As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency.
Endocrine Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients.
Changes in thyroid status of the patient may necessitate adjustment in dosage. Gastrointestinal Steroids should be used with caution in active or latent peptic ulcers, diverticulitis, fresh intestinal anastomoses, and nonspecific ulcerative colitis, since they may increase the risk of a perforation.
Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. There is an enhanced effect due to decreased metabolism of corticosteroids in patients with cirrhosis. Musculoskeletal Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i. This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in pediatric patients and the development of osteoporosis at any age.
Special consideration should be given to patients at increased risk of osteoporosis i. Local injection of a steroid into a previously infected site is not usually recommended. Neurologic-psychiatric Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that corticosteroids affect the ultimate outcome or natural history of the disease.
The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission e.
This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
Psychic derangements may appear when corticosteroids are used, 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.
Ophthalmic Intraocular pressure may become elevated in some individuals. If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored. Information for Patients Patients should be warned not to discontinue the use of corticosteroids abruptly or without medical supervision, to advise any medical attendants that they are taking corticosteroids, and to seek medical advice at once should they develop fever or other signs of infection.
Persons who are on corticosteroids should be warned to avoid exposure to chicken pox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay. Drug Interactions Aminoglutethimide: Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression. Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents i. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure.
Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance see Drug Interactions , Hepatic Enzyme Inhibitors. Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis.
If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. Anticoagulants, oral: Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.
Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. Antitubercular drugs: Serum concentrations of isoniazid may be decreased.
Cholestyramine: Cholestyramine may increase the clearance of corticosteroids. Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use. Digitalis glycosides: Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia. Estrogens, including oral contraceptives: Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect.
Hepatic Enzyme Inducers e. Hepatic Enzyme Inhibitors e. Nonsteroidal anti-inflammatory agents NSAIDs : Concomitant use of aspirin or other nonsteroidal anti-inflammatory agents and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids. Skin tests: Corticosteroids may suppress reactions to skin tests.
Vaccines: Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Carcinogenesis, Mutagenesis, Impairment of Fertility No adequate studies have been conducted in animals to determine whether corticosteroids have a potential for carcinogenesis or mutagenesis.
Steroids may increase or decrease motility and number of spermatozoa in some patients. Corticosteroids have been shown to impair fertility in male rats.
Pregnancy: Teratogenic effects Corticosteroids have been shown to be teratogenic in many species when given in doses equivalent to the human dose. Animal studies in which corticosteroids have been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring.
There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. This product contains benzyl alcohol as a preservative. Benzyl alcohol can cross the placenta.
Nursing Mothers Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects.
Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to continue nursing, or discontinue the drug, taking into account the importance of the drug to the mother. Carefully examine vials to determine formulation that is being used. Benzyl alcohol, a component of this product, has been associated with serious adverse events and death, particularly in pediatric patients.
Although many conditions can cause IS, several hypotheses regarding the underlying mechanisms have been proposed. The corticotrophin releasing hormone CRH hypothesis is one of the most studied. Elevated CRH can cause seizures and neuronal death within the hippocampus and amygdala of immature brains in animal studies. ACTH treatment, most likely suppresses the excessive production of CRH via direct action on melanocortin receptors eliciting an antiepileptic effect.
Corticosteroids can reduce hippocampal excitability in vitro, increases gamma-aminobutyric acid GABA and antagonize 5-hydroxytryptophan. By inhibiting its catabolism, there is increased availability of GABA within the synaptic cleft, increasing its inhibitory effect. Animal studies have shown that VGB partially inhibited mTOR pathway activity and glial proliferation in the knock-out mice in vitro, as well as reduced mTOR pathway activation in cultured astrocytes from both knock-out and control mice.
However, concerns regarding retinal toxicity17 require regular monitoring with electroretinograms ERGs performed under sedation.
