ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Prednisolone (systemic): Drug information

Prednisolone (systemic): Drug information
(For additional information see "Prednisolone (systemic): Patient drug information" and see "Prednisolone (systemic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Millipred DP 12-Day [DSC];
  • Millipred DP [DSC];
  • Millipred [DSC];
  • Orapred ODT;
  • Pediapred
Brand Names: Canada
  • Pediapred;
  • PMS-Prednisolone
Pharmacologic Category
  • Corticosteroid, Systemic
Dosing: Adult

Note: Dosing: Evidence to support an optimal dose and duration is lacking for most indications; recommendations provided are general guidelines only and primarily based on expert opinion. In general, glucocorticoid dosing should be individualized and the minimum effective dose/duration should be used. For select indications with weight-based dosing, consider using ideal body weight in patients with obesity, especially with longer durations of therapy (Erstad 2004; Furst 2019). Hypothalamic-pituitary-adrenal (HPA) suppression: Although some patients may become HPA suppressed with lower doses or briefer exposure, some experts consider HPA-axis suppression likely in any adult receiving >20 mg/day (daytime dosing) or ≥5 mg/day (evening or night dosing) for >2 weeks or with Cushingoid appearance (Furst 2022; Joseph 2016); do not abruptly discontinue treatment in these patients; dose tapering may be necessary (Cooper 2003).

Usual dosage range:

Note: Dose is based on prednisone equivalency.

Oral: 10 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses; Low dose: 2.5 to 10 mg/day; High dose: 1 to 1.5 mg/kg/day (usually not to exceed 80 to 100 mg/day).

The following dosing is an example of a tapered-dosage regimen:

Day 1: 30 mg on day 1 administered as 10 mg at breakfast, 5 mg at lunch, 5 mg at dinner, and 10 mg at bedtime.

Day 2: 25 mg on day 2 administered as 5 mg at breakfast, 5 mg at lunch, 5 mg at dinner, and 10 mg at bedtime.

Day 3: 20 mg on day 3 administered as 5 mg at breakfast, 5 mg at lunch, 5 mg at dinner, and 5 mg at bedtime.

Day 4: 15 mg on day 4 administered as 5 mg at breakfast, 5 mg at lunch, and 5 mg at bedtime.

Day 5: 10 mg on day 5 administered as 5 mg at breakfast and 5 mg at bedtime.

Day 6: 5 mg on day 6 administered as 5 mg at breakfast.

Indication-specific dosing:

Note: Dose is based on prednisone equivalency.

Adrenal insufficiency, primary chronic

Adrenal insufficiency, primary chronic (alternative agent):

Note: In general, hydrocortisone is preferred. Use in conjunction with fludrocortisone.

Chronic maintenance dosing:

Oral: Usual dosage range: 2.5 to 7.5 mg once daily (ES [Bornstein 2016]; Nieman 2020).

Stress dosing:

Note: Patients who are unable to tolerate oral medication (eg, due to vomiting or diarrhea), are in active labor, or are under moderate to major surgical stress may require parenteral corticosteroid therapy (preferably with hydrocortisone) to prevent adrenal crisis (Allolio 2015; ES [Bornstein 2016]).

Patients with febrile illness: Double the chronic maintenance dose until recovery for fever 38°C (100.4°F) to 39°C (102.2°F) or triple the chronic maintenance dose until recovery for fever >39°C (102.2°F), then return to baseline dose within 1 to 3 days (Allolio 2015; ES [Bornstein 2016]).

Minor surgical stress (eg, hernia repair, procedures with local anesthetic): Continue chronic maintenance dose (no additional supplementation needed) (Coursin 2002; Hamrahian 2020; Salem 1994); may give an additional 5 mg (equivalent to ~20 mg hydrocortisone) postoperatively if signs or symptoms of adrenal insufficiency are present (Allolio 2015; Husebye 2014).

Alcoholic hepatitis

Alcoholic hepatitis (severe) (Maddrey Discriminant Function [MDF] score ≥32) (off-label use): Oral: 40 mg daily for 28 days, followed by a 2- to 4-week taper (AASLD [Crabb 2020]; ACG [Singal 2018]).

Angioedema and/or new-onset urticaria

Angioedema (acute allergic) and/or new-onset urticaria: Note: For moderate to severe symptoms without signs of anaphylaxis. Use epinephrine if anaphylaxis symptoms (eg, risk of airway or cardiovascular compromise) are present (AAAAI/ACAAI [Bernstein 2014]; Zuraw 2023). In patients with new-onset urticaria, reserve use for those with significant angioedema or with symptoms that are unresponsive to antihistamines (AAAAI/ACAAI [Bernstein 2014]; Asero 2023; EAACI [Zuberbier 2022]).

Oral: Dose is based on prednisone equivalency. The optimal dosing strategy has not been defined; an example regimen is 20 to 60 mg daily initially, followed by a taper over 5 to 7 days (Asero 2023; EAACI [Zuberbier 2022]; Zuraw 2023). The total treatment duration should not exceed 10 days (EAACI [Zuberbier 2022]).

Asthma, acute exacerbation

Asthma, acute exacerbation: Note: For moderate to severe exacerbations or in patients who do not respond promptly and completely to short-acting beta agonists; administer within 1 hour of presentation to emergency department (GINA 2023).

Oral: 40 to 60 mg daily for 5 to 7 days; administer in 1 or 2 divided doses. If symptoms do not resolve and peak expiratory flow is not at least 70% of personal best, then longer treatment may be required (GINA 2023; NAEPP 2007).

Bell palsy

Bell palsy (off-label use): Oral: 60 mg once daily for 5 days, then taper dose downward by 10 mg daily for 5 days (total treatment duration: 10 days) (Berg 2012; Engstrom 2008) or 50 mg daily (in 1 or 2 divided doses) for 10 days (begin within 72 hours of onset of symptoms) (Baugh 2013; Sullivan 2007).

Bullous pemphigoid

Bullous pemphigoid (off-label use): Oral: Initial: 0.5 mg/kg/day. May begin gradual taper over 4 to 6 months when disease is controlled (eg, no new lesions or pruritic symptoms for ≥2 weeks and most established lesions have healed). May discontinue therapy if complete remission maintained for at least 3 to 6 months on doses ≤0.1 mg/kg/day (usual total duration: 9 to 12 months) (EADV [Borradori 2022]; Joly 2002; Kirtschig 2010; Murrell 2023).

Inadequate initial control: In patients who do not achieve disease control within 1 to 3 weeks of initial therapy, may increase to 0.75 mg/kg/day; may also consider addition of other agents (eg, topical corticosteroids, immunosuppressants) (EADV [Borradori 2022]).

Disease recurrence: Return to the preceding lowest effective treatment dose; if not effective, return to initial effective dose (EADV [Borradori 2022]; Murrell 2023).

Chronic obstructive pulmonary disease, acute exacerbation

Chronic obstructive pulmonary disease, acute exacerbation (off-label use):

Note: In patients with severe but not life-threatening exacerbations, oral regimens are recommended. In patients who cannot tolerate oral therapy (eg, shock, mechanically ventilated), use IV methylprednisolone (GOLD 2023; Stoller 2023).

Oral: 40 to 60 mg once daily for 5 to 14 days (de Jong 2007; GOLD 2023; Leuppi 2013; Stoller 2023). Note: The optimal dose and duration has not been established. If patient improves with therapy, may discontinue without taper. If patient does not improve, a longer duration of therapy may be indicated (Stoller 2023).

Duchenne muscular dystrophy

Duchenne muscular dystrophy (off-label use): Oral: 0.75 mg/kg/day (AAN [Gloss 2016]; Escolar 2011). Some experts use a maximum dose of 40 mg/day due to potential for greater adverse effects and decreased benefit at higher doses (Darras 2020).

Note: In patients who experience intolerable adverse effects, may decrease the dose by 25% to 33% (Birnkrant 2018). If adverse effects persist, continue to gradually taper to as low as 0.3 mg/kg/day, which may provide benefit (AAN [Gloss 2016]; Darras 2020). Doses as high as 1.5 mg/kg/day have been studied, but there is no evidence that doses >0.75 mg/kg/day provide greater efficacy (AAN [Gloss 2016]; Matthews 2016).

Giant cell arteritis, treatment

Giant cell arteritis, treatment (off-label use): Note: To reduce the risk of visual loss, start treatment immediately once diagnosis is highly suspected (BSR/BHPR [Dasgupta 2010]; Loddenkemper 2007). In patients presenting with threatened vision loss, pulse IV methylprednisolone is suggested as initial therapy prior to an oral glucocorticoid (eg, prednisolone) (ACR/VF [Maz 2021]).

Oral: 40 to 60 mg once daily for 2 to 4 weeks; if reversible symptoms persist or worsen, may increase dose up to a maximum dose of 80 mg once daily until symptomatic control is achieved (BSR/BHPR [Dasgupta 2010]; Salvarani 2023). Alternatively, may initiate at 1 mg/kg once daily (maximum: 80 mg/day), particularly in patients with signs of ischemic organ damage (eg, vision loss) (ACR/VF [Maz 2021]; Salvarani 2023). Once signs/symptoms have declined and laboratory values have returned to normal or near normal, begin to taper until discontinuation over the next 6 to 12 months (BSR/BHPR [Dasgupta 2010]; Salvarani 2023).

Gout, treatment, acute flares

Gout, treatment, acute flares:

Note: Avoid use in patients with known or suspected septic arthritis (Gaffo 2023).

Oral: 30 to 40 mg/day given once daily or in 2 divided doses until symptom improvement (usually 2 to 5 days), then taper gradually as tolerated (typically over 7 to 10 days); a slower taper (eg, over 14 to 21 days) may be required, particularly in patients with multiple recent flares (ACP [Qaseem 2017]; ACR [Khanna 2012]; EULAR [Richette 2017]; Gaffo 2023).

Hepatitis, autoimmune

Hepatitis, autoimmune (off-label use): Note: Approach to treatment should be patient-specific and guided by response to treatment. Monotherapy induction regimen included below; other induction regimens (eg, combination therapy with a glucocorticoid-sparing agent) may be used in select patients (AASLD [Mack 2020]; EASL 2015; Heneghan 2022).

Induction: Initial: Oral: 40 to 60 mg once daily for 1 week or until biochemical remission achieved, followed by a taper (eg, reduce daily dose by 5 to 10 mg at weekly intervals) based on symptoms and laboratory values to 20 mg once daily or a dose sufficient for maintenance of remission (AASLD [Mack 2020]; Heneghan 2022). Some experts initiate therapy at 20 to 30 mg once daily depending on severity of disease and tolerance to glucocorticoids (Heneghan 2022).

Maintenance: Further taper dose to one that maintains remission (eg, taper the dose by 2.5 to 5 mg every 2 to 4 weeks to reach 5 to 10 mg/day). Specific maintenance approach will depend on patient response to initial treatment and tapering (AASLD [Mack 2020]).

IgA nephropathy, primary, nonvariant

IgA nephropathy, primary, nonvariant (adjunctive agent) (off-label use): Note: May consider for use in selected patients at high risk of chronic kidney disease progression (eg, proteinuria ≥0.75 to 1 g/day) despite 3 to 6 months of optimized doses of nonimmunosuppressive therapies (eg, renin-angiotensin system inhibitors) (Ref). The optimal dose of prednisolone has not been established and may vary based on institutional protocols and patient-specific factors; an example regimen (based on an equivalent dose of methylprednisolone) is provided below.

Oral: 0.5 mg/kg once daily for 2 months (maximum dose: 40 mg/day). Taper daily dose every month over an additional 4 to 7 months. Note: Antimicrobial prophylaxis for Pneumocystis pneumonia was also prescribed for the first 12 weeks of therapy (Ref).

Immune thrombocytopenia

Immune thrombocytopenia: Note: Goal of therapy is to provide a safe platelet count to prevent clinically important bleeding rather than normalization of the platelet count. For patients with severe bleeding, a pulse of dexamethasone or methylprednisolone is recommended; due to the short-term response associated with methylprednisolone, a prednisolone taper may be required following pulse doses of methylprednisolone. For minor bleeding, prednisolone is an appropriate initial therapy (Arnold 2022; Provan 2019).

Initial therapy: Oral: 1 mg/kg/day (range: 0.5 to 2 mg/kg/day; maximum: 80 mg/day) for 1 to 2 weeks, followed by a gradual taper (Arnold 2022; ASH [Neunert 2019]; Provan 2019). Total duration of therapy should not exceed 6 weeks; if there is no response within 2 weeks, taper over 1 week and discontinue (ASH [Neunert 2019]; Provan 2019).

Pregnancy associated: Oral: Initial: 10 to 20 mg once daily (ACOG 2019a). Adjust to the minimum effective dose to achieve response; generally, continue for at least 21 days, then taper to the minimum effective dose required to maintain platelet count to prevent major bleeding (ACOG 2019a; Provan 2019) or 1 mg/kg/day for 2 weeks, followed by a gradual taper (George 2022).

Fetal alloimmune thrombocytopenia (maternal administration): Oral: 0.5 to 1 mg/kg/day. Dose is dependent upon gestational age and risk of fetal/neonatal intracranial hemorrhage and is administered in addition to immune globulin IV (ACOG 2019a; Pacheco 2011).

Inflammatory bowel disease

Inflammatory bowel disease:

Crohn disease (moderate to severe or select patients with mild disease), induction: Note: Not for long-term use (ACG [Lichtenstein 2018]).

Oral: 40 to 60 mg once daily for 7 to 14 days, followed by a taper of up to 3 months (eg, reduce dose by 5 mg/day at weekly intervals until 20 mg/day is reached, then further reduce by 2.5 to 5 mg/day at weekly intervals) (ACG [Lichtenstein 2018]). Tapering regimens vary; some experts recommend a more rapid taper with a goal of discontinuing therapy within 1 to 2 months; if symptoms return, may resume therapy and taper more slowly (Regueiro 2022). Steroid-sparing agents (eg, biologic agents, immunomodulators) should be introduced with a goal of discontinuing corticosteroid therapy as soon as possible (ACG [Lichtenstein 2018]).

Ulcerative colitis (moderate to severe), induction: Note: Not for long-term use (ACG [Rubin 2019]).

Oral: 40 to 60 mg/day in 1 to 2 divided doses. Clinical improvement is expected within 7 days; pace of tapering (usually over 1 to 3 months) should be guided by symptoms, cumulative steroid exposure, and onset of action of additional therapies (ACG [Rubin 2019]; al Hashash 2019; Cohen 2022a).

Iodinated contrast media allergic-like reaction, prevention

Iodinated contrast media allergic-like reaction, prevention: Note: Generally reserved for patients with a prior allergic-like or unknown-type iodinated contrast reaction who will be receiving another iodinated contrast agent. Nonurgent premedication with an oral corticosteroid is generally preferred when contrast administration is scheduled to begin in ≥12 hours; however, consider an urgent (accelerated) regimen with an IV corticosteroid (eg, methylprednisolone) for those requiring contrast in <12 hours (ACR 2018).

