch marks (a consequence of rupture of collagen fibers), a pustular rash and fungal diseases may appear.

Prednisolone – medicinal product, which can have very serious side effects.

Galina Romanenko

Prednisolone (in Latin - Prednisolon) is an anti-inflammatory drug that is used to treat children and adults. It is often the first line of therapy.

Prednisolone is an anti-inflammatory drug that is used to treat children and adults.

The dosage of the active substance depends on the form of release:

1. Tablets can contain 1 and 5 mg of the main component. They also contain stearic acid, milk sugar, povidone, and starch.
2. The solution for intravenous administration per 1 ml contains 15 or 30 mg. The preparation includes water for injection, nicotinamide, sodium mitabisulfite and other substances as auxiliary components.
3. In drops the concentration is 0.5% (per 1 g - 5 mg).
4. The ointment consists of the following components: active substance (50 mg), glycerin, petroleum jelly, stearic acid and other components.

Release form

The product has several forms of release:

1. Ointment. Packaged in tubes of 10 and 15 g.
2. The tablets are white, round, flat on both sides, with a notch for division. Packing - contour blister pack contains 10 pcs., in one cardboard box There can be up to 10 blisters or a polymer jar containing from 20 to 60 tablets.
3. Lyophilisate (for preparing solution for injection). There are 5 ampoules in 1 cardboard box, placed in a blister pack.
4. Drops. Glass dropper bottle with a capacity of 5 ml, packed in a cardboard box.
5. The solution for injection is transparent, colorless or with a greenish-yellowish tint. In a cardboard package there are 3 ampoules of 1 ml each in a plastic tray.

pharmachologic effect

Pharmacodynamics: the product has:

• anti-inflammatory;
• antiallergic;
• immunosuppressive;
• anti-shock properties.

A complex of a steroid hormone with a receptor is delivered to the cell nucleus, where it begins to interact with effector elements concentrated in areas of chromatin, resulting in a change in messenger RNA and proteins.

Artificial suppression of immunity leads to a decrease in the number of T-lymphocytes and their influence on B-lymphocytes, and accelerates the production of immunoglobulins.

The antiallergic effect is explained by inhibition of the production of allergy provocateurs and a decrease in the development of lymphoid tissue. The product is effective for rapid allergic reactions.

Accelerates the breakdown of proteins and reduces their amount in plasma, accelerates gluconeogenesis in the liver and ensures the formation of enzyme proteins, accelerates the synthesis of albumin in the liver and kidneys. Promotes the redistribution of fat, increases the formation of higher fatty acids.

The antishock effect is associated with a slowdown in the synthesis of platelet activation.

Pharmacokinetics:

• binds to plasma proteins by 90-95%;
• the biotransformation process occurs in the liver, small intestine, kidneys and bronchi;
• the half-life from the blood takes 3-4 hours, from tissues – 17-36 hours;
• excreted through the kidneys, penetrates the placental barrier.

ATX

According to the anatomical-therapeutic-chemical classification, it has the code H02AB06.

What is Prednisolone for?

The drug is used to relieve inflammation of varying severity and reduce body temperature. It is also used as a means to suppress allergic reactions that can threaten human life (Quincke's edema, anaphylactic shock), allergic rhinitis, dermatitis.

The medicine is administered for swelling of the brain that develops as a result of injury, for inflammation and progression of infection, after neurosurgery. It has a beneficial effect on severe burns of the gastrointestinal tract and respiratory tract, severe injuries, and is used for severe bronchial asthma, systemic lupus erythematosus, scleroderma, and rheumatoid arthritis.

Prescribed for adrenal hyperplasia, berylliosis, multiple sclerosis, acute hepatitis, hepatic coma and other pathologies. Used for inhalation for problems with the respiratory system, ophthalmology, and oncology.

How to take Prednisolone and how much?

The choice of drug form and treatment regimen depend on the pathology and general condition sick. The instructions for use must be strictly followed.

Use of tablets

Treatment with tablets is long-term and is used for mild conditions.

During replacement therapy, 20-30 mg per day is prescribed for oral administration.

For nephrotic syndrome and rheumatic pathologies, the number of tablets increases. For mental disorders, high doses are prescribed in exceptional cases, treatment is carried out under constant medical supervision.

For children, the dose for treatment is 1-2 mg per 1 kg of weight, divided 4-6 times a day; to maintain the condition, 0.3-0.6 mg per 1 kg of weight is prescribed, and taken in the morning most of or the whole dose.