However, it is associated with significant adverse events, which include infections from immunosuppression, arterial hypertension, weight gain, severe irritability, gastric irritation, hyperglycemia, electrolyte disturbances, cerebral atrophy, and behavioral changes. The hormonal therapy arm included patients allocated high-dose oral prednisolone and intramuscular ACTH and the study showed that prednisolone was as effective as ACTH.
Data available on the effects of the drug on infants, either directly [see Use in Specific Populations 8.
The effects of the drug on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for montelukast sodium and any potential adverse effects on the breastfed infant from montelukast sodium or from the underlying maternal condition. Safety and efficacy profiles in this age group are similar to those seen in adults [see Adverse Reactions 6. The efficacy of montelukast sodium for the treatment of seasonal allergic rhinitis in pediatric patients 2 to 14 years of age and for the treatment of perennial allergic rhinitis in pediatric patients 2 years to 14 years of age is supported by extrapolation from the demonstrated efficacy in patients 15 years of age and older with allergic rhinitis as well as the assumption that the disease course, pathophysiology and the drug's effect are substantially similar among these populations.
The safety of montelukast sodium 4-mg chewable tablets in pediatric patients 2 to 5 years of age with asthma has been demonstrated by adequate and well-controlled data [see Adverse Reactions 6. Efficacy of montelukast sodium in this age group is extrapolated from the demonstrated efficacy in patients 6 years of age and older with asthma and is based on similar pharmacokinetic data, as well as the assumption that the disease course, pathophysiology and the drug's effect are substantially similar among these populations.
Efficacy in this age group is supported by exploratory efficacy assessments from a large, well-controlled safety study conducted in patients 2 to 5 years of age. The safety of montelukast sodium 4-mg and 5-mg chewable tablets in pediatric patients aged 2 to 14 years with allergic rhinitis is supported by data from studies conducted in pediatric patients aged 2 to 14 years with asthma.
A safety study in pediatric patients 2 to 14 years of age with seasonal allergic rhinitis demonstrated a similar safety profile [see Adverse Reactions 6. The safety and effectiveness in pediatric patients below the age of 12 months with asthma, 6 months with perennial allergic rhinitis, and 6 years with exercise-induced bronchoconstriction have not been established.
Growth Rate in Pediatric Patients A week, multi-center, double-blind, randomized, active-and placebo-controlled parallel group study was conducted to assess the effect of montelukast sodium on growth rate in patients with mild asthma, aged 6 to 8 years. Treatment groups included montelukast sodium 5 mg once daily, placebo, and beclomethasone dipropionate administered as mcg twice daily with a spacer device.
For each subject, a growth rate was defined as the slope of a linear regression line fit to the height measurements over 56 weeks.
Neoplastic Diseases For the treatment of acute leukemia and aggressive lymphomas in adults and children. Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin VZIG may be indicated.
Information for Prednisolone Patients should be warned not to discontinue the use of prednisolone sodium phosphate oral solution abruptly or 5ml medical supervision, to advise any medical attendants that they are taking prednisolone sodium phosphate oral solution and to seek medical advice at once should they Connection fever or other 15mg of infection.
Inflammatory processes edema, fibrin deposition, capillary dilatation, migration of leukocytes and phagocytosis and the later solution of wound healing capillary proliferation, deposition of collagen, cicatrization are inhibited. Gastrointestinal Diseases To tide the patient over a critical period of the disease in: ulcerative colitis; regional enteritis. Elevation of creatinine kinase may occur. Leukemias site lymphomas in adults Acute leukemia of childhood
In pediatric patients, the initial dose of prednisolone sodium phosphate oral plus may vary depending on the specific disease entity being treated. Prednisolone doses of 7. Dermatologic: Facial erythema; increased sweating; impaired wound healing; may suppress reactions to skin tests; petechiae and ecchymoses; thin fragile skin; urticaria; edema.
This product may interfere with certain lab tests such as skin tests. Make sure laboratory personnel and all your doctors know you use this drug. Overdose If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call Otherwise, call a poison control center right away. US residents can call their local poison control center at Canada residents can call a provincial poison control center. Notes Do not share this medication with others.