Nonurgent regimen: Oral: 50 mg administered 13 hours, 7 hours, and 1 hour before contrast medium administration in combination with oral diphenhydramine 50 mg (administered 1 hour prior to contrast) (ACR 2018).

Minimal change disease, treatment

Minimal change disease, treatment (off-label use): Initial therapy: Oral: 1 mg/kg/day (maximum: 80 mg/day) once daily or 2 mg/kg every other day (maximum: 120 mg every other day) for 4 to 16 weeks (if no response by 16 weeks, patient is most likely glucocorticoid resistant); ~2 weeks after achieving complete remission, gradually taper (eg, decrease by 5 to 10 mg/week for a total period of glucocorticoid exposure of up to 6 months); the duration of initial pulse therapy and tapering schedule can vary (Hogan 2013; KDIGO 2021; Vivarelli 2017).

Multiple sclerosis, acute exacerbation

Multiple sclerosis, acute exacerbation: Note: For patients with an acute exacerbation resulting in neurologic symptoms and increased disability or impairments in vision, strength, or cerebellar function (Olek 2019).

Initial pulse therapy using an oral glucocorticoid (alternative agent to IV methylprednisolone pulse therapy): Oral: 625 mg to 1.25 g daily for 3 to 7 days (5 days typically), either alone or followed by a taper (Morrow 2004; Olek 2019).

Taper following IV methylprednisolone or prednisone pulse therapy: Oral: 1 mg/kg/day (maximum: 80 mg/day), followed by a taper; total duration of oral therapy is usually 11 to 14 days (Goodin 2014; Murray 2006; Myhr 2009). Tapering schedules vary and some experts prefer to omit taper following initial pulse glucocorticoid therapy (Olek 2019).

Myasthenia gravis, crisis

Myasthenia gravis, crisis (adjunctive therapy) (off-label use): Note: Used in conjunction with immune globulin IV or plasma exchange (Bird 2021).

Oral: 1 mg/kg/day (usual dose range: 60 to 80 mg daily), followed by a taper (Bird 2021; Lacomis 2005).

Myopathies, treatment

Myopathies (dermatomyositis/polymyositis), treatment:

Initial therapy (or following initial therapy with pulse IV methylprednisolone in select patients): Oral: 1 mg/kg/day (maximum: 80 mg/day) as a single daily dose until improvement (usually for 4 to 6 weeks); then gradually tapered (total duration usually 9 to 12 months) (Dalakas 2011; Findlay 2015; Miller 2022). Note: Continuing high dose (1 mg/kg/day) for more than 6 weeks may increase risk of developing glucocorticoid-associated myopathy (Miller 2022).

Pericarditis, acute or recurrent

Pericarditis, acute or recurrent (alternative agent) (off-label use): Note: May be used for patients with contraindications or incomplete response to nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine. Glucocorticoid therapy early in the course of pericarditis is more likely to be associated with recurrent episodes (ESC [Adler 2015]; Imazio 2022). Glucocorticoid therapy should be avoided in patients with pericarditis secondary to acute myocardial infarction given lack of benefit and potential harm (ACCF/AHA [O’Gara 2013]; LeWinter 2022).

Oral: 0.2 to 0.5 mg/kg/day until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein) if monitored; the initial dose is typically continued for 2 to 4 weeks then gradually tapered over 2 to 3 months if patient remains asymptomatic and inflammatory biomarkers remain normal (if monitored). Use in combination with colchicine (ESC [Adler 2015]; Imazio 2022).

Pneumocystis pneumonia, adjunctive therapy for moderate to severe disease

Pneumocystis pneumonia, adjunctive therapy for moderate to severe disease (off-label use): Note: Recommended for patients with PaO2 <70 mm Hg on room air or PAO2-PaO2 ≥35 mm Hg (HHS [OI adult 2022]); some experts additionally recommend for patients with oxygen saturation <92% on room air (Sax 2022; Thomas 2022).

Oral: 40 mg twice daily on days 1 to 5 beginning as early as possible, followed by 40 mg once daily on days 6 to 10, then 20 mg once daily on days 11 to 21 (HHS [OI adult 2022]).

Polymyalgia rheumatica

Polymyalgia rheumatica: Note: Goal of therapy is to alleviate symptoms; therapy has not been shown to improve prognosis or prevent progression to giant cell arteritis (Salvarani 2021).

Oral: Initial: Usual dose: 15 mg/day in a single daily dose or in divided doses; some experts consider lower initial doses of 7.5 to 10 mg/day for smaller patients with mild symptoms or at high risk for side effects (eg, labile diabetes) and higher initial doses of 20 mg/day (or 25 mg/daily [rarely]) for patients with more severe symptoms. Divided doses may help with pain and stiffness in evenings and following morning. Once symptoms are controlled, maintain dose for 2 to 4 weeks and gradually taper (generally over a 1- to 2-year period); some patients may require longer treatment (Castañeda 2019; EULAR/ACR [Dejaco 2015]; Salvarani 2021).

Prostate cancer, advanced or metastatic

Prostate cancer, advanced or metastatic: Oral: 5 mg once daily (in combination with abiraterone); treatment duration depends on disease stage and radiotherapy intent (James 2017) or 10 mg once daily (in combination with docetaxel and androgen-deprivation therapy) for six 21-day cycles (James 2016) or 5 mg twice daily (in combination with abiraterone and olaparib) until disease progression or unacceptable toxicity (Clarke 2022) or 5 mg twice daily (in combination with mitoxantrone) for up to ten 21-day cycles (Tannock 2004).

Systemic rheumatic disorders

Systemic rheumatic disorders (eg, antineutrophil cytoplasmic antibody-associated vasculitis, mixed cryoglobulinemia syndrome, polyarteritis nodosa, rheumatoid arthritis, systemic lupus erythematosus): Note: The following dosage ranges are for guidance only; dosing should be highly individualized, taking into account disease severity, the specific disorder, and disease manifestations:

Mild to moderate disease: Oral: Initial: 5 to 30 mg/day in a single daily dose or in divided doses, then taper to the minimum effective dose, depending on response (ACR 2002; Cohen 2022b; Fervenza 2020; O’Dell 2020; Wallace 2020).

Severe disease: Initial therapy (or following initial therapy with pulse IV methylprednisolone in select patients):

Oral: 1 mg/kg/day (maximum: 60 to 80 mg/day) in a single daily dose or in divided doses; typically given for several weeks, then tapered gradually; may be given as part of an appropriate combination regimen; for severe systemic lupus erythematosus, up to 2 mg/kg/day may be given initially (Fervenza 2020; Muchtar 2017; Pietrogrande 2011; Wallace 2020).

Takayasu arteritis

Takayasu arteritis (off-label use): Oral: Initial: 40 to 60 mg daily in combination with appropriate steroid-sparing agent; gradually taper to lowest effective dose (ACCF/AHA [Hiratzka 2010]; EULAR [Hellmich 2020]); some experts initiate treatment with 1 mg/kg/day (maximum: 60 to 80 mg/day) (Merkel 2020). Note: Long-term therapy may be required to prevent progression (ACCF/AHA [Hiratzka 2010]; Merkel 2020).

Thyroid eye disease, moderate to severe

Thyroid eye disease, moderate to severe (off-label use):

Note: For use as an alternative to IV glucocorticoids (eg, methylprednisolone); in patients with sight-threatening disease (eg, compressive optic neuropathy), urgent administration of IV glucocorticoids is required (ATA/ETA [Burch 2022]; EUGOGO [Bartalena 2021]).

Oral: 60 to 100 mg once daily for 7 days, then gradually taper dose by 5 to 10 mg/week over 4 to 6 months based on clinical response and then discontinue (Bartalena 1997; EUGOGO [Bartalena 2021]; Kahaly 2005; Marcocci 2001).

Thyroiditis, subacute

Thyroiditis, subacute (off-label use): Note: For use in patients whose pain does not respond to full dose of NSAIDs over several days or patients who present initially with moderate to severe pain (ATA [Ross 2016]).

Oral: Initial: 40 mg/day for 1 to 2 weeks; gradually taper (eg, by 5 to 10 mg/day every 5 to 7 days) based on clinical response. If pain recurs, increase to the lowest dose that controlled the pain; maintain that dose for ~2 weeks and attempt to taper again (ATA [Ross 2016]; Burman 2022).

Urticaria, chronic spontaneous, acute exacerbation

Urticaria, chronic spontaneous, acute exacerbation (off-label use): Note: For the temporary control of severe exacerbations (AAAAI/ACAAI [Bernstein 2014]; EAACI [Zuberbier 2022]; Powell 2015).

Oral: 35 to 40 mg once daily until symptoms are controlled (usually occurs after 2 to 3 days of therapy), then taper by 5 to 10 mg/day over a period of 1 to 3 weeks followed by discontinuation (AAAAI/ACAAI [Bernstein 2014]; Khan 2023; Powell 2015).

Warm autoimmune hemolytic anemia

Warm autoimmune hemolytic anemia: Oral: 1 to 2 mg/kg/day until a hemoglobin response has occurred (typically within 1 to 3 weeks). After hemoglobin stabilization, begin tapering to the lowest dose to maintain remission followed by gradual tapering with an eventual goal of discontinuation (total duration of therapy: 3 to 12 months); a clinician experienced with the treatment of hemolytic anemia should be involved with therapy (Barros 2010; Brodsky 2019; Roumier 2014; Zanella 2014).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Note: The pharmacokinetics and pharmacodynamics of prednisolone in kidney impairment are not well understood (Bergmann 2012; Czock 2005; Honoré 2014). Prednisolone clearance is reduced ~40% in patients with uremia (Bergrem 1983) and is slightly dialyzable (≤17.5%) (Frey 1982); however, the clinical implications of these findings are unclear.

Altered kidney function: No dosage adjustment necessary for any degree of kidney impairment (expert opinion).

Hemodialysis, intermittent (thrice weekly): No supplemental dose or dosage adjustment necessary (expert opinion).

Peritoneal dialysis: No dosage adjustment necessary (expert opinion).

CRRT: No dosage adjustment necessary (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing; use lowest effective dose.

Dosing: Pediatric

(For additional information see "Prednisolone (systemic): Pediatric drug information")

Note: Adjust dose depending upon condition being treated and response of patient. The lowest possible dose should be used to control the condition; when dose reduction is possible, the dose should be reduced gradually. Consider alternate day therapy for long-term therapy.

General dosing, anti-inflammatory or immunosuppressive: Infants, Children, and Adolescents: Oral: 0.1 to 2 mg/kg/day in divided doses 1 to 4 times daily.

Asthma

Asthma:

National Asthma Education and Prevention Program guidelines (NAEPP 2007):

Asthma exacerbations (emergency care or hospital doses):

Infants and Children <12 years: Oral: 1 to 2 mg/kg/day in 2 divided doses; continue until peak expiratory flow is 70% of predicted or personal best; maximum daily dose: 60 mg/day.

Children ≥12 years and Adolescents: Oral: 40 to 80 mg in divided doses 1 to 2 times daily until peak expiratory flow is 70% of predicted or personal best.

Short-course "burst" (outpatient acute asthma):

Infants and Children <12 years: Oral: 1 to 2 mg/kg/day in divided doses 1 to 2 times daily for 3 to 10 days; maximum daily dose: 60 mg/day; Note: Burst should be continued until symptoms resolve or patient achieves peak expiratory flow 80% of personal best; usually requires 3 to 10 days of treatment (~5 days on average); longer treatment may be required.

Children ≥12 years and Adolescents: Oral: 40 to 60 mg in divided doses 1 to 2 times daily for 3 to 10 days; Note: Burst should be continued until symptoms resolve or patient achieves peak expiratory flow 80% of personal best; usually requires 3 to 10 days of treatment (~5 days on average); longer treatment may be required.

Long-term treatment for severe, persistent asthma (non-acute):

Infants and Children <12 years: Oral: 0.25 to 2 mg/kg/day given as a single dose in the morning or every other day as needed for asthma control; maximum daily dose: 60 mg/day.

Children ≥12 years and Adolescents: Oral: 7.5 to 60 mg daily given as a single dose in the morning or every other day as needed for asthma control.

Global Initiative for Asthma guidelines (GINA 2020): Management in primary care or acute care facility.

Infants and Children <12 years: Oral: 1 to 2 mg/kg/day for 3 to 5 days.

Maximum daily dose age-dependent:

Infants and Children ≤2 years: 20 mg/day.

Children 3 to 5 years: 30 mg/day.

Children 6 to 11 years: 40 mg/day.

Children ≥12 years and Adolescents: Oral: 1 mg/kg/day usually given as a single dose for 5 to 7 days; maximum daily dose: 50 mg/day.

Bell palsy

Bell palsy: Limited data available:

Infants, Children, and Adolescents <16 years: Optimal regimen not defined: Oral: 1 to 2 mg/kg/day for 5 to 7 days, followed by a 7- to 10-day taper. Begin treatment within 72 hours of onset of symptoms; usual maximum daily dose: 50 to 60 mg/day (Arican 2017; Babl 2017; Yoo 2018). Pediatric patients with Bell palsy may experience spontaneous recovery, even without treatment; potential benefit of treatment is unclear (AAO-HNSF [Baugh 2013]; Chen 2005; Pitaro 2012; Yoo 2018).

Adolescents ≥16 years: Oral: 50 mg daily given in 1 or 2 divided doses for 10 days; treatment should begin within 72 hours of onset of symptoms (AAO-HNSF [Baugh 2013]; Sullivan 2007) or 1 mg/kg/day for 7 days; maximum daily dose 60 mg/day; followed by a gradual taper over 7 days (Yoo 2018).

Congenital adrenal hyperplasia

Congenital adrenal hyperplasia: Note: Individualize dose by monitoring growth, hormone levels, and bone age; mineralocorticoid (eg, fludrocortisone) and sodium supplement may be required in salt losers (Endocrine Society [Speiser 2018]):

Adolescents (fully grown): Oral: 4 to 6 mg daily in divided doses 2 times daily; use of a liquid dosage form may be preferable to allow for better dose titration (Endocrine Society [Speiser 2018]). Note: For younger patients who are still growing, hydrocortisone or fludrocortisone are preferred.

Crohn disease

Crohn disease: Note: Use for induction in patients with active luminal disease if exclusive enteral nutrition is poorly tolerated or ineffective (ECCO/ESPGHAN [van Rheenen 2020]). Limited data available:

Weight-directed dosing: Children and Adolescents: Oral: 1 to 2 mg/kg/day; maximum daily dose: 60 mg/day; continue for 2 to 4 weeks until remission, then gradually taper over 4 to 8 weeks (BSPGHAN [Sandhu 2010]; Irving 2007; NASPGHAN [Rufo 2012]).

Fixed dose (ECCO/ESPGHAN [van Rheenen 2020]): Children and Adolescents: Oral:

10 to 20 kg: 20 mg once daily until clinical remission or a maximum of 4 weeks (whichever occurs first) followed by tapering in 2.5 to 5 mg increments every 5 to 7 days. Goal to discontinue by ≤10 weeks.