Prednisolone in ampoules

Injections are given intramuscularly, through a vein or into a joint. The use of ampoules does not involve mixing the product with other medications in a syringe or dropper.

Drug dose:

1. For adults, 4-60 mg is administered intravenously or intramuscularly per day.
2. Children from 6 to 12 years old are given 25-25 mg per day; for children over 12 years old this dose is 25-50 mg. It is injected deep into the gluteal muscle and used strictly as prescribed by a doctor and under his supervision. The course of treatment and administration regimen are selected individually.
3. When diagnosed with Addison's disease, the dose for an adult is 4-60 mg intramuscularly or intravenously.
4. Ulcerative colitis is treated for 5-6 days with a dose of 8-12 ml per day; for severe Crohn's disease, the dose is from 10 to 13 ml per day, the course is 5-7 days.
5. In severe conditions, it is administered slowly intravenously (about 3 minutes) or through a dropper, the dose is 30-60 mg. If it is impossible to inject the drug through a vein, inject it intramuscularly deeply. The dose is increased individually, according to indications.
6. When administered intra-articularly for an adult, the dose for large joints is 30 mg, for medium joints – 10-25 mg, for small joints – 5-10 mg. The procedure is carried out after 3 days, treatment – ​​up to 3 weeks.

Ointment

The product is applied in a thin layer to the skin up to 3 times a day, lightly rubbed in. The course is chosen individually, depends on the disease and the effectiveness of treatment, lasts from 6 to 14 days, no more.

For children over one year of age, treatment lasts 3-7 days, and warming and fixing bandages should not be applied to the site where the ointment is applied, so as not to increase the absorption of corticosteroids.

Eye drops

The drug in the form of a 0.5% solution is injected into the eye 3 times a day, 1-2 drops. In acute conditions, the procedure is carried out every 2-4 hours. After eye surgery, the product is applied 3 or 5 days after surgery.

Before or after meals

The product is used during meals or after meals.

In the morning or evening

special instructions

Prescribed with caution for diabetes mellitus. For tuberculosis and other infections, it is prescribed with antibiotics or tuberculostatic agents.

During treatment, it is necessary to monitor blood pressure and vision, monitor glucose levels in the blood and urine, and test feces for occult blood. With sudden withdrawal, nausea, lethargy, and anorexia may develop.

Use during pregnancy and lactation

During pregnancy, especially in the first trimester, the drug is prescribed for health reasons, when the benefits of treatment outweigh the harm from using the drug.

It is best to start feeding 4 hours after taking the drug.

Can Prednisolone be given to children?

There are no age restrictions for use, but the drug can negatively affect some processes occurring in the child’s body, therefore it is prescribed strictly according to indications and under the constant supervision of a doctor.

Use in old age

In old age, glucocorticosteroids can have a negative effect on the body, so you need to take the drug with caution and strictly according to the recommendations of doctors.

Use for renal impairment

Not used to treat patients with severe renal failure.

Use for liver dysfunction

Prohibited in case of severe liver failure.

Alcohol compatibility

A one-time consumption of alcoholic beverages during treatment will not have a negative effect on the body, but the systematic combination of alcohol and glucocorticoid treatment can lead to serious consequences.

Impact on the ability to drive vehicles and complex mechanisms

The drug sometimes causes dizziness and other side effects, so it should be taken with caution when driving a car or operating complex machinery where quick reactions and concentration are required.

How to reduce the dosage of Prednisolone

The dosage of the drug is reduced slowly, according to the scheme chosen by the doctor. If you abruptly stop using the drug, the disease may recur.

How long does it take for Prednisolone to work?

The drug in tablets begins to act 90 minutes after administration for 18-36 hours. When administered intramuscularly, the medicine acts after 15 minutes, and when administered intravenously, after 3 minutes.

The product in the form of ointment and drops has an effect immediately after use.

How is the drug harmful?

The product is a systemic drug, therefore it affects the entire body and, along with the benefits, can have negative impact on organs and systems. When taken continuously, the hormonal drug reduces immunity, so it is prescribed in short courses.

Prednisolone withdrawal regimen

When reducing the dose, it is necessary to take into account the results of blood tests. The withdrawal of the drug occurs gradually. After reducing the daily dose to 10 mg per day, the reduction should be made by less than 1 mg per month. This could be 1 mg every 2 months.