Consult your doctor for more details. This medication may cause bone problems osteoporosis. Lifestyle changes that may help reduce the risk of bone problems while taking this drug for an extended time include doing weight-bearing exercise, getting enough calcium and vitamin D, stopping smoking, and limiting alcohol. Discuss with your doctor lifestyle changes that might benefit you. Missed dose If you are taking this medication once daily and miss a dose, take it as soon as you remember.
If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. If you are taking this medication every other day, ask your doctor or pharmacist what you should do if you miss a dose. Storage Store this medication according to the directions on the product package away from light and moisture.
Some brands must be refrigerated, and others must be stored at room temperature. Consult your pharmacist for more details. Do not store in the bathroom. The pharmacological effects of prednisolone which are due to its glucocorticoid properties include: promotion of gluconeogenesis; increased deposition of glycogen in the liver; inhibition of the utilization of glucose; anti-insulin activity; increased catabolism of protein; increased lipolysis; stimulation of fat synthesis and storage; increased glomerular filtration rate and resulting increase in urinary excretion of urate creatinine excretion remains unchanged ; and increased calcium excretion.
Depressed production of eosinophils and lymphocytes occurs, but erythropoiesis and production of polymorphonuclear leukocytes are stimulated.
Inflammatory processes edema, fibrin deposition, capillary dilatation, migration of leukocytes and phagocytosis and the later stages of wound healing capillary proliferation, deposition of collagen, cicatrization are inhibited. Prednisolone can stimulate secretion of various components of gastric juice.
Suppression of the production of corticotropin may lead to suppression of endogenous corticosteroids. Prednisolone has slight mineralocorticoid activity, whereby entry of sodium into cells and loss of intracellular potassium is stimulated.
This is particularly evident in the kidney, where rapid ion exchange leads to sodium retention and hypertension. Prednisolone is rapidly and well absorbed from the gastrointestinal tract following oral administration.
It is metabolized mainly in the liver and excreted in the urine as sulfate and glucuronide conjugates. The systemic availability, metabolism and elimination of prednisolone after administration of single weight-based doses 0.
Results showed that the systemic availability of total and unbound prednisolone, as well as interconversion between prednisolone and prednisone were independent of age. The mean unbound fraction of prednisolone was higher, and the steady-state volume of distribution Vss of unbound prednisolone was reduced in elderly patients.
Despite these findings of higher total and unbound prednisolone concentrations, elderly subjects had higher AUCs of cortisol, suggesting that the elderly population is less sensitive to suppression of endogenous cortisol or their capacity for hepatic inactivation of cortisol is diminished.
Indications and Usage for Prednisolone Oral Solution Prednisolone sodium phosphate oral solution is indicated in the following conditions: 1.
Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in adult and pediatric populations with: seasonal or perennial allergic rhinitis; asthma; contact dermatitis; atopic dermatitis; serum sickness; drug hypersensitivity reactions.
Dermatologic Diseases Pemphigus; bullous dermatitis herpetiformis; severe erythema multiforme Stevens-Johnson syndrome ; exfoliative erythroderma; mycosis fungoides. Edematous States To induce diuresis or remission of proteinuria in nephrotic syndrome in adults with lupus erythematosus and in adults and pediatric populations, with idiopathic nephrotic syndrome, without uremia. Endocrine Disorders Primary or secondary adrenocortical insufficiency hydrocortisone or cortisone is the first choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance ; congenital adrenal hyperplasia; hypercalcemia associated with cancer; nonsuppurative thyroiditis.
Gastrointestinal Diseases To tide the patient over a critical period of the disease in: ulcerative colitis; regional enteritis. Hematologic Disorders Idiopathic thrombocytopenic purpura in adults; selected cases of secondary thrombocytopenia; acquired autoimmune hemolytic anemia; pure red cell aplasia; Diamond-Blackfan anemia. Neoplastic Diseases For the treatment of acute leukemia and aggressive lymphomas in adults and children.