>20 to 30 kg: 30 mg once daily until clinical remission or a maximum of 4 weeks (whichever occurs first) followed by tapering in 5 mg increments every 5 to 7 days. Goal to discontinue by ≤10 weeks.

>30 kg: 40 mg once daily until clinical remission or a maximum of 4 weeks (whichever occurs first) followed by tapering in 5 mg increments every 5 to 7 days. Goal is to discontinue by ≤10 weeks.

Croup, mild to moderate

Croup (laryngotracheobronchitis), mild to moderate (alternative agent): Limited data available; optimal place in therapy not defined:

Single-dose treatment: Infants and Children: Oral: 1 mg/kg/day as single dose; clinical studies comparing this regimen to dexamethasone have shown variable results; two studies found no difference in efficacy or outcome compared to dexamethasone (Fifoot 2007; Parker 2019); another study found that while there were no differences in time spent in the emergency department, epinephrine use and duration of symptoms between the 2 groups, patients in the prednisolone group were more likely to have symptom recurrence (Sparrow 2006).

3- dose treatment: Infants and Children ≤8 years: Oral: 2 mg/kg/day for 3 days. Maximum dose: 60 mg/dose. One randomized study compared multidose prednisolone to a single dexamethasone dose in patients presenting with croup; no differences in outcomes were noted between the 2 treatment groups in regard to symptom control or additional health care for croup needed (Garbutt 2013).

Dermatomyositis, juvenile

Dermatomyositis, juvenile: Limited data available: Children and Adolescents: Oral: 1 to 2 mg/kg/day; usual recommended maximum daily dose: 60 mg/day; higher doses of 80 mg/day have also been reported; continue for 4 weeks then if adequate patient response, begin taper; taper dose by 0.5 mg/kg increments every 2 weeks based on response until dose is 0.5 mg/kg/day, then taper every 4 weeks as tolerated; optimal duration is unknown; use in combination with other immunosuppressants (eg, methotrexate) (CARRA [Huber 2010]; CARRA [Huber 2012]; CARRA [Huber 2017]; CARRA [Kim 2017]; SHARE [Bellutti Enders 2017]; Hinze 2018).

Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD): Children ≥4 years and Adolescents: Oral: Usual recommended dose: 0.75 mg/kg/day; maximum dose: 40 mg/dose (AAN [Gloss 2016]; Escolar 2011; Fenichel 1991; Mendell 1989; Matthews 2016). If adverse effects persist, continue to gradually taper to as low as 0.3 mg/kg/day, which may provide benefit (AAN [Gloss 2016]). Doses as high as 1.5 mg/kg/day have been studied, but there is no evidence that doses >0.75 mg/kg/day provide greater efficacy and it is associated with more adverse effects (AAN [Gloss 2016]; Fenichel 1991; Mendell 1989; Matthews 2016).

Infantile hemangioma, second-line treatment

Infantile hemangioma, second-line treatment: Note: Use if oral propranolol is contraindicated, poorly tolerated, or produces inadequate response (AAP [Krowchuk 2019]).

Infants: Oral: 2 to 3 mg/kg/day up to 5 mg/kg/day; may be administered once daily or in divided doses up to 4 times daily; duration depends on response rate, patient age, and phase of hemangioma growth, but usually ranges for 4 to 12 weeks followed by a gradual taper and completion of therapy by 9 to 12 months of age (AAP [Darrow 2015]; AAP [Krowchuk 2019]; Akyüz 2001; Bennett 2001; Dinehart 2001; Greene 2011; Metry 2000; Sadan 1996)

Immune thrombocytopenia, newly diagnosed

Immune thrombocytopenia (ITP), newly diagnosed (non-life threatening bleeding): Variable regimens reported: Infants, Children, and Adolescents: Oral: Initial: 2 to 4 mg/kg/day in 3 to 4 divided doses for 5 to 7 days; maximum daily dose: 120 mg/day; higher maximum doses of 200 mg/day have also been reported (ASH [Neunert 2019]; Provan 2019); alternatively, 1 to 2 mg/kg/day up to 80 mg/day for 1 to 2 weeks followed by a taper with goal of discontinuing therapy by 3 weeks (Provan 2019).

Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA): Note: Therapy should be individualized based on type of JIA as well as disease severity and activity (ACR/AF [Ringold 2019]; CARRA [Dewitt 2012]).

Polyarticular JIA: Note: In patients with polyarticular JIA with high or moderate disease activity, bridging therapy with a limited course (<3 months) of oral glucocorticoids during initiation or escalation of therapy is recommended; chronic low dose glucocorticoids is not recommended (ACR/AF [Ringold 2019]).

Children and Adolescents (CARRA [Ringold 2014]): Variable regimens reported:

Low dose: Oral: 0.25 mg/kg/day; maximum daily dose: 20 mg/day; after 1 week begin tapering dose by decreasing dose to 0.125 mg/kg/day, then in 3 to 4 days, decrease to 0.05 mg/kg/day and discontinue after a total of 2 weeks.

Medium dose: Oral: 0.5 mg/kg/day; maximum daily dose: 30 mg/day; after 1 week begin taper by decreasing dose to 0.4 mg/kg/day for 7 days, then decrease to 0.25 mg/kg/day for 7 days and then 0.1 mg/kg/day for 7 days; discontinue after a total of 4 weeks.

High dose: Oral: 1 mg/kg/day; maximum daily dose: 60 mg/day; begin tapering dose after 1 to 2 weeks; decrease dose in 0.25 mg/kg/day increments every 1 to 4 weeks; tapering duration varies with some tapering doses over 4 weeks and others use a slower taper and taper off over 3 months.

Systemic JIA: Infants ≥6 months, Children, and Adolescents: Oral: Initial: 1 mg/kg/day administered once daily (initial maximum daily dose: 60 mg/day); may be used in combination with methylprednisolone pulse therapy; evaluate initial response at 1 to 2 weeks and then at 1 month of therapy; if patient improves then taper prednisolone, if unchanged then continue current prednisolone therapy and if worsened then increase dose to 2 mg/kg/day (maximum daily dose: 100 mg/day) . After 1 month, if improvement, begin taper; if condition worsens or unchanged then increase or continue prednisolone dose at 2 mg/kg/day (maximum daily dose: 100 mg/day) and/or may add or repeat methylprednisolone pulse therapy. After 3 months of glucocorticoid therapy, if improvement (prednisolone dose <50% starting dose), continue taper and reassess monthly; if patient remains unchanged (prednisolone dose >50% of starting dose) or worsened, additional therapy should be considered (CARRA [Dewitt 2012]).

Kawasaki disease, primary adjunctive treatment for patients at high risk for intravenous immune globulin resistance or coronary artery aneurysms

Kawasaki disease (KD), primary adjunctive treatment for patients at high risk for intravenous immune globulin (IVIG) resistance or coronary artery aneurysms: Limited data available: Note: Use to transition patients receiving IV corticosteroids for treatment of KD (in combination with IVIG and aspirin):

Infants and Children: Oral: 2 mg/kg/day in divided doses every 8 hours until c-reactive protein (CRP) normalizes; maximum daily dose: 60 mg/day (ACR/VF [Gorelik 2022]; AHA [McCrindle 2017]; Kobayashi 2012). Some centers use less frequent dosing (eg, every 12 hours) to minimize adverse reactions (eg, effect on sleep) and for convenience (eg, ease of dosing at home). Once CRP normalized, taper over 15 days according to institutional practice (tapers may vary); a longer course, tapering over 2 to 3 weeks, may be considered (AHA [McCrindle 2017]; Kobayashi 2012).

Nephrotic syndrome; steroid-sensitive

Nephrotic syndrome; steroid-sensitive (SSNS): Note: Obese patients should be dosed based on ideal body weight:

Children and Adolescents: Oral:

Initial episode: 2 mg/kg/day or 60 mg/m2/day once daily, maximum daily dose: 60 mg/day for 4 to 6 weeks; then adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose, maximum dose: 40 mg/dose (Gipson 2009; KDIGO 2012; KDOQI 2013); prolonged duration has not been shown to reduce risk of relapse; treatment duration should be limited to 2 to 3 months for the first episode of SSNS (Hahn 2015; Hodson 2015; Larkins 2016).

Relapse: 2 mg/kg/day or 60 mg/m2/day once daily, maximum daily dose: 60 mg/day; continue until complete remission for at least 3 days; then adjust to an alternate-day schedule of 1.5 mg/kg/dose or 40 mg/m2/dose on alternate days as a single dose, maximum dose: 40 mg/dose; recommended duration of alternate-day dosing is variable: may continue for at least 4 weeks then taper. Longer duration of treatment may be necessary in patients who relapse frequently, some patients may require up to 3 months of treatment (Gipson 2009; KDIGO 2012; KDOQI 2013).

Maintenance therapy for frequently relapsing SSNS: Taper previous dose down to lowest effective dose which maintains remission using an alternate day schedule; usual effective range: 0.1 to 0.5 mg/kg/dose on alternating days; other patients may require doses up to 0.7 mg/kg/dose every other day (KDIGO 2012; KDOQI 2013).

Ulcerative colitis, moderate to severe

Ulcerative colitis, moderate to severe: Note: Not for long-term maintenance; use for induction only.

Children and Adolescents: Oral: 1 to 2 mg/kg/day administered in the morning for 2 to 3 weeks; maximum daily dose: 60 mg/day; if no response after 7 to 14 days optimal dosing and compliance should be assessed; after the initial 2 to 3 weeks, the dose is gradually decreased over 8 to 10 weeks (Kliegman 2020; ECCO/ESPGHAN [Turner 2018]; NASPGHAN [Rufo 2012]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution.

Hemodialysis: Slightly dialyzable (7% to 17.5%) (Frey 1990).

Intermittent hemodialysis: Supplemental dose necessary (Aronoff 2007).

Peritoneal dialysis: Supplemental dose is not necessary (Aronoff 2007).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Bradycardia, cardiomegaly, cholesterol embolus syndrome, circulatory shock, edema, heart failure, hypertrophic cardiomyopathy (premature infants), myocardial rupture (after recent myocardial infarction), syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis

Dermatologic: Acne vulgaris, allergic dermatitis, atrophic striae, diaphoresis, dry scalp, ecchymoses, facial erythema, hyperpigmentation, hypopigmentation, inadvertent suppression of skin test reaction, skin atrophy, skin rash, thinning hair (scalp), urticaria

Endocrine & metabolic: Decreased serum potassium, fluid retention, growth retardation (children), hirsutism, HPA-axis suppression, hypokalemic alkalosis, impaired glucose tolerance, menstrual disease, negative nitrogen balance (due to protein catabolism), sodium retention, weight gain

Gastrointestinal: Hiccups, impaired intestinal carbohydrate absorption, increased appetite, nausea, pancreatitis

Genitourinary: Asthenospermia, oligospermia

Hematologic & oncologic: Petechia

Hepatic: Hepatomegaly, increased liver enzymes

Hypersensitivity: Nonimmune anaphylaxis

Infection: Sterile abscess

Nervous system: Abnormal sensory symptoms, amyotrophy, arachnoiditis, headache, increased intracranial pressure (with papilledema), insomnia, malaise, meningitis, myasthenia, neuritis, neuropathy, paraplegia, paresis (paraparesis), paresthesia, seizure, vertigo

Neuromuscular & skeletal: Aseptic necrosis of femoral head, aseptic necrosis of humeral head, Charcot arthropathy, rupture of tendon

Ophthalmic: Exophthalmos

Respiratory: Pulmonary edema

Miscellaneous: Wound healing impairment

Postmarketing:

Cardiovascular: Cardiac arrhythmia (including atrial fibrillation) (van der Hooft 2006), hypertension (Mebrahtu 2020), venous thrombosis (Johannesdottir 2013)

Endocrine & metabolic: Cushing syndrome (Hopkins 2005), diabetes mellitus (Tamez-Perez 2015), exacerbation of diabetes mellitus (Tamez-Perez 2015), hyperglycemia (Tamez-Perez 2015), moon face (Hopkins 2005), prediabetes (Tamez-Perez 2015), redistribution of body fat (Hopkins 2005)

Gastrointestinal: Abdominal distention (Liu 2013), peptic ulcer (with possible perforation and hemorrhage) (Liu 2013), ulcerative esophagitis (Liu 2013)

Hypersensitivity: Anaphylaxis (Erdman 2005), angioedema (Gaspar de Sousa 2010)

Infection: Infection (Youssef 2016)

Nervous system: Psychological disorder (including depression, emotional lability, euphoria, personality changes) (Ciriaco 2013)

Neuromuscular & skeletal: Bone fracture (Buckley 2018), osteoporosis (Buckley 2018), steroid myopathy (Haran 2018), vertebral compression fracture (Buckley 2018)

Ophthalmic: Glaucoma (Razeghinejed 2012), increased intraocular pressure (Phulke 2017), subcapsular posterior cataract (Urban 1986)

Contraindications

Hypersensitivity to prednisolone or any component of the formulation; administration of live or live attenuated virus vaccines (with immunosuppressive doses of corticosteroids); systemic fungal infections.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Hepatitis; herpes; shingles; varicella; measles; uncontrolled active infections; uncontrolled psychotic states.

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Particular care is required when patients are transferred from systemic corticosteroids to inhaled products due to possible adrenal insufficiency or withdrawal from steroids, including an increase in allergic symptoms. Adult patients receiving >20 mg per day of prednisone (or equivalent) may be most susceptible. Fatalities have occurred due to adrenal insufficiency in asthmatic patients during and after transfer from systemic corticosteroids to aerosol steroids; aerosol steroids do not provide the systemic steroid needed to treat patients having trauma, surgery, or infections.

• Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.

• Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, cause activation of latent infections, mask acute infection (including fungal infections) or prolong or exacerbate viral infections or limit response to killed or inactivated vaccines. Exposure to chickenpox or measles should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria or viral hepatitis. Close observation is required in patients with tuberculosis (TB) infection (latent TB) and/or TB reactivity; restrict use in TB disease (active TB) (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to initiation of corticosteroids. Use with extreme caution in patients with Strongyloides infections; hyperinfection, dissemination and fatalities have occurred.

• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).

• Myopathy: Acute myopathy has been reported with high dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatine kinase; recovery may be delayed.

• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including severe depression, euphoria, insomnia, mood swings, personality changes, and frank psychotic manifestations. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with HF and/or hypertension; use has been associated with fluid retention, electrolyte disturbances, and hypertension. Use with caution following acute MI; corticosteroids have been associated with myocardial rupture.

• Diabetes: Use corticosteroids with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.

• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, ulcerative colitis, abscess or other pyogenic infection) due to perforation risk. Avoid ethanol may enhance gastric mucosal irritation.

• Head injury: Increased mortality was observed in patients receiving high-dose IV methylprednisolone. High-dose corticosteroids should not be used for the management of head injury.

• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis; long-term use has been associated with fluid retention.

• Kidney impairment: Use with caution in patients with kidney impairment; fluid retention may occur.

• Myasthenia gravis: Use may cause transient worsening of myasthenia gravis (MG) (eg, within first 2 weeks of treatment); monitor for worsening MG (AAN [Narayanaswami 2021]).

• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged use. Use with caution in patients with a history of ocular herpes simplex; corneal perforation has occurred; do not use in active ocular herpes simplex. Not recommended for the treatment of optic neuritis; may increase frequency of new episodes. Consider routine eye exams in chronic users.

• Osteoporosis: Use with caution in patients with osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures.

• Seizure disorders: Use corticosteroids with caution in patients with a history of seizure disorder; seizures have been reported with adrenal crisis.

• Systemic sclerosis: Use with caution in patients with systemic sclerosis; an increase in scleroderma renal crisis incidence has been observed with corticosteroid use. Monitor BP and kidney function in patients with systemic sclerosis treated with corticosteroids (EULAR [Kowal-Bielecka 2017]).

• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in hyperthyroid patients and decreases in hypothyroid ones.

Special populations:

• Older adults: Use cautiously in older adults with the smallest possible effective dose for the shortest duration.

• Pediatric: May affect growth velocity; growth should be routinely monitored in pediatric patients.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).

Other warnings/precautions:

• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.

• Stress: Patients may require higher doses when subject to stress (ie, trauma, surgery, severe infection).

Warnings: Additional Pediatric Considerations

May cause osteoporosis (at any age) or inhibition of bone growth in pediatric patients. Use with caution in patients with osteoporosis. In a population-based study of children, risk of fracture was shown to be increased with >4 courses of corticosteroids; underlying clinical condition may also impact bone health and osteoporotic effect of corticosteroids (Leonard 2007). Increased intraocular pressure (IOP) may occur, especially with prolonged use; in children, increased IOP has been shown to be dose dependent and produce a greater IOP in children <6 years than older children treated with ophthalmic dexamethasone (Lam 2005). Corticosteroids have been associated with myocardial rupture; hypertrophic cardiomyopathy has been reported in premature neonates.

Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Dosage Forms Considerations

Orapred oral solution contains fructose.

Orapred ODT dispersible tablets contain sucrose.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Oral:

Generic: 15 mg/5 mL (240 mL, 480 mL)

Solution, Oral, as sodium phosphate [strength expressed as base]:

Pediapred: 5 mg/5 mL (120 mL) [alcohol free, dye free, sugar free; contains edetate (edta) disodium, methylparaben; raspberry flavor]

Generic: 10 mg/5 mL (237 mL); 15 mg/5 mL (237 mL); 20 mg/5 mL (237 mL); 25 mg/5 mL (30 mL [DSC], 237 mL); 5 mg/5 mL (120 mL)

Tablet, Oral, as base:

Millipred: 5 mg [DSC] [scored; contains fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10), sodium benzoate]

Generic: 5 mg

Tablet Disintegrating, Oral, as sodium phosphate [strength expressed as base]:

Orapred ODT: 10 mg, 15 mg, 30 mg [grape flavor]

Generic: 10 mg, 15 mg, 30 mg

Tablet Therapy Pack, Oral, as base:

Millipred DP: 5 mg (21 ea [DSC], 48 ea [DSC]) [scored; contains fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10), sodium benzoate]

Millipred DP 12-Day: 5 mg (48 ea [DSC]) [scored; contains fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10), sodium benzoate]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (Pediapred Oral)

6.7 (5 Base) mg/5 mL (per mL): $1.66

Solution (prednisoLONE Oral)

15 mg/5 mL (per mL): $1.44

Solution (prednisoLONE Sodium Phosphate Oral)

6.7 (5 Base) mg/5 mL (per mL): $0.82 - $2.50

10 mg/5 mL (per mL): $2.99 - $3.84

15 mg/5 mL (per mL): $0.31

20 mg/5 mL (per mL): $4.24 - $5.46

25 mg/5 mL (per mL): $1.48 - $1.55

Tablet, orally-disintegrating (Orapred ODT Oral)

10 mg (per each): $26.10

15 mg (per each): $33.90

30 mg (per each): $43.00

Tablet, orally-disintegrating (prednisoLONE Sodium Phosphate Oral)

10 mg (per each): $14.38

15 mg (per each): $23.97

30 mg (per each): $30.82

Tablets (prednisoLONE Oral)

5 mg (per each): $16.80

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Oral, as sodium phosphate [strength expressed as base]:

Pediapred: 5 mg/5 mL (120 mL) [contains edetate (edta) disodium, methylparaben]

Generic: 5 mg/5 mL (120 mL)

Administration: Adult

Oral: Administer after meals or with food or milk to decrease GI upset.

Orapred ODT: Do not break, cut, split or use partial tablet. Remove tablet from blister pack just prior to use. May swallow whole or allow to dissolve on tongue.

Administration: Pediatric

Oral: Administer after meals or with food or milk to decrease GI upset.

Orapred ODT: Do not cut, split, or break tablets; do not use partial tablets. Remove tablet from blister pack immediately prior to use. May swallow tablet whole or allow to dissolve on tongue.

Use: Labeled Indications

Anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases, including allergic (eg, angioedema, new-onset urticaria), hematologic (eg, immune thrombocytopenia, warm autoimmune hemolytic anemia), dermatologic, GI, inflammatory, ophthalmic, neoplastic, rheumatic (eg, acute gout flare, vasculitis, dermatomyositis, mixed cryoglobulinemia syndrome, polyarteritis nodosa, polymyositis, polymyalgia rheumatica, rheumatoid arthritis, systemic lupus erythematosus), autoimmune, nervous system (eg, acute exacerbations of multiple sclerosis), renal, respiratory (eg, asthma), and endocrine (eg, primary or secondary adrenocorticoid deficiency); solid organ rejection (acute/chronic).

Use: Off-Label: Adult

Alcoholic hepatitis (severe); Bell palsy; Bullous pemphigoid; Chronic obstructive pulmonary disease, acute exacerbation; Duchenne muscular dystrophy; Giant cell arteritis, treatment; Hepatitis, autoimmune; IgA nephropathy, primary, nonvariant; Minimal change disease, treatment; Myasthenia gravis, crisis; Pericarditis, acute or recurrent; Pneumocystis pneumonia, adjunctive therapy for moderate to severe disease; Takayasu arteritis; Thyroid eye disease, moderate to severe; Thyroiditis, subacute; Urticaria, chronic spontaneous, acute exacerbation

Medication Safety Issues
Sound-alike/look-alike issues:

PrednisoLONE may be confused with predniSONE

Pediapred may be confused with Pediazole

Prelone may be confused with PROzac

Metabolism/Transport Effects

Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abrocitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Abrocitinib. Management: The use of abrocitinib in combination with other immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Acetylcholinesterase Inhibitors: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Risk C: Monitor therapy

Aldesleukin: Corticosteroids (Systemic) may diminish the therapeutic effect of Aldesleukin. Risk X: Avoid combination

Amphotericin B: Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Androgens: Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens. Risk C: Monitor therapy

Antacids: May decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antithymocyte Globulin (Equine): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of systemic corticosteroid is reduced. Corticosteroids (Systemic) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy

Baricitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Baricitinib. Management: The use of baricitinib in combination with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

BCG Products: Corticosteroids (Systemic) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination

Bile Acid Sequestrants: May decrease the absorption of Corticosteroids (Oral). Risk C: Monitor therapy

Brincidofovir: Corticosteroids (Systemic) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy

Brivudine: May enhance the adverse/toxic effect of Corticosteroids (Systemic). Risk X: Avoid combination

Calcitriol (Systemic): Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol (Systemic). Risk C: Monitor therapy

Carbimazole: May decrease the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

CAR-T Cell Immunotherapy: Corticosteroids (Systemic) may enhance the adverse/toxic effect of CAR-T Cell Immunotherapy. Specifically, the severity and duration of neurologic toxicities may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of CAR-T Cell Immunotherapy. Management: Avoid use of corticosteroids as premedication before treatment with CAR-T cell immunotherapy agents. Corticosteroids are indicated and may be required for treatment of toxicities such as cytokine release syndrome or neurologic toxicity. Risk D: Consider therapy modification

Chikungunya Vaccine (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Chikungunya Vaccine (Live). Risk X: Avoid combination

Cladribine: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination

Coccidioides immitis Skin Test: Corticosteroids (Systemic) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing systemic corticosteroids (dosed at 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks) several weeks prior to coccidioides immitis skin antigen testing. Risk D: Consider therapy modification

Corticorelin: Corticosteroids (Systemic) may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy

Cosyntropin: Corticosteroids (Systemic) may diminish the diagnostic effect of Cosyntropin. Risk C: Monitor therapy

COVID-19 Vaccine (Adenovirus Vector): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters) Risk D: Consider therapy modification

COVID-19 Vaccine (Inactivated Virus): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy

COVID-19 Vaccine (mRNA): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification

COVID-19 Vaccine (Subunit): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy

COVID-19 Vaccine (Virus-like Particles): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy

CycloSPORINE (Systemic): May enhance the neuroexcitatory and/or seizure-potentiating effect of PrednisoLONE (Systemic). PrednisoLONE (Systemic) may decrease the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

Deferasirox: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Dengue Tetravalent Vaccine (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination

Denosumab: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and systemic corticosteroids. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification

Desirudin: Corticosteroids (Systemic) may enhance the anticoagulant effect of Desirudin. More specifically, corticosteroids may increase hemorrhagic risk during desirudin treatment. Management: Discontinue treatment with systemic corticosteroids prior to desirudin initiation. If concomitant use cannot be avoided, monitor patients receiving these combinations closely for clinical and laboratory evidence of excessive anticoagulation. Risk D: Consider therapy modification

Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

Deucravacitinib: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Management: The use of deucravacitinib in combination with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Estrogen Derivatives: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Etrasimod: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Etrasimod. Risk C: Monitor therapy

Filgotinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Filgotinib. Management: Coadministration of filgotinib with systemic corticosteroids at doses equivalent to greater than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks is not recommended. Risk D: Consider therapy modification

Gallium Ga 68 Dotatate: Corticosteroids (Systemic) may diminish the diagnostic effect of Gallium Ga 68 Dotatate. Risk C: Monitor therapy

Growth Hormone Analogs: Corticosteroids (Systemic) may diminish the therapeutic effect of Growth Hormone Analogs. Growth Hormone Analogs may decrease serum concentrations of the active metabolite(s) of Corticosteroids (Systemic). Risk C: Monitor therapy

Hyaluronidase: Corticosteroids (Systemic) may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Corticosteroids (Systemic) may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Management: Carefully consider the need for corticosteroids, at doses of a prednisone-equivalent of 10 mg or more per day, during the initiation of immune checkpoint inhibitor therapy. Use of corticosteroids to treat immune related adverse events is still recommended Risk D: Consider therapy modification

Indium 111 Capromab Pendetide: Corticosteroids (Systemic) may diminish the diagnostic effect of Indium 111 Capromab Pendetide. Risk X: Avoid combination

Inebilizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy

Influenza Virus Vaccines: Corticosteroids (Systemic) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiation of systemic corticosteroids at immunosuppressive doses. Influenza vaccines administered less than 14 days prior to or during such therapy should be repeated 3 months after therapy. Risk D: Consider therapy modification

Isoniazid: Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid. Risk C: Monitor therapy

Leflunomide: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as systemic corticosteroids. Risk D: Consider therapy modification

Licorice: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Loop Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Lutetium Lu 177 Dotatate: Corticosteroids (Systemic) may diminish the therapeutic effect of Lutetium Lu 177 Dotatate. Management: Avoid repeated use of high-doses of corticosteroids during treatment with lutetium Lu 177 dotatate. Use of corticosteroids is still permitted for the treatment of neuroendocrine hormonal crisis. The effects of lower corticosteroid doses is unknown. Risk D: Consider therapy modification

Macimorelin: Corticosteroids (Systemic) may diminish the diagnostic effect of Macimorelin. Risk X: Avoid combination

MethIMAzole: May decrease the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

MetyraPONE: Corticosteroids (Systemic) may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking systemic corticosteroids. Risk D: Consider therapy modification

Mifamurtide: Corticosteroids (Systemic) may diminish the therapeutic effect of Mifamurtide. Risk X: Avoid combination

MiFEPRIStone: May diminish the therapeutic effect of Corticosteroids (Systemic). MiFEPRIStone may increase the serum concentration of Corticosteroids (Systemic). Management: Avoid mifepristone in patients who require long-term corticosteroid treatment of serious illnesses or conditions (eg, for immunosuppression following transplantation). Corticosteroid effects may be reduced by mifepristone treatment. Risk X: Avoid combination

Mumps- Rubella- or Varicella-Containing Live Vaccines: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination

Nadofaragene Firadenovec: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination

Natalizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination

Neuromuscular-Blocking Agents (Nondepolarizing): May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Management: If concomitant therapy is required, use the lowest dose for the shortest duration to limit the risk of myopathy or neuropathy. Monitor for new onset or worsening muscle weakness, reduction or loss of deep tendon reflexes, and peripheral sensory decriments Risk D: Consider therapy modification

Nicorandil: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nicorandil. Gastrointestinal perforation has been reported in association with this combination. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Nonselective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May enhance the adverse/toxic effect of Corticosteroids (Systemic). Specifically, the risk of gastrointestinal bleeding, ulceration, and perforation may be increased. Risk C: Monitor therapy

Ocrelizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy

Ofatumumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy

Ozanimod: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ozanimod. Risk C: Monitor therapy

Pidotimod: Corticosteroids (Systemic) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Risk X: Avoid combination

Pneumococcal Vaccines: Corticosteroids (Systemic) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Poliovirus Vaccine (Live/Trivalent/Oral): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination

Polymethylmethacrylate: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Polymethylmethacrylate. Specifically, the risk for hypersensitivity or implant clearance may be increased. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification

Quinolones: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. Risk C: Monitor therapy

Rabies Vaccine: Corticosteroids (Systemic) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification

Ritlecitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination

Ritodrine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Ritodrine. Risk C: Monitor therapy

Ruxolitinib (Topical): Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination

Salicylates: May enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor therapy

Sargramostim: Corticosteroids (Systemic) may enhance the therapeutic effect of Sargramostim. Specifically, corticosteroids may enhance the myeloproliferative effects of sargramostim. Risk C: Monitor therapy

Sipuleucel-T: Corticosteroids (Systemic) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing immunosuppressants, such as systemic corticosteroids, prior to initiating sipuleucel-T therapy. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone given for 2 or more weeks are immunosuppressive. Risk D: Consider therapy modification

Sodium Benzoate: Corticosteroids (Systemic) may diminish the therapeutic effect of Sodium Benzoate. Risk C: Monitor therapy

Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Risk C: Monitor therapy

Succinylcholine: Corticosteroids (Systemic) may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Tacrolimus (Systemic): Corticosteroids (Systemic) may decrease the serum concentration of Tacrolimus (Systemic). Conversely, when discontinuing corticosteroid therapy, tacrolimus concentrations may increase. Risk C: Monitor therapy

Tacrolimus (Topical): Corticosteroids (Systemic) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination

Talimogene Laherparepvec: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination

Tertomotide: Corticosteroids (Systemic) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination

Thiazide and Thiazide-Like Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tofacitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Typhoid Vaccine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination

Ublituximab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy

Upadacitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Upadacitinib. Management: Coadministration of upadacitinib with systemic corticosteroids at doses equivalent to greater than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks is not recommended. Risk D: Consider therapy modification

Urea Cycle Disorder Agents: Corticosteroids (Systemic) may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Corticosteroids (Systemic) may increase protein catabolism and plasma ammonia concentrations, thereby increasing the doses of Urea Cycle Disorder Agents needed to maintain these concentrations in the target range. Risk C: Monitor therapy

Vaccines (Inactivated/Non-Replicating): Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification

Vaccines (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Avoid live vaccines during and for 1 month after therapy with immunosuppressive doses of corticosteroids (equivalent to prednisone > 2 mg/kg or 20 mg/day in persons over 10 kg for at least 2 weeks). Give live vaccines 4 weeks prior to therapy if possible. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Corticosteroids (Systemic) may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Yellow Fever Vaccine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination

Pregnancy Considerations

Prednisolone crosses the placenta; prior to reaching the fetus, prednisolone is converted by placental enzymes to prednisone. As a result, the amount of prednisolone reaching the fetus is ~8 to 10 times lower than the maternal serum concentration (healthy individuals at term; similar results observed with preterm pregnancies complicated by HELLP syndrome) (Beitins 1972; van Runnard Heimel 2005). Some studies have shown an association between first trimester systemic corticosteroid use and oral clefts or decreased birth weight; however, information is conflicting and may be influenced by maternal dose/indication for use (Lunghi 2010; Park-Wyllie 2000; Pradat 2003). Hypoadrenalism may occur in newborns following maternal use of corticosteroids in pregnancy; monitor.