The initial dose is reduced by 2.5 mg every month or to 10 mg per day every 2 weeks, then by 1 mg every 6-8 weeks until complete cessation of treatment.

Contraindications

Does not apply in the following cases:

1. In case of hypersensitivity to the substances contained in the product.
2. Diseases of the stomach and duodenum.
3. For osteoporosis.
4. Itsenko-Cushing's disease.
5. Thromboembolism.
6. Development of renal failure, nephrourolithiasis.
7. Development of hypoalbuminemia.
8. Hypertension.
9. Internal and external viral infections.
10. Diabetes.
11. Vaccination of any kind.
12. Systemic mycosis.
13. Tuberculosis is active and in latent form.
14. Cataract and glaucoma.
15. Progressive mental illnesses, depressive states.
16. Herpes.
17. Syphilis.
18. Pregnancy and lactation period.
19. Infections at the injection site during intra-articular injections.

Side effects

The occurrence of side effects depends on the duration of the course of treatment, the dose and regimen of the drug.

Negative consequences can occur from all organs and systems. A person’s blood pressure may increase; due to the drug’s effect on glucose production, obese patients have problems losing weight and diabetes mellitus progresses.

Numerous digestive problems, pancreatitis, and internal bleeding may occur. Arrhythmia and bradycardia develop, after a heart attack the area of ​​necrosis increases, the growth of scar tissue slows down, which can lead to heart rupture. Nervous system disorders, euphoria, hallucinations, psychoses occur, intracranial pressure increases, insomnia, convulsions, severe headaches, and problems with the cerebellum appear.

Problems with the organs of vision arise: intraocular pressure increases, which may cause damage to the optic nerve; cataracts and secondary infections may develop. In children, the formation of the musculoskeletal system is disrupted; in adults, osteoporosis and other problems with bones and cartilage develop.

Numerous rashes may appear on the skin, healing of damage slows down, and candidiasis develops. Night urination becomes more frequent and urolithiasis appears.

A complete list of adverse reactions should be obtained from your doctor.

Overdose

In case of overdose, the manifestation of side effects increases.

Drug interactions

Combining medications can have a negative effect on the body.

When treating, the following conditions must be taken into account:

1. Ephedrine, Phenobarbital and Theophylline reduce the concentration of the active substance. Combination with diuretics accelerates the removal of potassium from the body. Sodium-containing drugs increase blood pressure and provoke the formation of edema.
2. Combination with anticoagulants and thrombolytics can lead to severe bleeding and ulcers in the gastrointestinal tract. Indomethacin increases side effects.
3. The drug enhances the negative effect of Paracetamol on the liver and reduces the effect of taking insulin.
4. Intraocular pressure increases when used together with antidepressants and nitrates.
5. When using a drug to reduce adrenal activity, an increase in the dose of the active substance may be required.
6. Neuroleptics provoke the development of cataracts.
7. Vaccines containing live viruses increase the risk of contracting viral infections.

When treating, the doctor takes everything into account possible risks from combining drugs.

Analogues

The following analogues have a general structure:

• Metypred, Dexamed, Dexamethasone;
• Betamethasone, Diprospan, Maxidex;
• Flosterone, Kenalog, Hydrocortisone;
• Suprastin.

Conditions of release and storage

Sold in pharmacies upon presentation of a prescription.

Best before date

Tablets and solution in ampoules are stored for 5 years, the product in the form of an ointment is allowed to be used for 2 years.

Price

The price of the drug depends on the manufacturer and the quantity in 1 package. Tablets cost from 50 to 700 rubles. The ointment can be purchased at prices ranging from 14 to 450 rubles. Injection solution costs from 20 to 200 rubles, drops - from 50 to 200 rubles.

Analogues

These are medicines belonging to the same pharmaceutical group that contain different active substances(INN), differ in name, but are used to treat the same diseases.

• - Suspension for intramuscular and intraarticular administration 25 mg/ml
• - Suspension for injection 40 mg/ml
• - Tablets 4 mg

Indications for use of the drug Prednisolone

Endocrinological diseases:

Adrenal cortex insufficiency: primary (Addison's disease) and secondary;

Adrenogenital syndrome (congenital adrenal hyperplasia);

Acute adrenal insufficiency;

Before surgical interventions and in case of severe illnesses and injuries in patients with adrenal insufficiency;

Subacute thyroiditis.