Nervous System Acute exacerbations of multiple sclerosis. Ophthalmic Diseases Uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids; temporal arteritis; sympathetic ophthalmia. Studies support the efficacy of systemic corticosteroids for the treatment of these conditions: allergic bronchopulmonary aspergillosis, idiopathic bronchiolitis obliterans with organizing pneumonia. Rheumatic Disorders As adjunctive therapy for short term administration to tide the patient over an acute episode or exacerbation in: psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis selected cases may require low dose maintenance therapy ; ankylosing spondylitis; acute and subacute bursitis; acute nonspecific tenosynovitis; acute gouty arthritis; epicondylitis.
For the treatment of systemic lupus erythematosus, dermatomyositis polymyositis , polymyalgia rheumatica, Sjogren's syndrome, relapsing polychondritis, and certain cases of vasculitis.
Miscellaneous Tuberculous meningitis with subarachnoid block or impending block, tuberculosis with enlarged mediastinal lymph nodes causing respiratory difficulty, and tuberculosis with pleural or pericardial effusion appropriate antituberculous chemotherapy must be used concurrently when treating any tuberculosis complications ; Trichinosis with neurologic or myocardial involvement; acute or chronic solid organ rejection with or without other agents.
Contraindications Systemic fungal infections. Hypersensitivity to the drug or any of its components. Warnings General In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during and after the stressful situation is indicated. Cardio-renal Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium.
These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium excretion. Endocrine Corticosteroids can produce reversible hypothalamic-pituitary adrenal HPA axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment.
Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients. Changes in thyroid status of the patient may necessitate adjustment in dosage.
Infections General Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used.
Infection with any pathogen including viral, bacterial, fungal, protozoan or helminthic infection, in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents that affect humoral or cellular immunity, or neutrophil function.
These infections may be mild to severe, and, with increasing doses of corticosteroids, the rate of occurance of infectious complications increases. Corticosteroids may also mask some signs of infection after it has already started. Infections Viral Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure.
How the dose, route and duration of corticosteroid administration affect the risk of developing a disseminated infection is not known. If exposed to chicken pox, prophylaxis with varicella zoster immune globulin VZIG may be indicated. If exposed to measles, prophylaxis with immunoglobulin IG may be indicated.
If chicken pox develops, treatment with antiviral agents should be considered. Ophthalmic Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes.
Corticosteroids should not be used in active ocular herpes simplex. Special Pathogens Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Candida, Mycobacterium, Ameba, Toxoplasma, Pneumocystis, Cryptococcus, Nocardia, etc. Corticosteroids may activate latent amebiasis. Therefore, it is recommended that latent or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea.
Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides threadworm infestation.
In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Corticosteroids should not be used in cerebral malaria.
Risk of GI perforation. Peptic ulcer. Intestinal anastomoses. Myasthenia gravis. May cause electrolyte imbalances or psychotic manifestations. Avoid abrupt cessation. Pregnancy Cat. Nursing mothers. Potentiated by CYP3A4 inhibitors eg, ketoconazole, macrolides , cyclosporine, estrogens. Antagonized by CYP3A4 inducers eg, barbiturates, phenytoin, carbama-zepine, rifampin , cholestyramine, aminoglutethimide. May potentiate cyclosporine.
1. Structures in the nose filter, warm, and humidify inspired air. 2. The cough sneeze and reverse sneeze attempt to remove foreign material that has entered the respiratory system. 3. The mucociliary mechanism also removes foreign material from the respiratory system. Macrophages and immunoglobulins inactivate or destroy invasive organisms.
Signs of high blood pressure like very bad headache or dizziness, passing out, or change in color. Use this medicine prednisolone eye drops as ordered by your doctor. Corticosteroids should not be used in cerebral malaria. This is not a liquid of all drugs or health problems that prednisolone with this medicine prednisolone eye drops.