Prednisolone is a preferred oral corticosteroid for the treatment of maternal conditions during pregnancy because placental enzymes limit passage to the embryo (ACOG 2019).

When systemic corticosteroids are needed in pregnancy for rheumatic disorders, nonfluorinated corticosteroids such as prednisolone are preferred. Chronic high doses should be avoided (ACR [Sammaritano 2020]).

Prednisolone may be used (alternative agent) to treat primary adrenal insufficiency (PAI) in pregnancy. Pregnant patients with PAI should be monitored at least once each trimester (ES [Bornstein 2016]). Prednisolone may be used to treat patients during pregnancy who require therapy for congenital adrenal hyperplasia (ES [Speiser 2018]).

For dermatologic disorders in pregnant patients, systemic corticosteroids are generally not preferred for initial therapy; should be avoided during the first trimester; and used during the second or third trimester at the lowest effective dose (Bae 2012; Leachman 2006). Topical agents are preferred for managing atopic dermatitis in pregnancy; for severe symptomatic or recalcitrant atopic dermatitis, a short course of prednisolone may be used during the third trimester (Koutroulis 2011).

Uncontrolled asthma is associated with adverse events in pregnancy (increased risk of perinatal mortality, preeclampsia, preterm birth, low birth weight infants, cesarean delivery, and the development of gestational diabetes). Poorly controlled asthma or asthma exacerbations may have a greater fetal/maternal risk than what is associated with appropriately used asthma medications. Maternal treatment improves pregnancy outcomes by reducing the risk of some adverse events (eg, preterm birth, gestational diabetes). Inhaled corticosteroids are recommended for the treatment of asthma during pregnancy; however, systemic corticosteroids should be used to control acute exacerbations or treat severe persistent asthma. Maternal asthma symptoms should be monitored monthly during pregnancy (ERS/TSANZ [Middleton 2020]; GINA 2023).

Prednisolone is an alternative corticosteroid for use in pregnant patients with severe or critical COVID-19 due to limited placental transfer. Treatment algorithms are available for pregnant patients with severe or critical COVID-19 who require corticosteroids (Saad 2020; Teelucksingh 2022). In general, the treatment of COVID-19 during pregnancy is the same as in nonpregnant patients. However, because data for most therapeutic agents in pregnant patients are limited, treatment options should be evaluated as part of a shared decision-making process (NIH 2023). The risk of severe illness from COVID-19 infection is increased in symptomatic pregnant patients compared to nonpregnant patients (ACOG 2023). Information related to the treatment of COVID-19 during pregnancy continues to emerge; refer to current guidelines for the treatment of pregnant patients.

Breastfeeding Considerations

Prednisolone is present in breast milk.

Data related to the presence of prednisolone in breast milk are available from a study of 6 lactating women on maintenance treatment with prednisolone 10 to 80 mg/day. The highest breast milk concentration (317 ng/mL) was observed 1 hour following an 80 mg dose in a patient 53 days postpartum; breast milk concentrations decreased to <100 ng/mL 4 hours after the maternal dose. Using data from all women in this study, milk concentrations were 5% to 25% of the maternal serum concentration with peak concentrations occurring ~1 hour after the maternal dose. The milk/plasma ratio was found to be 0.2 with doses ≥30 mg/day and 0.1 with doses <30 mg/day (Ost 1985). Using a milk concentration of 317 ng/mL, the estimated exposure to the breastfeeding infant would be 0.05 mg/kg/day (relative infant dose 4% based on a weight-adjusted maternal dose of 80 mg/day). In general, breastfeeding is considered acceptable when the relative infant dose of a medication is <10% (Anderson 2016; Ito 2000).

One manufacturer notes that when used systemically, maternal use of corticosteroids have the potential to cause adverse events in a breastfeeding infant (eg, growth suppression, interfere with endogenous corticosteroid production). Therefore, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Corticosteroids are generally considered acceptable in patients who are breastfeeding when used in usual doses; however, monitoring of the breastfeeding infant is recommended (WHO 2002). Prednisolone is classified as a nonfluorinated corticosteroid; when systemic corticosteroids are needed in a lactating patient for rheumatic disorders, low doses of nonfluorinated corticosteroids are preferred (ACR [Sammaritano 2020]). If there is concern about exposure to the infant, some guidelines recommend waiting 4 hours after the maternal dose of an oral systemic corticosteroid before breastfeeding in order to decrease potential exposure to the breastfed infant (ACR [Sammaritano 2020]; Bae 2012; Butler 2014; ERS/TSANZ [Middleton 2020]; Leachman 2006; Ost 1985).

Dietary Considerations

Should be taken after meals or with food or milk to decrease GI upset; increase dietary intake of pyridoxine, vitamin C, vitamin D, folate, calcium, and phosphorus.

Monitoring Parameters

BP; weight; serum glucose; electrolytes; growth in pediatric patients; presence of infection, bone mineral density; assess HPA axis suppression (eg, ACTH stimulation test, morning plasma cortisol test, urinary free cortisol test); Hgb, occult blood loss; chest x-ray (at regular intervals during prolonged therapy); IOP with therapy >6 weeks, eye examination (periodically during therapy [AASLD (Mack 2020)]).

Mechanism of Action

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and volume of the lymphatic system

Pharmacokinetics (Adult Data Unless Noted)

Duration: 18 to 36 hours (Pickup 1979).

Absorption: Rapid; well-absorbed.

Distribution: Vd: 0.22 to 0.7 L/kg.

Protein binding (concentration dependent): 70% to 90% (to albumin and corticosteroid binding globulin); decreased in older adults.

Metabolism: Primarily hepatic.

Half-life elimination: 2 to 4 hours; reduced in children and prolonged in hepatic disease (Pickup 1979).

Time to peak, plasma: 1 to 2 hours; prolonged with food.