Severe allergic diseases resistant to other therapy:

Contact dermatitis;

Atopic dermatitis;

Serum sickness;

Hypersensitivity reactions to drugs;

Permanent or seasonal allergic rhinitis;

Anaphylactic reactions;

Angioedema.

Rheumatic diseases:

Rheumatoid arthritis, juvenile rheumatoid arthritis (in cases resistant to other treatment methods);

Psoriatic arthritis;

Ankylosing spondylitis;

Acute gouty arthritis;

Acute rheumatic fever;

Myocarditis (including rheumatic);

Dermatomyositis;

Systemic lupus erythematosus;

Granulomatous giant cell mesoarteritis;

Systemic scleroderma;

Periarteritis nodosa;

Relapsing polychondritis;

Polymyalgia rheumatica (Horton's disease);

Systemic vasculitis.

Dermatological diseases:

Exfoliative dermatitis;

Bullous dermatitis herpetiformis;

Severe seborrheic dermatitis;

Severe erythema multiforme (Stevens-Johnson syndrome);

Mycosis fungoides;

Pemphigus;

Severe psoriasis;

Severe forms of eczema;

Pemphigoid.

Hematological diseases:

Acquired autoimmune hemolytic anemia;

Congenital aplastic anemia;

Idiopathic thrombocytopenic purpura (Werlhof's disease) in adults;

Hemolysis.

Liver diseases:

Alcoholic hepatitis with encephalopathy;

Chronic active hepatitis.

Hypercalcemia in malignancy or sarcoidosis.

Inflammatory joint diseases:

Acute and subacute bursitis;

Epicondylitis;

Acute tenosynovitis;

Post-traumatic osteoarthritis.

Oncological diseases:

Acute and chronic leukemia;

Lymphomas;

Mammary cancer;

Prostate cancer;

Multiple myeloma.

Neurological diseases:

Tuberculous meningitis with subarachnoid block;

Multiple sclerosis in the acute phase;

Myasthenia.

Eye diseases (severe acute and chronic allergic and inflammatory processes):

Severe sluggish anterior and posterior uveitis;

Optic neuritis;

Sympathetic ophthalmia.

Pericarditis.

Respiratory diseases:

Bronchial asthma;

Beryllium;

Loeffler's syndrome;

Symptomatic sarcoidosis;

Fulminant or disseminated pulmonary tuberculosis (in combination with anti-tuberculosis chemotherapy);

Chronic pulmonary emphysema (resistant to treatment with aminophylline and beta-agonists).

During organ and tissue transplantation to prevent and treat graft rejection (in combination with other immunosuppressive drugs).

Release form of the drug Prednisolone

tablets 5 mg; polypropylene bottle (bottle) 100 cardboard pack 1;

Tablets 5 mg; bottle (bottle) 30 cardboard pack 1;

Tablets 5 mg; plastic bag (bag) 100 plastic bottle (bottle) 1;

Tablets 5 mg; contour packaging 10 cardboard pack 1;

Tablets 5 mg; contour packaging 10 cardboard pack 10;

Pharmacodynamics of the drug Prednisolone

The mechanism of the immunosuppressive effect of prednisolone is not fully understood. The drug reduces the number of T-lymphocytes, monocytes and acidophilic granulocytes, as well as the binding of immunoglobulins to receptors on the surface of cells, inhibits the synthesis or release of interleukins by reducing the blastogenesis of T-lymphocytes; reduces the early immunological response. It also inhibits the penetration of immunological complexes through membranes and reduces the concentration of complement components and immunoglobulins.

Prednisolone acts on the distal part of the renal tubules, increasing the reabsorption of sodium and water, as well as increasing the excretion of potassium and hydrogen ions.

Prednisolone inhibits the secretion of ACTH by the pituitary gland, which leads to a decrease in the production of corticosteroids and androgens by the adrenal cortex. After long-term use of the drug in high doses, adrenal function can be restored within a year, and in some cases, persistent suppression of their function develops. Prednisolone enhances protein catabolism and induces enzymes involved in amino acid metabolism. Inhibits the synthesis and enhances the catabolism of proteins in lymphatic, connective, and muscle tissue. With prolonged use, atrophy of these tissues (as well as the skin) may develop.