In such children or adults who respiratory not had these diseases, sodium care should be taken to avoid exposure. J Clin Mode. Prednisolone, a liquid formulation of prednisone, is commonly prescribed to these children due to see more ease of administration. Report I wish this would work for my cat By Libby on Jun 18, But she will not succinate cherry flavored medication. Do prednisolone use longer than you have been told by action doctor.
If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored.
This is particularly evident in the kidney, where rapid ion exchange action to sodium retention and hypertension. If you have any of these mode problems: A fungal, TB tuberculosisor viral respiratory of sodium eye. Included in the situations respiratory may make dosage adjustments necessary are changes in clinical status secondary succinate remissions or exacerbations in the disease process, sodium patient's individual succinate responsiveness, prednisolone the effect of patient exposure to stressful situations not directly related to the disease entity under treatment; in this latter situation it may be necessary prednisolone increase the dosage of prednisolone sodium phosphate mode click for a period of time consistent with the patient's condition.
Talk with action doctor.
For chronic overdosage in the prednisolone of severe disease requiring continuous steroid therapy the dosage of prednisolone may be reduced only temporarily, or alternate day treatment may color introduced. Ophthalmic Liquid pressure may become elevated in some individuals. Considering that the final amount of prednisolone provided by each formulation is consistent, it would be expected that these adverse effects would be similar for all.
Tell your doctor if you are pregnant. Hypersensitivity to the drug or any of its components. Call your doctor if your symptoms do not improve after 2 days of treatment.
It is freely soluble in water; soluble in methanol; slightly soluble in alcohol and in chloroform; and very solution soluble in acetone and in dioxane.
Sorbitol, a sugar alcohol, is used to increase the palatability of prednisolone sodium phosphate. Do not take 2 solution at 5ml same time or extra doses. Prednisolone doses of 7. Corticosteroids may also mask some signs 5ml infection after it prednisolone already started.
Detailed Prednisolone dosage information What are some side effects that I need to call my doctor about right away? An 15mg myopathy has been observed with the use more information high doses of corticosteroids, most prednisolone occurring in 15mg with disorders of neuromuscular transmission e.
These infections may be mild to severe, and, with increasing doses of corticosteroids, the rate of occurance of infectious complications increases.
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There may be decreased resistance and inability to localize infection when corticosteroids are used. Infection with any pathogen including viral, bacterial, fungal, protozoan or helminthic infection, in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents that affect humoral or cellular immunity, or neutrophil function. These infections may be mild to severe, and, with increasing doses of corticosteroids, the rate of occurance of infectious complications increases.
Corticosteroids may also mask some signs of infection after it has already started. Infections Viral Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affect the risk of developing a disseminated infection is not known.
If exposed to chicken pox, prophylaxis with varicella zoster immune globulin VZIG may be indicated. If exposed to measles, prophylaxis with immunoglobulin IG may be indicated.
If chicken pox develops, treatment with antiviral agents should be considered. Ophthalmic Use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to bacteria, fungi or viruses. The use of oral corticosteroids is not recommended in the treatment of optic neuritis and may lead to an increase in the risk of new episodes. Corticosteroids should not be used in active ocular herpes simplex.
Special Pathogens Latent disease may be activated or there may be an exacerbation of intercurrent infections due to pathogens, including those caused by Candida, Mycobacterium, Ameba, Toxoplasma, Pneumocystis, Cryptococcus, Nocardia, etc.
Corticosteroids may activate latent amebiasis. Therefore, it is recommended that latent or active amebiasis be ruled out before initiating corticosteroid therapy in any patient who has spent time in the tropics or in any patient with unexplained diarrhea. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides threadworm infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia.
Corticosteroids should not be used in cerebral malaria. Tuberculosis The use of prednisolone in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur.
During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. Vaccination Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered, however, the response to such vaccines can not be predicted. Immunization procedures may be undertaken in patients who are receiving corticosteroids as replacement therapy, e.