Excretion: Primarily urine (as sulfate and glucuronide conjugate).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Older adult: Mean unbound fraction of prednisolone was higher and Vss unbound prednisolone was reduced in older adults.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Deltacortril | Gupisone | Isolone | Wysolone;
  • (AT) Austria: Aprednislon | Prednihexal | Prednisolon | Prednisolon Agepha;
  • (AU) Australia: Panafcortelone | Predsolone | Redipred | Solone;
  • (BD) Bangladesh: Bexipred | Cortan | Cortisol | Deltacort | Deltapred | Inflagic | Pednisol | Precodil | Pred | Prednelan | Prednicortil | Solone;
  • (BE) Belgium: Deltacortril | Prednicortelone;
  • (BG) Bulgaria: Prednisolon | Prednisolon cortico;
  • (BR) Brazil: Oralpred | Percoide | Pred gran | Prednisolona | Predsigma | Predsim | Prelone | Preni;
  • (CH) Switzerland: Prednisolon | Prednisolon Amino | Prednisolon galepharm | Prednisolon Medinova | Prednisolon Streuli | Prednisolon Wiedenmann AG | Prednisolone Labatec | Spiricort;
  • (CL) Chile: Preventan;
  • (CO) Colombia: Pentasol | Prednisolona | Prednisolona mk | Scherisolona | Tebonal | Uniplen;
  • (DE) Germany: Decortin h | Dermosolon | Predni H | Prednisolon | Prednisolon acis | Prednisolon al | Prednisolon blue | Prednisolon dura | Prednisolon galen | Prednisolon jenapharm | Prednisolon stada;
  • (DK) Denmark: Prednisolon "DLF";
  • (DO) Dominican Republic: Alertine | Amcort | Bronal | Inflavir | Kamelox | Lexidrol | Lonapred | Prednabene | Prednisil | Prednisolona | Prelone | Prinosi | Revir | Solupred;
  • (EC) Ecuador: Prednimax | Prednisolona | Ramacort;
  • (EE) Estonia: Prednisolon | Prednisolon al | Prednisolon galen | Prednisolon jenapharm | Prednisolon richter | Prednisolon stada | Prednisolon-ratiopharm | Prednisolut l;
  • (EG) Egypt: Deltacortril | Disprelone d | Epicopred | Predilon | Predilone | Predsol | Predsol forte | Solupred | Unipricort | Unipridol | Xilon | Xilone | Xilone forte;
  • (ES) Spain: Dacortin h | Normonsona;
  • (FI) Finland: Delta hycortol | Prednisolon | Prednisolon alternova | Prednisolon Frederiksberg | Prednisolon nuriso;
  • (FR) France: Hydrocortancyl | Prednisolone accord | Prednisolone actavis | Prednisolone apotex | Prednisolone Arrow | Prednisolone biogaran | Prednisolone cristers | Prednisolone dci | Prednisolone EG | Prednisolone qualimed | Prednisolone ranbaxy | Prednisolone Teva;
  • (GB) United Kingdom: Codelcortone | Delta Cortef | Deltacortril | Deltalone | Deltastab | Dilacort | Parisilon | Pevanti | Precortisyl | Prednisolone Almus | Prednisolone Arrow | Prednisolone cox | Prednisolone dc | Prednisolone kent;
  • (GR) Greece: Adelcort | Deltacortril | Prezolon;
  • (HK) Hong Kong: Delcorlon | Desolone | Dhasolone | Emsolone | Eurocortone | Panadin | Panafcortelone | Preconin | Prednioval | Prelone | Prenol | Presone | Presurin | Setsolone | U Prednisolone | Uni Solone | Xepasone;
  • (HN) Honduras: Predin ona;
  • (HU) Hungary: Prednisolon;
  • (IE) Ireland: Deltacortril;
  • (IL) Israel: Danalone | Prelone;
  • (IN) India: Acticort | Apred | Balsolone | Besone | Delsone | Deltacortril | Emsolone | Kid pred | Monocortil | Nephcorte | Nisolone | Nucort | Omnacortil | Pednisol | Prado | Predcip | Predicort | Prednij | Prednisafe | Prednitop | Predone | Rivsole | Safecort | Solon | Wysolone;
  • (IQ) Iraq: As prislone | Pisolon | Prednicort | Prednisolonawa | Presilon d | Presol | Presoldain | Prilone | Prisolone;
  • (IT) Italy: Cison | Idelt;
  • (JO) Jordan: Corotrope | Predone;
  • (JP) Japan: Codelcortone | Delta prenin | Deltacortril | Donisolone | Prednisolon.fujimo | Prednisolon.isei | Prednisolon.kob.ka | Prednisolon.sankei | Prednisolon.sho.s | Prednisolon.sho.y | Prednisolon.tobish | Predohan | Predonine | Prelon | Scherisolon;
  • (KE) Kenya: Astolon | Dawasolone | P solon | Pedsol | Plone | Pred paed | Predilone | Predimed | Prednifil | Predsol | Predsol forte | Prelone;
  • (KR) Korea, Republic of: Delta Cortef | Deltacortril | Dresol | Hostacortin h | Korus prednisolone | Nisolone | Prd | Prednisolon | Prednisolone | Predron | Preron | Preson | Scherisolon | Sintisone | Solondo | Union pednisolone;
  • (KW) Kuwait: Gupisone | Predo;
  • (LB) Lebanon: Orapred | Predalone | Predo;
  • (LT) Lithuania: Decortin h | Prednisolon | Prednisolone polfa | Solupred;
  • (LU) Luxembourg: Deltacortril | Prednicortelone;
  • (LV) Latvia: Prednisolon | Prednisolon richter;
  • (MA) Morocco: Anapred | Hostacortin h | Isolone | Polypred | Siprozone;
  • (MX) Mexico: Prednidib | Prednisolona;
  • (MY) Malaysia: Asisolone | Axcel prednisolone | Deltasolone | Dhasolone | Nisolon | Prednisa | Prednisyn | Predsolone | Prelone | Prisolone | Rexolone | Setsolone | Sp cortil | Sterosone | Triosolone | Xepasone | Xilone | Zoralone;
  • (NG) Nigeria: Astra prednisolone | Colo | Dizpharm prednisolone | Jawapred | Kpi prednisolone | Nelb prednisolone | Perel | Pilolin | Predicure | Predilin | Predni j | Prednisam | Predsone | Prolone | Rcpred | Rgi prednisolone | Sivopred | Sparlone | Talibex prednisolone | Zonason prednisolone;
  • (NL) Netherlands: Prednisolon | Prednisolon CF | Prednisolon merck | Prednisolon Sandoz;
  • (NO) Norway: Prednisolon | Prednisolon alternova | Prednisolon campus | Prednisolon EQL Pharma | Prednisolon galen | Prednisolon jenapharm | Prednisolone accord | Spiricort;
  • (PE) Peru: Meprecort | Neocortiprex | Predomin | Prenhixin;
  • (PH) Philippines: Impresol | Kidsolone | Liquipred | Liquisone | Medsone | Optipred;
  • (PK) Pakistan: Deltacortril | Inflagic | Persolon | Rapicort | Steron;
  • (PL) Poland: Decortin h | Deltacortril | Encortolon | Predasol | Prednisolon | Solupred;
  • (PR) Puerto Rico: Prednisolone | Prelone;
  • (PT) Portugal: Lepicortinolo | Prednisolona;
  • (PY) Paraguay: Etisona | Ultracort;
  • (QA) Qatar: Corotrope | Gupisone | Prednisolone Jenapharm | Predo | Solupred;
  • (RU) Russian Federation: Medopred | Prednisol | Prednisolon | Prednisolone nycomed;
  • (SA) Saudi Arabia: Deltacortril | Gupison | Gupisone | Pms prednisolone | Predo | Respred;
  • (SE) Sweden: Prednisolon actavis | Prednisolon alternova | Prednisolon EQL Pharma | Prednisolon fermenta | Prednisolon pfizer | Prednisolon pilum | Prednisolon Recip;
  • (SG) Singapore: Deltasolone | Dhasolone | Prelone | Sp cortil | Unisolone | Walesolon | Xepasone;
  • (SI) Slovenia: Prednisolon | Prednisolon Agepha | Prednisolon jenapharm;
  • (TH) Thailand: Chlorsolone | Cureral | Deltacorsolone | Di adreson f | Fortisone | Frisoca | Lesolone | Medisolone | Medsolone | Minisolone | Neosolone | Precortisyl | Predil | Predisole | Predman | Prednersone | Prednibemed | Prednidon | Prednisil | Predsirup | Predso | Predsomed | Predsone | Predstar | Presoga | Privalone | Rp Solone | S.co.sone | Shornisone | Sintisone | Starpred;
  • (TN) Tunisia: Copred | Orocort | Prednicort | Vitapred;
  • (TR) Turkey: Codelton | Corlto | Deltacortril | Neocorten | Prednisolon;
  • (TW) Taiwan: Compesolon | Delta Cortef | Deltalone | Docan | Donison | Kingcort | Paloson | Pidonin | Polenin | Preanin | Preconin | Pred | Prednisolon | Predonine | Predron | Prein | Prekilinen | Prelon | Prelone | Prenilone | Prenin | Presolone | Preson | Presurin | Prithmon | Prithmow | Procosone | Pyreson | Sintisone | Siulon | Sunpred | Tonfonrin | Zesanine;
  • (UA) Ukraine: Prednisolon | Prednisolon Rivopharm;
  • (UG) Uganda: Agopred | Astolon | Kam predsol | Predilone | Predsone;
  • (UY) Uruguay: Neocortiprex | Scherisolona;
  • (VE) Venezuela, Bolivarian Republic of: Amcort | Predna | Prednisolona | Prelone;
  • (VN) Viet Nam: Cetecocenvadia | Prencoid;
  • (ZA) South Africa: Capsoid | Lenisolone | Preflam | Prelone;
  • (ZM) Zambia: Adnicor | Be-tabs prednisolone | Ednisol | Kampred | Lenisolone | Metapred | Prednifil | Prelone
  1. Abraham E and Evans T, “Corticosteroids and Septic Shock [editorial],” JAMA, 2002, 288(7):886-7. [PubMed 12186608]
  2. Adler Y, Charron P, Imazio M, et al; ESC Scientific Document Group. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921-2964. doi:10.1093/eurheartj/ehv318 [PubMed 26320112]
  3. Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
  4. Akyüz C, Yariş N, Kutluk MT, Büyükpamukçu M. Management of cutaneous hemangiomas: a retrospective analysis of 1109 cases and comparison of conventional dose prednisolone with high-dose methylprednisolone therapy. Pediatr Hematol Oncol. 2001;18(1):47-55. doi:10.1080/088800101750059855 [PubMed 11205840]
  5. al Hashash J, Regueiro M. Medical management of low-risk adult patients with mild to moderate ulcerative colitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 23, 2019.
  6. Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol. 2015;172(3):R115-R124. doi:10.1530/EJE-14-0824 [PubMed 25288693]
  7. American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 207: thrombocytopenia in pregnancy. Obstet Gynecol. 2019a;133(3):e181-e193. doi:10.1097/AOG.0000000000003100 [PubMed 30801473]
  8. American College of Obstetricians and Gynecologists (ACOG). COVID-19 FAQs for obstetricians-gynecologists, obstetrics. https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics. Accessed April 24, 2023.
  9. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 776: Immune modulating therapies in pregnancy and lactation. Obstet Gynecol. 2019;133(4):e287-e295. doi:10.1097/AOG.0000000000003176
  10. American College of Radiology (ACR) Committee on Drugs and Contrast Media. ACR manual on contrast media. Version 10.3. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Published 2018. Accessed April 18, 2019.
  11. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46(2):328-346. doi:10.1002/art.10148 [PubMed 11840435]
  12. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  13. Annane D, Sebille V, Charpentier C, et al, “Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock,” JAMA, 2002, 288(7):862-71. [PubMed 12186604]
  14. Arican P, Dundar NO, Gencpinar P, Cavusoglu D. Efficacy of low-dose corticosteroid therapy versus high-dose corticosteroid therapy in Bell's palsy in children. J Child Neurol. 2017;32(1):72-75. doi:10.1177/0883073816668774 [PubMed 27686096]
  15. Arnold DM. Initial treatment of immune thrombocytopenia (ITP) in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 19, 2022.
  16. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
  17. Asero R. New-onset urticaria. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 16, 2023.
  18. Babl FE, Mackay MT, Borland ML, et al. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr. 2017;17(1):53. doi:10.1186/s12887-016-0702-y [PubMed 28193257]
  19. Bae YS, Van Voorhees AS, Hsu S, et al, "Review of Treatment Options for Psoriasis in Pregnant or Lactating Women: From the Medical Board of the National Psoriasis Foundation," J Am Acad Dermatol, 2012, 67(3):459-77. [PubMed 22018758]
  20. Barros MM, Blajchman MA, Bordin JO. Warm autoimmune hemolytic anemia: recent progress in understanding the immunobiology and the treatment. Transfus Med Rev. 2010;24(3):195-210. doi:10.1016/j.tmrv.2010.03.002 [PubMed 20656187]
  21. Bartalena L, Kahaly GJ, Baldeschi L, et al EUGOGO †. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021;185(4):G43-G67. doi:10.1530/EJE-21-0479 [PubMed 34297684]
  22. Bartalena L, Marcocci C, Pinchera A. Treating severe Graves' ophthalmopathy. Baillieres Clin Endocrinol Metab. 1997;11(3):521-536. doi:10.1016/s0950-351x(97)80738-0 [PubMed 9532337]
  23. Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 suppl):s1-s27. [PubMed 24189771]
  24. Beck L, Bomback AS, Choi MJ, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis. 2013;62(3):403-441. doi:10.1053/j.ajkd.2013.06.002 [PubMed 23871408]
  25. Beitins IZ, Bayard F, Ances IG, et al, “The Transplacental Passage of Prednisone and Prednisolone in Pregnancy Near Term,” J Pediatr, 1972, 81(5):936-45. [PubMed 5086721]
  26. Bellutti Enders F, Bader-Meunier B, Baildam E, et al. Consensus-based recommendations for the management of juvenile dermatomyositis. Ann Rheum Dis. 2017;76(2):329-340. [PubMed 27515057]
  27. Bennett ML, Fleischer AB Jr, Chamlin SL, Frieden IJ. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001;137(9):1208-1213. doi:10.1001/archderm.137.9.1208 [PubMed 11559219]
  28. Berg T, Bylund N, Marsk E, et al, “The Effect of Prednisolone on Sequelae in Bell’s Palsy,” Arch Otolaryngol Head Neck Surg, 2012, 138(5):445-9. [PubMed 22652942]
  29. Bergmann TK, Barraclough KA, Lee KJ, Staatz CE. Clinical pharmacokinetics and pharmacodynamics of prednisolone and prednisone in solid organ transplantation. Clin Pharmacokinet. 2012;51(11):711-741. doi:10.1007/s40262-012-0007-8 [PubMed 23018468]
  30. Bergrem H. The influence of uremia on pharmacokinetics and protein binding of prednisolone. Acta Med Scand. 1983;213(5):333-337. doi:10.1111/j.0954-6820.1983.tb03747.x [PubMed 6880855]
  31. Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270-1277. doi:10.1016/j.jaci.2014.02.036 [PubMed 24766875]
  32. Bhandari A, Schramm CM, Kimble C, et al, "Effect of a Short Course of Prednisolone in Infants With Oxygen-Dependent Bronchopulmonary Dysplasia," Pediatrics, 2008, 121(2):e344-9. [PubMed 18245407]
  33. Bird SJ. Myasthenic crisis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 13, 2021.
  34. Birnkrant DJ, Bushby K, Bann CM, et al; DMD Care Considerations Working Group. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management. Lancet Neurol. 2018;17(3):251-267. doi:10.1016/S1474-4422(18)30024-3 [PubMed 29395989]
  35. Black DA, Rose G, Brewer DB. Controlled trial of prednisone in adult patients with the nephrotic syndrome. Br Med J. 1970;3(5720):421-426. doi:10.1136/bmj.3.5720.421 [PubMed 4916790]
  36. Bonifati MD, Ruzza G, Bonometto P, et al. A multicenter, double-blind, randomized trial of deflazacort versus prednisone in Duchenne muscular dystrophy. Muscle Nerve. 2000;23(9):1344-1347. [PubMed 10951436]
  37. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. doi:10.1210/jc.2015-1710 [PubMed 26760044]
  38. Borradori L, Van Beek N, Feliciani C, et al. Updated S2 K guidelines for the management of bullous pemphigoid initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2022;36(10):1689-1704. doi:10.1111/jdv.18220 [PubMed 35766904]
  39. Brodsky RA. Warm autoimmune hemolytic anemia. N Engl J Med. 2019;381(7):647-654. doi:10.1056/NEJMcp1900554 [PubMed 31412178]
  40. Buckley L, Humphrey MB. Glucocorticoid-induced osteoporosis. N Engl J Med. 2018;379(26):2547-2556. doi:10.1056/NEJMcp1800214 [PubMed 30586507]
  41. Burch HB, Perros P, Bednarczuk T, et al. Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1439-1470. doi:10.1089/thy.2022.0251 [PubMed 36480280]
  42. Burman KD. Subacute thyroiditis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 24, 2022.
  43. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70(3):417. [PubMed 24528912]
  44. Castañeda S, García-Castañeda N, Prieto-Peña D, et al. Treatment of polymyalgia rheumatica. Biochem Pharmacol. 2019;165:221-229. doi:10.1016/j.bcp.2019.03.027 [PubMed 30904473]
  45. Cattran DC, Appel GB, Coppo R. IgA nephropathy: treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 13, 2023.
  46. Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm [PubMed 6810084]
  47. Chen WX, Wong V. Prognosis of Bell's palsy in children--analysis of 29 cases. Brain Dev. 2005;27(7):504-508. [PubMed 16198208]
  48. Ciriaco M, Ventrice P, Russo G, et al. Corticosteroid-related central nervous system side effects. J Pharmacol Pharmacother. 2013;4(Suppl 1):S94-S98. doi:10.4103/0976-500X.120975 [PubMed 24347992]
  49. Clarke NW, Armstrong AJ, Thiery-Vuillemin A, et al. Abiraterone and olaparib for metastatic castration-resistant prostate cancer. NEJM Evidence. doi:10.1056/EVIDoa2200043. Published online June 3, 2022. Accessed June 6, 2023. [PubMed 24673465]
  50. Coggins CH. Adult minimal change nephropathy: experience of the collaborative study of glomerular disease. Trans Am Clin Climatol Assoc. 1986;97:18-26. [PubMed 3915841]
  51. Cohen RD, Stein AS. Management of moderate to severe ulcerative colitis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 25, 2022a.
  52. Cohen S, Mikuls TR. Initial treatment of rheumatoid arthritis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 27, 2022b.
  53. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003;348(8):727-734. doi:10.1056/NEJMra020529 [PubMed 12594318]