Increases blood glucose concentrations by inducing gluconeogenesis enzymes in the liver, stimulating protein catabolism (which increases the amount of amino acids for gluconeogenesis) and reducing glucose consumption in peripheral tissues. This leads to the accumulation of glycogen in the liver, increasing blood glucose concentrations and increasing insulin resistance.

With prolonged use of the drug, redistribution of adipose tissue is possible.

Inhibits the formation of bone tissue and enhances its resorption, reducing the concentration of calcium in the blood serum, which leads to secondary hyperfunction of the parathyroid glands and simultaneous stimulation of osteoclasts and inhibition of osteoblasts.

These effects, together with a secondary reduction in the amount of protein components as a result of protein catabolism, can lead to suppression of bone growth in children and adolescents and to the development of osteoporosis in children of all ages.

Enhances the effect of endo- and exogenous catecholamines.

Use of Prednisolone during pregnancy

With extreme caution, especially in the first trimester of pregnancy; When breastfeeding, caution should be exercised if the baby has hyperbilirubinemia.

Contraindications to the use of the drug Prednisolone

Peptic ulcer of the stomach and duodenum, Cushing's syndrome, osteoporosis, predisposition to thromboembolism, renal failure, severe arterial hypertension, chickenpox, herpes simplex and herpes zoster, vaccination period.

Side effects of the drug Prednisolone

With short-term use of prednisolone (as well as other corticosteroids), side effects are rarely observed. When using prednisolone for a long time, the following side effects may develop.

From the side of the central nervous system and peripheral nervous system: increased intracranial pressure with optic nerve congestion syndrome (occurs most often in children, after too rapid dose reduction, symptoms - headache, deterioration of visual acuity, double vision); convulsions, dizziness, headache, sleep disturbances.

From the endocrine status: secondary adrenal and hypothalamic-pituitary insufficiency (especially during stressful situations: illness, injury, surgery); Cushing's syndrome, growth suppression in children, menstrual irregularities, hyperglycemia, glycosuria, decreased tolerance to carbohydrates, manifestation of latent diabetes mellitus and increased need for insulin or oral hypoglycemic drugs in patients with diabetes mellitus, hirsutism.

From the organ of vision: posterior subcapsular cataract, increased intraocular pressure, glaucoma, exophthalmos.

From the mental sphere: most often appear during the first 2 weeks of therapy, symptoms can imitate schizophrenia, mania, delirium; Women and patients with systemic lupus erythematosus are most susceptible to developing mental disorders.

Metabolism: negative nitrogen balance (as a result of protein catabolism).

From laboratory parameters: an increase in the number of leukocytes (20,000/μl), a decrease in the number of lymphocytes and monocytes, an increase or decrease in the number of platelets, an increase in the concentration of calcium in the blood and urine, an increase in the level of total cholesterol, LDL, triglycerides in the blood serum, an increase in the concentration 17-hydroxycorticosteroids and 17-ketosteroids in urine, decreased uptake of labeled technetium bone tissue and brain tumor tissue, decreased uptake of labeled iodine by the thyroid gland; weakening of the reaction in skin allergy tests and tuberculin test.

Other: anaphylactic reactions, hypersensitivity reactions; obliterating arteritis, weight gain, fainting.

Method of administration and dosage of the drug Prednisolone

Orally, without chewing and with a small amount of liquid. The dose is selected individually. When prescribing, the circadian secretory rhythm of GCS should be taken into account: most of the dose (2/3 of the dose) or the entire dose should be taken in the morning (about 8 a.m.), and 1/3 in the evening. Treatment is stopped slowly, gradually reducing the dose.

Adults: for acute conditions and as replacement therapy, the initial daily dose is 20–30 mg, the maintenance daily dose is 5–10 mg. If necessary, the initial daily dose can be 15–100 mg, maintenance - 5–15 mg/day.

Children: the initial daily dose is 1–2 mg/kg body weight and is divided into 4–6 doses, the maintenance daily dose is 300–600 mcg/kg.

Overdose of Prednisolone

The risk of overdose increases with long-term use of prednisolone, especially in high doses.

Symptoms: increased blood pressure, peripheral edema; In addition, increased side effects are possible.

Treatment: temporarily stop taking the drug or reduce the dose.

Interactions of Prednisolone with other drugs

When used together with cardiac glycosides, the risk of developing cardiac arrhythmias and glycoside toxicity associated with hypokalemia increases. Barbiturates, anticonvulsants (phenytoin, carbamazepine), rifampicin, glutethimide accelerate the metabolism of GCS (by inducing microsomal enzymes) and weaken their effect.