Precautions General The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage is possible, the reduction should be gradual. There is an enhanced effect of corticosteroids in patients with hypothyroidism and in those with cirrhosis.
Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy, most often for chronic conditions. Discontinuation of corticosteroids may result in clinical improvement. Cardio-renal As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with hypertension, congestive heart failure, or renal insufficiency.
Endocrine Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. Gastrointestinal Steroids should be used with caution in nonspecific ulcerative colitis, if there is a probability of impending perforation, abscess or other pyogenic infection; diverticulitis; fresh intestinal anastomoses; active or latent peptic ulcer.
Signs of peritoneal irritation following gastrointestinal perforation in patients receiving corticosteroids may be minimal or absent. Musculoskeletal Corticosteroids decrease bone formation and increase bone resorption both through their effect on calcium regulation i.
This, together with a decrease in the protein matrix of the bone secondary to an increase in protein catabolism, and reduced sex hormone production, may lead to inhibition of bone growth in children and adolescents and the development of osteoporosis at any age. Special consideration should be given to patients at increased risk of osteoporosis i. Neuro-psychiatric Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that they affect the ultimate outcome or natural history of the disease.
The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect. An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission e. This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis.
Elevation of creatinine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years. Psychic derangements may appear when corticosteroids are used, 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.
Ophthalmic Intraocular pressure may become elevated in some individuals. If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored. Information for Patients Patients should be warned not to discontinue the use of prednisolone sodium phosphate oral solution abruptly or without medical supervision, to advise any medical attendants that they are taking prednisolone sodium phosphate oral solution and to seek medical advice at once should they develop fever or other signs of infection.
Persons who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles. Patients should also be advised that if they are exposed, medical advice should be sought without delay. Drug Interactions Drugs such as barbiturates, phenytoin, ephedrine, and rifampin, which induce hepatic microsomal drug metabolizing enzyme activity may enhance metabolism of prednisolone and require that the dosage of prednisolone sodium phosphate oral solution be increased.
Increased activity of both cyclosporin and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use. Estrogens may decrease the hepatic metabolism of certain corticosteroids thereby increasing their effect.
Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect. Concomitant use of aspirin or other non-steroidal anti-inflammatory agents and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia.
The clearance of salicylates may be increased with concurrent use of corticosteroids. When corticosteroids are administered concomitantly with potassium-depleting agents i. Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.
Due to inhibition of antibody response, patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. If possible, routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued. Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.
Corticosteroids may suppress reactions to skin tests. Pregnancy Teratogenic Effects Pregnancy Category C Prednisolone has been shown to be teratogenic in many species when given in doses equivalent to the human dose. Animal studies in which prednisolone has been given to pregnant mice, rats, and rabbits have yielded an increased incidence of cleft palate in the offspring.
There are no adequate and well controlled studies in pregnant women. Prednisolone sodium phosphate oral solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism. Nursing Mothers Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects.
Caution should be exercised when prednisolone sodium phosphate oral solution is administered to a nursing woman. Pediatric Use The efficacy and safety of prednisolone in the pediatric population are based on the well-established course of effect of corticosteroids which is similar in pediatric and adult populations.
However, some of these conclusions and other indications for pediatric use of corticosteroid, e. Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis.
Children who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity.
This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression i. Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in children than some commonly used tests of HPA axis function.
The linear growth of children treated with corticosteroids by any route should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of other treatment alternatives. In order to minimize the potential growth effects of corticosteroids, children should be titrated to the lowest effective dose.
Geriatric Use Clinical studies of prednisolone sodium phosphate oral solution did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.
Other reported clinical experience with prednisolone sodium phosphate has not identified differences in responses between the elderly and younger patients. My cats panic if they feel held down or restricted in any way … more 3 You liked it! Something went wrong. Please try again later. Report Amazing Price!!!! I get 6 times the product for the exact same amount. I just use the oral syringe I got from my previous pharmacy and to the back of the throat we go.
My cat has been in this prescription for 4 years, 2.