  54. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA. 2002;287(2):236-240. doi:10.1001/jama.287.2.236 [PubMed 11779267]
  55. Crabb DW, Im GY, Szabo G, Mellinger JL, Lucey MR. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020;71(1):306-333. doi:10.1002/hep.30866 [PubMed 31314133]
  56. Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61-98. doi:10.2165/00003088-200544010-00003 [PubMed 15634032]
  57. Dalakas MC. Immunotherapy of inflammatory myopathies: practical approach and future prospects. Curr Treat Options Neurol. 2011;13(3):311-323. doi:10.1007/s11940-011-0119-8 [PubMed 21365201]
  58. Darras BT. Duchenne and Becker muscular dystrophy: glucocorticoid and disease-modifying treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2020.
  59. Darrow DH, Greene AK, Mancini AJ, et al. Diagnosis and management of infantile hemangioma. Pediatrics. 2015;136(4):e1060-1104. [PubMed 26416931]
  60. Dasgupta B, Borg FA, Hassan N, et al; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594-1597. doi:10.1093/rheumatology/keq039a [PubMed 20371504]
  61. de Jong YP, Uil SM, Grotjohan HP, Postma DS, Kerstjens HA, van den Berg JW. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132(6):1741-1747. doi:10.1378/chest.07-0208 [PubMed 17646228]
  62. de Jonghe B, Sharshar T, Lefaucheur JP, et al, “Paresis Acquired in the Intensive Care Unit. A Prospective Multicenter Study,” JAMA, 2002, 288(22):2859-67. [PubMed 12472328]
  63. Dejaco C, Singh YP, Perel P, et al; European League Against Rheumatism; American College of Rheumatology. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015;74(10):1799-1807. doi:10.1136/annrheumdis-2015-207492 [PubMed 26359488]
  64. de Sousa NG, Santa-Marta C, Morais-Almeida M. Systemic corticosteroid hypersensitivity in children. J Investig Allergol Clin Immunol. 2010;20(6):529-532. [PubMed 21243939]
  65. DeWitt EM, Kimura Y, Beukelman T, et al. Consensus treatment plans for new-onset systemic juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2012;64(7):1001-1010. [PubMed 22290637]
  66. Dinehart SM, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg. 2001;27(5):475-485. doi:10.1046/j.1524-4725.2001.00227.x [PubMed 11359498]
  67. Docken WP. Treatment of giant cell arteritis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 21, 2021.
  68. Engström M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7(11):993-1000. [PubMed 18849193]
  69. Erdmann SM, Abuzahra F, Merk HF, Schroeder A, Baron JM. Anaphylaxis induced by glucocorticoids. J Am Board Fam Pract. 2005;18(2):143-146. doi:10.3122/jabfm.18.2.143 [PubMed 15798144]
  70. Erstad BL. Dosing of medications in morbidly obese patients in the intensive care unit setting. Intensive Care Med. 2004;30(1):18-32. doi:10.1007/s00134-003-2059-6 [PubMed 14625670]
  71. Escolar DM, Hache LP, Clemens PR, et al. Randomized, blinded trial of weekend vs daily prednisone in Duchenne muscular dystrophy. Neurology. 2011;77(5):444-452. doi:10.1212/WNL.0b013e318227b164 [PubMed 21753160]
  72. European Association for the Study of the Liver. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004. doi:10.1016/j.jhep.2015.06.030 [PubMed 26341719]
  73. Fenichel GM, Mendell JR, Moxley RT 3rd, et al. A comparison of daily and alternate-day prednisone therapy in the treatment of Duchenne muscular dystrophy. Arch Neurol. 1991;48(6):575-579. [PubMed 2039377]
  74. Fervenza FC, Leise MD, Roccatello D, Kyle RA. Mixed cryoglobulinemia syndrome: treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2020.
  75. Fifoot AA, Ting JY. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Emerg Med Australas. 2007;19(1):51-58. doi:10.1111/j.1742-6723.2006.00919.x [PubMed 17305661]
  76. Findlay AR, Goyal NA, Mozaffar T. An overview of polymyositis and dermatomyositis. Muscle Nerve. 2015;51(5):638-656. doi:10.1002/mus.24566 [PubMed 25641317]
  77. Flo-Pred (prednisolone acetate) [prescribing information]. Hawthorne, NY: TaroPharma; July 2021.
  78. Frey BM and Frey FJ, "Clinical Pharmacokinetics of Prednisone and Prednisolone," Clin Pharmacokinet, 1990, 19(2):126-46. [PubMed 2199128]
  79. Frey FJ, Gambertoglio JG, Frey BM, Benet LZ, Amend WJ. Nonlinear plasma protein binding and haemodialysis clearance of prednisolone. Eur J Clin Pharmacol. 1982;23(1):65-74. doi:10.1007/BF01061379 [PubMed 6751835]
  80. Frey FJ, "Kinetics and Dynamics of Prednisolone," Endocr Rev, 1987, 8(4):453-73. [PubMed 3319533]
  81. Furst DE, Saag KG. Determinants of glucocorticoid dosing. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 1, 2019.
  82. Furst DE, Saag KG. Glucocorticoid withdrawal. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 22, 2022.
  83. Gaffo AL. Treatment of gout flares. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 9, 2023.
  84. Gambertoglio JG, Amend WJ Jr and Benet LZ, "Pharmacokinetics and Bioavailability of Prednisone and Prednisolone in Healthy Volunteers and Patients: A Review," J Pharmacokinet Biopharm, 1980, 8(1):1-52. [PubMed 6991663]
  85. Garbutt JM, Conlon B, Sterkel R, et al. The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial. Clin Pediatr (Phila). 2013;52(11):1014-1021. doi:10.1177/0009922813504823 [PubMed 24092872]
  86. George JN, Mcintosh JJ, Perez Botero J. Thrombocytopenia in pregnancy. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 24, 2022.
  87. Gipson DS, Massengill SF, Yao L, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124(2):747-757. [PubMed 19651590]
  88. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf. Updated 2020. Accessed May 6, 2020.
  89. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. https://ginasthma.org/2023-gina-main-report/. Updated 2023. Accessed August 23, 2023.
  90. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for prevention, diagnosis and management of COPD: 2022 report. https://goldcopd.org/2023-gold-report-2/. Updated 2023. Accessed January 30, 2023.
  91. Gloss D, Moxley RT 3rd, Ashwal S, Oskoui M. Practice guideline update summary: corticosteroid treatment of Duchenne muscular dystrophy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016;86(5):465-472. doi:10.1212/WNL.0000000000002337 [PubMed 26833937]
  92. Goedert JJ, Vitale F, Lauria C, et al, “Risk Factors for Classical Kaposi's Sarcoma,” J Natl Cancer Inst, 2002, 94(22):1712-8. [PubMed 12441327]
  93. González-Gay MA, López-Mejías R, Pina T, Blanco R, Castañeda S. IgA vasculitis: genetics and clinical and therapeutic management. Curr Rheumatol Rep. 2018;20(5):24. doi:10.1007/s11926-018-0735-3 [PubMed 29611051]
  94. Goodin DS. Glucocorticoid treatment of multiple sclerosis. Handb Clin Neurol. 2014;122:455-464. doi:10.1016/B978-0-444-52001-2.00020-0 [PubMed 24507531]
  95. Gorelik M, Chung SA, Ardalan K, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of Kawasaki disease. Arthritis Care Res (Hoboken). 2022;74(4):538-548. doi:10.1002/acr.24838 [PubMed 35257507]
  96. Greene AK, Couto RA. Oral prednisolone for infantile hemangioma: efficacy and safety using a standardized treatment protocol. Plast Reconstr Surg. 2011;128(3):743-752. doi:10.1097/PRS.0b013e3182221398 [PubMed 21572374]
  97. Gronseth GS and Paduga R, "Evidence-Based Guideline Update: Steroids and Antivirals for Bell Palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology," Neurology, 2012, 79(22):2209-13. [PubMed 23136264]
  98. Hahn D, Hodson EM, Willis NS, Craig JC. Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev. 2015;2015(3):CD001533. [PubMed 25785660]
  99. Hamrahian AH, Roman S, Milan S. The management of the surgical patient taking glucocorticoids. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 8, 2020.
  100. Haran M, Schattner A, Kozak N, Mate A, Berrebi A, Shvidel L. Acute steroid myopathy: a highly overlooked entity. QJM. 2018;111(5):307-311. doi:10.1093/qjmed/hcy031 [PubMed 29462474]
  101. Hellmich B, Agueda A, Monti S, et al. 2018 update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020;79(1):19-30 . doi:10.1136/annrheumdis-2019-215672 [PubMed 31270110]
  102. Heneghan MA. Autoimmune hepatitis: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 4, 2022.
  103. Hinze CH, Oommen PT, Dressler F, et al. Development of practice and consensus-based strategies including a treat-to-target approach for the management of moderate and severe juvenile dermatomyositis in Germany and Austria. Pediatr Rheumatol Online J. 2018;16(1):40. [PubMed 29940960]
  104. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27-e129. doi:10.1016/j.jacc.2010.02.015 [PubMed 20359588]
  105. Hodson EM, Hahn D, Craig JC. Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2015;30(7):1043-1046. [PubMed 25912994]
  106. Hogan J, Radhakrishnan J. The treatment of minimal change disease in adults. J Am Soc Nephrol. 2013;24(5):702-711. doi:10.1681/ASN.2012070734 [PubMed 23431071]
  107. Honoré PM, Jacobs R, De Waele E, et al. What do we know about steroids metabolism and 'PK/PD approach' in AKI and CKD especially while on RRT--current status in 2014. Blood Purif. 2014;38(2):154-157. doi:10.1159/000368390 [PubMed 25471548]
  108. Hopkins RL, Leinung MC. Exogenous Cushing's syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin North Am. 2005;34(2):371-384. doi:10.1016/j.ecl.2005.01.013 [PubMed 15850848]
  109. Hotchkiss RS and Karl IE, “The Pathophysiology and Treatment of Sepsis,” N Engl J Med, 2003, 348(2):138-50. [PubMed 12519925]
  110. Huber AM, Giannini EH, Bowyer SL, et al. Protocols for the initial treatment of moderately severe juvenile dermatomyositis: results of a Children's Arthritis and Rheumatology Research Alliance Consensus Conference. Arthritis Care Res (Hoboken). 2010;62(2):219-225. [PubMed 20191521]
  111. Huber AM, Kim S, Reed AM, et al. Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with persistent skin rash. J Rheumatol. 2017;44(1):110-116. [PubMed 27803135]
  112. Huber AM, Robinson AB, Reed AM, et al. Consensus treatments for moderate juvenile dermatomyositis: beyond the first two months. Results of the second Childhood Arthritis and Rheumatology Research Alliance consensus conference. Arthritis Care Res (Hoboken). 2012;64(4):546-553. [PubMed 22076847]
  113. Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115. doi:10.1111/joim.12162 [PubMed 24330030]
  114. Imazio M. Acute pericarditis: treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 27, 2022.
  115. "Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  116. Irving PM, Gearry RB, Sparrow MP, Gibson PR. Review article: appropriate use of corticosteroids in Crohn's disease. Aliment Pharmacol Ther. 2007;26(3):313-329. doi:10.1111/j.1365-2036.2007.03379.x [PubMed 17635367]
  117. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  118. James ND, de Bono JS, Spears MR, et al; STAMPEDE Investigators. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017;377(4):338-351. doi:10.1056/NEJMoa1702900 [PubMed 28578639]
  119. James ND, Sydes MR, Clarke NW, et al; STAMPEDE investigators. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet. 2016;387(10024):1163-1177. doi:10.1016/S0140-6736(15)01037-5 [PubMed 26719232]
  120. Johannesdottir SA, Horváth-Puhó E, Dekkers OM, et al, "Use of Glucocorticoids and Risk of Venous Thromboembolism: A Nationwide Population-Based Case-Control Study," JAMA Intern Med, 2013, 1:1-10. [PubMed 23546607]
  121. Joly P, Roujeau JC, Benichou J, et al; Bullous Diseases French Study Group. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. 2002;346(5):321-327. doi:10.1056/NEJMoa011592 [PubMed 11821508]
  122. Joseph RM, Hunter AL, Ray DW, Dixon WG. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin Arthritis Rheum. 2016;46(1):133-141. doi:10.1016/j.semarthrit.2016.03.001 [PubMed 27105755]
  123. Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves' orbitopathy. J Clin Endocrinol Metab. 2005;90(9):5234-5240. doi:10.1210/jc.2005-0148 [PubMed 15998777]
  124. Khan DA. Chronic spontaneous urticaria: standard management and patient education. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 16, 2023.
  125. Khanna D, Khanna PP, Fitzgerald JD, et al; American College of Rheumatology (ACR). 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447-1461. doi:10.1002/acr.21773 [PubMed 23024029]
  126. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1-S276. doi:10.1016/j.kint.2021.05.021 [PubMed 34556256]
  127. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2:139–274. http://kdigo.org/home/glomerulonephritis-gn/. Accessed February 19, 2016.
  128. Kim S, Kahn P, Robinson AB, et al. Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease. Pediatr Rheumatol Online J. 2017;15(1):1. [PubMed 28077146]
  129. King WM, Ruttencutter R, Nagaraja HN, et al. Orthopedic outcomes of long-term daily corticosteroid treatment in Duchenne muscular dystrophy. Neurology. 2007;68(19):1607-1613. [PubMed 17485648]
  130. Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP. Interventions for bullous pemphigoid. Cochrane Database Syst Rev. 2010;2010(10):CD002292. doi:10.1002/14651858.CD002292.pub3 [PubMed 20927731]
  131. Kliegman RM and St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Saunders Elsevier; 2020.
  132. Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial. Lancet. 2012;379(9826):1613-1620. [PubMed 22405251]
  133. Koutroulis I, Papoutsis J, and Kroumpouzos G, "Atopic Dermatitis in Pregnancy: Current Status and Challenges," Obstet Gynecol Surv, 2011, 66(10):654-63. [PubMed 22112526]
  134. Kowal-Bielecka O, Fransen J, Avouac J, et al; EUSTAR Coauthors. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017;76(8):1327-1339. doi:10.1136/annrheumdis-2016-209909 [PubMed 27941129]
  135. Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1):e20183475. doi:10.1542/peds.2018-3475 [PubMed 30584062]
  136. Lacomis D. Myasthenic crisis. Neurocrit Care. 2005;3(3):189-194. doi:10.1385/NCC:3:3:189 [PubMed 16377829]
  137. Lam DS, Fan DS, Ng JS, et al, "Ocular Hypertensive and Anti-Inflammatory Responses to Different Dosages of Topical Dexamethasone in Children: A Randomized Trial," Clin Experiment Ophthalmol, 2005, 33(3):252-8. [PubMed 15932528]
  138. Larkins N, Kim S, Craig J, Hodson E. Steroid-sensitive nephrotic syndrome: an evidence-based update of immunosuppressive treatment in children. Arch Dis Child. 2016;101(4):404-408. [PubMed 26289063]
  139. Leachman SA and Reed BR, "The Use of Dermatologic Drugs in Pregnancy and Lactation," Dermatol Clin, 2006, 24(2):167-97, vi. [PubMed 16677965]
  140. Leonard MB, "Glucocorticoid-Induced Osteoporosis in Children: Impact of the Underlying Disease," Pediatrics, 2007, 119 Suppl 2:S166-74. [PubMed 17332238]
  141. Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013;309(21):2223-2231. doi:10.1001/jama.2013.5023 [PubMed 23695200]
  142. LeWinter MM. Pericardial complications of myocardial infarction. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 2, 2022.
  143. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27 [PubMed 29610508]
  144. Linafelter A, Cuna A, Liu C, et al. Extended course of prednisolone in infants with severe bronchopulmonary dysplasia. Early Hum Dev. 2019;136:1-6. doi:10.1016/j.earlhumdev.2019.06.007 [PubMed 31265946]
  145. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30 [PubMed 23947590]
  146. Loddenkemper T, Sharma P, Katzan I, Plant GT. Risk factors for early visual deterioration in temporal arteritis. J Neurol Neurosurg Psychiatry. 2007;78(11):1255-1259. doi:10.1136/jnnp.2006.113787 [PubMed 17504884]
  147. Lunghi L, Pavan B, Biondi C, et al, "Use of Glucocorticoids in Pregnancy," Curr Pharm Des, 2010, 16(32):3616-37. [PubMed 20977425]
  148. Lv J, Wong MG, Hladunewich MA, et al; TESTING Study Group. Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA. 2022;327(19):1888-1898. doi:10.1001/jama.2022.5368 [PubMed 35579642]
  149. Lv J, Zhang H, Chen Y, et al. Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial. Am J Kidney Dis. 2009;53(1):26-32. doi:10.1053/j.ajkd.2008.07.029 [PubMed 18930568]
  150. Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American Association for the Study of Liver Diseases. Hepatology. 2020;72(2):671-722. doi:10.1002/hep.31065 [PubMed 31863477]
  151. Mackie SL, Dejaco C, Appenzeller S, et al. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford). 2020;59(3):e1-e23. doi:10.1093/rheumatology/kez672 [PubMed 31970405]
  152. Manno C, Torres DD, Rossini M, Pesce F, Schena FP. Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transplant. 2009;24(12):3694-3701. doi:10.1093/ndt/gfp356 [PubMed 19628647]