When used together, histamine H1 receptor blockers weaken the effect of prednisolone.

When prednisolone is used together with amphotericin B, carbonic anhydrase inhibitors, hypokalemia, left ventricular myocardial hypertrophy, and circulatory failure may develop.

When used together with paracetamol, it is possible to develop hypernatremia, peripheral edema, increase calcium excretion, and increase the risk of hypocalcemia and osteoporosis, as well as hepatotoxic reactions associated with paracetamol.

When used together with anabolic steroids, androgens, the risk of developing peripheral edema and acne increases (this combination requires caution, especially in the case of concomitant diseases heart and liver).

When used simultaneously with oral contraceptives containing estrogens, it is possible to increase the concentration of steroid-binding globulins in the blood serum, slow down metabolism, increase T1/2 and enhance the effect of prednisolone.

When used together with anticholinergics (atropine), intraocular pressure may increase.

When used together with anticoagulants (coumarin derivatives, indadione, heparin), streptokinase, urokinase, a decrease (in some patients - an increase) of effectiveness is possible, and the formation of ulcers and bleeding from the gastrointestinal tract is possible; the dose should be determined based on prothrombin time.

When used together with tricyclic antidepressants, it is possible to increase mental disorders associated with taking prednisolone (the use of tricyclic antidepressants for the correction of mental disorders while taking corticosteroids is not recommended).

When used together with prednisone, the hypoglycemic effect of insulin and oral hypoglycemic agents may be weakened, and glucose levels may increase (which may require dose adjustment of antidiabetic drugs).

When used together with prednisolone, dose adjustment or discontinuation of antithyroid drugs or thyroid hormones may be required, because changes in thyroid function indicators are possible.

When used together with prednisolone, the effect of potassium-sparing diuretics and hypokalemia may be weakened.

When used together with prednisolone, the effect of laxatives and the development of hypokalemia may be weakened.

When used together, ephedrine may accelerate the metabolism of corticosteroids (prednisolone dose adjustment may be required).

When prednisolone is used together with other immunosuppressive drugs, the likelihood of developing infections, lymphomas and other lymphoproliferative diseases increases.

When used simultaneously with prednisolone, a decrease in the concentration of isoniazid in the blood plasma is possible (mainly in individuals with rapid acetylation); a dose adjustment of prednisolone may be required.

When used simultaneously with prednisolone, an accelerated metabolism of mexiletine and a decrease in its concentration in plasma are observed.

When used together with depolarizing muscle relaxants, it should be noted that hypocalcemia associated with the use of prednisolone may enhance synaptic blockade, leading to an increase in the duration of neuromuscular blockade.

Acetylsalicylic acid and other NSAIDs, ethanol weaken the effect of prednisolone, increase the risk of developing peptic ulcers and bleeding from the gastrointestinal tract.

Drugs and foods containing sodium, when used simultaneously with prednisone, increase the likelihood of developing arterial hypertension and peripheral edema.

The use of corticosteroids increases the need for folic acid.

Precautions when taking Prednisolone

Glucocorticoids should be prescribed in the smallest dosages and for the minimum duration necessary to achieve the desired therapeutic effect. When prescribing, the daily circadian rhythm of endogenous secretion of glucocorticoids should be taken into account: at 6–8 a.m., most (or all) of the dose is prescribed.

In the event of stressful situations, patients on corticosteroid therapy are advised to administer parenteral corticosteroids before, during and after the stressful situation.

If there is a history of psychosis, high doses are prescribed under the strict supervision of a physician.

During treatment, especially with long-term use, the dynamics of growth and development in children should be carefully monitored; observation by an ophthalmologist, monitoring of blood pressure, water and electrolyte balance, blood glucose levels, and regular analyzes of the cellular composition of peripheral blood are necessary.

Sudden cessation of treatment may cause the development of acute adrenal insufficiency; with long-term use, the drug should not be suddenly discontinued; the dose should be reduced gradually. With sudden withdrawal after long-term use, withdrawal syndrome may develop, manifested by increased body temperature, myalgia and arthralgia, and malaise. These symptoms can appear even in cases where there is no adrenal insufficiency.

Special instructions when taking Prednisolone

Prednisolone is contraindicated in patients with systemic fungal infections due to the risk of worsening the infection. The drug is in some cases used in the treatment of fungal infections with amphotericin B to reduce the side effects of the antifungal drug, but this combination can lead to the development of circulatory failure and left ventricular myocardial hypertrophy, as well as severe hypokalemia.

In case of stressful situations, patients receiving Prednisolone are recommended to administer parenteral corticosteroids.

Sudden withdrawal of GCS can cause the development of acute adrenal insufficiency, so the dose of Prednisolone should be reduced gradually.

Prednisolone can mask the symptoms of infection, reduce the body's resistance to infections, and also reduce the body's ability to localize the infectious process.

With the use of the drug, clinical manifestations of latent amoebiasis are possible.

In persons arriving from tropical countries or in patients with dysentery of unknown etiology, dysenteric amoebiasis should be excluded before using Prednisolone. Long-term use of Prednisolone increases the risk of developing secondary fungal or viral infections.

Long-term use of corticosteroids may lead to the development of cataracts and glaucoma (including damage to the optic nerve).

When using Prednisolone in high doses, you should monitor blood pressure (possible development of arterial hypertension), body weight of patients (possible occurrence of peripheral edema).

Serum electrolyte concentrations should be monitored periodically. In some cases, you may need to limit your sodium intake and increase your potassium intake.

Prednisolone also causes an increase in calcium excretion.

Patients receiving GCS should not be vaccinated with live viral vaccines (due to possible viral replication and development of viral diseases), and there may be a decrease in antibody production. Administration of an inactivated viral or bacterial vaccine may not produce the expected increase in antibodies. Patients who receive corticosteroids as replacement therapy, for example, for Addison's disease, can be vaccinated. In addition, patients taking GCS have an increased risk of developing neurological complications.

Prescribing GCS to patients with an active form of tuberculosis is possible only in cases of disseminated or fulminant tuberculosis and only in combination with anti-tuberculosis therapy. Patients with latent tuberculosis or a positive tuberculin test taking Prednisolone should be monitored due to the high risk of activation of the tuberculosis process. With long-term use of GCS, this category of patients should receive chemoprophylaxis.

The use of the drug may mask the symptoms of infectious diseases.

With sudden withdrawal of Prednisolone (especially after long-term use), withdrawal syndrome may develop (manifested by anorexia, fever, myalgia and arthralgia, general weakness). Symptoms can occur even in cases where there is no adrenal insufficiency.

In patients with hypothyroidism or liver cirrhosis, the effect of Prednisolone is enhanced.

When using Prednisolone, the development of mental disorders (euphoria, insomnia, sudden mood changes, personality changes, severe depression, symptoms of psychosis) is possible. Pre-existing emotional instability or psychotic tendencies may increase during GCS therapy.

When using GCS in patients with hypoprothrombinemia, acetylsalicylic acid should be prescribed with caution.

The drug is prescribed with caution for nonspecific ulcerative colitis due to the risk of developing intestinal perforation, abscess or other purulent infections; with intestinal diverticulosis, fresh intestinal anastomoses, erosive and ulcerative lesions of the gastrointestinal tract, with renal failure, arterial hypertension, osteoporosis, myasthenia gravis, diabetes mellitus, liver dysfunction, glaucoma, viral infections, hyperlipidemia, hypoalbuminemia.

With the development of gastrointestinal perforation during the use of corticosteroids, the symptoms of peritonitis may be slightly expressed or absent altogether.

In some patients, during GCS therapy, the number and motility of sperm changes.

Taking the drug with food may reduce the likelihood of developing gastrointestinal side effects. The effectiveness of antacid medications in preventing the formation of ulcers, gastrointestinal bleeding, or intestinal perforation has not been confirmed.

With the development of steroid myopathy and the impossibility of discontinuing GCS therapy, replacing prednisolone with another GCS can alleviate the symptoms.

The risk of developing osteoporosis associated with long-term use GCS can be reduced by taking vitamin D and calcium supplements or, if the patient's condition allows, by performing appropriate physical exercise.

If psychosis or depression occurs, reduce the dose or stop taking the drug if possible. If necessary, phenothiazine or lithium preparations can be used. The use of tricyclic antidepressants is contraindicated.

In order to mitigate some of the symptoms of withdrawal syndrome, it is possible to prescribe acetylsalicylic acid or other NSAIDs.

Use in pediatrics

When prescribing the drug to children, monitoring of their growth and development is necessary.