  153. Marcocci C, Bartalena L, Tanda ML, et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves' ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab. 2001;86(8):3562-3567. doi:10.1210/jcem.86.8.7737 [PubMed 11502779]
  154. Markham LW, Kinnett K, Wong BL, Woodrow Benson D, Cripe LH. Corticosteroid treatment retards development of ventricular dysfunction in Duchenne muscular dystrophy. Neuromuscul Disord. 2008;18(5):365-370. doi:10.1016/j.nmd.2008.03.002 [PubMed 18436445]
  155. Martin SI, Fishman JA; AST Infectious Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplantation. Am J Transplant. 2013;(13)(suppl 4):272-279. doi:10.1111/ajt.12119 [PubMed 23465020]
  156. Matthews E, Brassington R, Kuntzer T, Jichi F, Manzur AY. Corticosteroids for the treatment of Duchenne muscular dystrophy. Cochrane Database Syst Rev. 2016;(5):CD003725. doi:10.1002/14651858.CD003725.pub4 [PubMed 27149418]
  157. Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol. 2021;73(8):1349-1365. doi:10.1002/art.41774 [PubMed 34235884]
  158. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017;135(17):e927-e999. [PubMed 28356445]
  159. McGee S and Hirschmann J, “Use of Corticosteroids in Treating Infectious Diseases,” Arch Intern Med, 2008, 168(10):1034-46. [PubMed 18504331]
  160. Mebrahtu TF, Morgan AW, West RM, Stewart PM, Pujades-Rodriguez M. Oral glucocorticoids and incidence of hypertension in people with chronic inflammatory diseases: a population-based cohort study. CMAJ. 2020;192(12):E295-E301. doi:10.1503/cmaj.191012 [PubMed 32392512]
  161. Mendell JR, Moxley RT, Griggs RC, et al. Randomized, double-blind six-month trial of prednisone in Duchenne's muscular dystrophy. N Engl J Med. 1989;320(24):1592-1597. doi:10.1056/NEJM198906153202405 [PubMed 2657428]
  162. Merkel PA. Treatment of Takayasu arteritis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2020.
  163. Metry DW, Hebert AA. Benign cutaneous vascular tumors of infancy: when to worry, what to do. Arch Dermatol. 2000;136(7):905-914. doi:10.1001/archderm.136.7.905 [PubMed 10890993]
  164. Middleton PG, Gade EJ, Aguilera C, et al. ERS/TSANZ Task Force statement on the management of reproduction and pregnancy in women with airways diseases. Eur Respir J. 2020;55(2):1901208. doi:10.1183/13993003.01208-2019 [PubMed 31699837]
  165. Miller ML. Initial treatment of dermatomyositis and polymyositis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 24, 2022.
  166. Millipred (prednisolone) [prescribing information]. Rockville, MD: Avalo Therapeutics; July 2021.
  167. Morrow SA, Stoian CA, Dmitrovic J, Chan SC, Metz LM. The bioavailability of IV methylprednisolone and oral prednisone in multiple sclerosis. Neurology. 2004;63(6):1079-1080. doi:10.1212/01.wnl.0000138572.82125.f5 [PubMed 15452302]
  168. Muchtar E, Magen H, Gertz MA. How I treat cryoglobulinemia. Blood. 2017;129(3):289-298. doi:10.1182/blood-2016-09-719773 [PubMed 27799164]
  169. Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ. 2006;332(7540):525-527. doi:10.1136/bmj.332.7540.525 [PubMed 16513709]
  170. Murray-Lyon IM, Stern RB, Williams R. Controlled trial of prednisone and azathioprine in active chronic hepatitis. Lancet. 1973;1(7806):735-737. [PubMed 4121073]
  171. Murrell DF, Ramirez-Quizon M. Management and prognosis of bullous pemphigoid. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 20, 2023.
  172. Myhr KM, Mellgren SI. Corticosteroids in the treatment of multiple sclerosis. Acta Neurol Scand Suppl. 2009;(189):73-80. doi:10.1111/j.1600-0404.2009.01213.x [PubMed 19566504]
  173. Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021;96(3):114-122. doi:10.1212/WNL.0000000000011124 [PubMed 33144515]
  174. National Institute for Health and Care Excellence (NICE). Multiple sclerosis in adults: management. NICE clinical guideline CG186. London, UK: National Institute for Health and Care Excellence; October 2014. https://nice.org.uk/guidance/cg186. Accessed October 28, 2016.
  175. National Institutes of Health (NIH). Coronavirus disease (COVID-19) treatment guidelines. https://www.covid19treatmentguidelines.nih.gov. Last updated April 20, 2023. Accessed May 9, 2023.
  176. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. [PubMed 31794604]
  177. Nieman LK. Treatment of adrenal insufficiency in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 14, 2020.
  178. O’Connell MB, Fritsch MA. Musculoskeletal and connective tissue disorders. Fundamentals of Geriatric Pharmacotherapy. 2nd ed. Hutchison LC, Sleeper RB, eds. ASHP Publications; 2015.
  179. O'Dell JR. Use of glucocorticoids in the treatment of rheumatoid arthritis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 5, 2020.
  180. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019 [PubMed 23256914]
  181. Olek MJ, Howard J. Treatment of acute exacerbations of multiple sclerosis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 23, 2019.
  182. Orapred ODT orally disintegrating tablets (prednisolone sodium phosphate) [prescribing information]. Dublin, Ireland: Amdipharm Limited; May 2021.
  183. Ost L, Wettrell G, Björkhem I, et al, “Prednisolone Excretion in Human Milk,” J Pediatr, 1985, 106(6):1008-11. [PubMed 3998938]
  184. Pacheco LD, Berkowitz RL, Moise KJ Jr, Bussel JB, McFarland JG, Saade GR. Fetal and neonatal alloimmune thrombocytopenia: a management algorithm based on risk stratification. Obstet Gynecol. 2011;118(5):1157-1163. doi:10.1097/AOG.0b013e31823403f4 [PubMed 22015886]
  185. Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest. 1998;113(5):1215-1224. doi:10.1378/chest.113.5.1215 [PubMed 9596297]
  186. Parker CM, Cooper MN. Prednisolone versus dexamethasone for croup: a randomized controlled trial. Pediatrics. 2019;144(3):e20183772. doi:10.1542/peds.2018-3772 [PubMed 31416827]
  187. Park-Wyllie L, Mazzotta P, Pastuszak A, et al, "Birth defects After Maternal Exposure to Corticosteroids: Prospective Cohort Study and Meta-Analysis of Epidemiological Studies," Teratology, 2000, 62(6):385-92. [PubMed 11091360]
  188. Pediapred (prednisolone) [prescribing information]. Manasquan, NJ: Royal Pharmaceuticals; February 2018.
  189. Pediapred (prednisolone) [product monograph]. Laval, Quebec, Canada: Sanofi-aventis Canada Inc; August 2022.
  190. Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced glaucoma: an avoidable irreversible blindness. J Curr Glaucoma Pract. 2017;11(2):67-72. doi:10.5005/jp-journals-l0028-1226 [PubMed 28924342]
  191. Pickup ME. Clinical pharmacokinetics of prednisone and prednisolone. Clin Pharmacokinet. 1979;4(2):111-128. [PubMed 378499]
  192. Pietrogrande M, De Vita S, Zignego AL, et al. Recommendations for the management of mixed cryoglobulinemia syndrome in hepatitis C virus-infected patients. Autoimmun Rev. 2011;10(8):444-454. doi:10.1016/j.autrev.2011.01.008 [PubMed 21303705]
  193. Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell's palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol. 2012;76(7):921-926. [PubMed 22503409]
  194. Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT; British Society for Allergy and Clinical Immunology. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015;45(3):547-565. doi:10.1111/cea.12494 [PubMed 25711134]
  195. Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: a randomised controlled trial. Lancet. 1999;353(9156):883-887. doi:10.1016/s0140-6736(98)03563-6 [PubMed 10093981]
  196. Pradat P, Robert-Gnansia E, Di Tanna GL, et al, “First Trimester Exposure to Corticosteroids and Oral Clefts,” Birth Defects Res A Clin Mol Teratol, 2003, 67(12):968-70. [PubMed 14745915]
  197. Prednisolone sodium phosphate oral solution 15 mg per 5 mL [prescribing information]. Bridgewater, NJ: Amneal Pharmaceuticals LLC; October 2022.
  198. Prednisolone sodium phosphate oral solution 15 mg per 5 mL (refrigerated) [prescribing information]. Greenville, SC: Pharmaceutical Associates Inc; November 2019.
  199. Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817. doi:10.1182/bloodadvances.2019000812 [PubMed 31770441]
  200. Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians (ACP). Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(1):58-68. doi: 10.7326/M16-0570. [PubMed 27802508]
  201. Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012;47(2):66-80. doi:10.1159/000328630 [PubMed 21757964]
  202. Regueiro M, Al Hashash J. Overview of the medical management of mild (low risk) Crohn disease in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 24, 2022.
  203. Report of a Workshop by the British Association for Paediatric Nephrology and Research Unit, Royal College of Physicians, “Consensus Statement on Management and Audit Potential for Steroid Responsive Nephrotic Syndrome,” Arch Dis Child, 1994, 70(2):151-7. [PubMed 8129444]
  204. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. doi:10.1136/annrheumdis-2016-209707 [PubMed 27457514]
  205. Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734. [PubMed 31021516]
  206. Ringold S, Weiss PF, Colbert RA, et al. Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2014;66(7):1063-1072. [PubMed 24339215]
  207. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. doi:10.1089/thy.2016.0229 [PubMed 27521067]
  208. Roumier M, Loustau V, Guillaud C, et al. Characteristics and outcome of warm autoimmune hemolytic anemia in adults: new insights based on a single-center experience with 60 patients. Am J Hematol. 2014;89(9):E150-E155. doi:10.1002/ajh.23767 [PubMed 24847759]
  209. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384-413. doi:10.14309/ajg.0000000000000152 [PubMed 30840605]
  210. Rufo PA, Denson LA, Sylvester FA, et al. Health supervision in the management of children and adolescents with IBD: NASPGHAN recommendations. J Pediatr Gastroenterol Nutr. 2012;55(1):93-108. [PubMed 22516861]
  211. Saad AF, Chappell L, Saade GR, Pacheco LD. Corticosteroids in the management of pregnant patients with Coronavirus disease (COVID-19). Obstet Gynecol. 2020;136(4):823-826. doi:10.1097/AOG.0000000000004103 [PubMed 32769659]
  212. Sadan N, Wolach B. Treatment of hemangiomas of infants with high doses of prednisone. J Pediatr. 1996;128(1):141-146. doi:10.1016/s0022-3476(96)70446-8 [PubMed 8551406]
  213. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219(4):416-425. doi:10.1097/00000658-199404000-00013 [PubMed 8161268]
  214. Salvarani C, Muratore F. Treatment of giant cell arteritis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 23, 2023.
  215. Salvarani C, Muratore F. Treatment of polymyalgia rheumatica. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 31, 2021.
  216. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology (ACR) guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol. 2020;72(4):529‐556. doi:10.1002/art.41191 [PubMed 32090480]
  217. Sandhu BK, Fell JM, Beattie RM, et al. Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. J Pediatr Gastroenterol Nutr. 2010;(50 Suppl 1):S1-13. [PubMed 20081543]
  218. Sax PE. Treatment and prevention of Pneumocystis infection in patients with HIV. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 21, 2022.
  219. Schram G, Fournier A, Leduc H, et al. All-cause mortality and cardiovascular outcomes with prophylactic steroid therapy in Duchenne muscular dystrophy. J Am Coll Cardiol. 2013;61:948-954. [PubMed 23352781]
  220. Scott TF, Frohman EM, De Seze J, et al. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011 Dec 13;77(24):2128-2134. [PubMed 22156988]
  221. Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017 [PubMed 32001253]
  222. Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259. [PubMed 19188870]
  223. Singal AK, Bataller R, Ahn J, et al. ACG Clinical Guideline: alcoholic liver disease. Am J Gastroenterol. 2018;113(2):175-194. doi:10.1038/ajg.2017.469 [PubMed 29336434]
  224. Soloway RD, Summerskill WH, Baggenstoss AH, et al. Clinical, biochemical, and histological remission of severe chronic active liver disease: a controlled study of treatments and early prognosis. Gastroenterology. 1972;63(5):820-833. [PubMed 4538724]
  225. Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child. 2006;91(7):580-583. doi:10.1136/adc.2005.089516 [PubMed 16624882]
  226. Speiser PW, Arlt W, Auchus RJ, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(11):4043-4088. doi:10.1210/jc.2018-01865 [PubMed 30272171]
  227. Steen VD, Medsger TA Jr. Case-control study of corticosteroids and other drugs that either precipitate or protect from the development of scleroderma renal crisis. Arthritis Rheum. 1998;41(9):1613-1619. [PubMed 9751093]
  228. Stoller JK. COPD exacerbations: management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 30, 2023.
  229. Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007;357(16):1598-1607. [PubMed 17942873]
  230. Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes. 2015;6(8):1073-1081. doi:10.4239/wjd.v6.i8.1073 [PubMed 26240704]
  231. Tannock IF, de Wit R, Berry WR, et al; TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351(15):1502-1512. doi:10.1056/NEJMoa040720 [PubMed 15470213]
  232. Teelucksingh S, Nana M, Nelson-Piercy C. Managing COVID-19 in pregnant women. Breathe (Sheff). 2022;18(2):220019. doi:10.1183/20734735.0019-2022 [PubMed 36337130]
  233. Thomas CF Jr, Limper AH. Treatment and prevention of Pneumocystis infection in patients without HIV. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 21, 2022.
  234. Trang G, Steele R, Baron M, Hudson M. Corticosteroids and the risk of scleroderma renal crisis: a systematic review. Rheumatol Int. 2012;32(3):645-653. doi:10.1007/s00296-010-1697-6 [PubMed 21132302]
  235. Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis, part 1: ambulatory care-an evidence-based guideline from European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018;67(2):257-291. [PubMed 30044357]
  236. US Department of Health and Human Services (HHS); National Institutes of Health; National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program (NAEPP): 2020 focused updates to the asthma management guidelines. https://www.nhlbi.nih.gov/health-topics/asthma-management-guidelines-2020-updates. Published 2020.
  237. US Department of Health and Human Services (HHS); National Institutes of Health; National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program (NAEPP): expert panel report 3: guidelines for the diagnosis and management of asthma. https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf. Published 2007.
  238. US Department of Health and Human Services Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf. Accessed November 21, 2022.
  239. Urban RC Jr, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986;31(2):102-110. doi:10.1016/0039-6257(86)90077-9 [PubMed 3541262]
  240. van der Hooft CS, Heeringa J, Brusselle GG, et al. Corticosteroids and the risk of atrial fibrillation. Arch Intern Med. 2006;166(9):1016-1020. doi:10.1001/archinte.166.9.1016 [PubMed 16682576]
  241. van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn's disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis. Published online October 7, 2020. [PubMed 33026087]
  242. van Runnard Heimel PJ, Schobben AF, Huisjes AJ, et al, “The Transplacental Passage of Prednisolone in Pregnancies Complicated by Early-Onset HELLP Syndrome,” Placenta, 2005, 26(10):842-5. [PubMed 16226134]
  243. Vivarelli M, Massella L, Ruggiero B, Emma F. Minimal change disease. Clin J Am Soc Nephrol. 2017;12(2):332-345. doi:10.2215/CJN.05000516 [PubMed 27940460]
  244. Wallace DJ. Overview of the management and prognosis of systemic lupus erythematosus in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 17, 2020.
  245. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. Available at https://apps.who.int/iris/handle/10665/62435
  246. Yoo HW, Yoon L, Kim HY, et al. Comparison of conservative therapy and steroid therapy for Bell's palsy in children. Korean J Pediatr. 2018;61(10):332-337. doi:10.3345/kjp.2018.06380 [PubMed 30304913]
  247. Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am. 2016;42(1):157-176. doi:10.1016/j.rdc.2015.08.004 [PubMed 26611557]
  248. Zanella A, Barcellini W. Treatment of autoimmune hemolytic anemias. Haematologica. 2014;99(10):1547-1554. doi:10.3324/haematol.2014.114561 [PubMed 25271314]
  249. Zar T, Graeber C, Perazella MA. Recognition, treatment, and prevention of propylene glycol toxicity. Semin Dial. 2007;20(3):217-219. [PubMed 17555487]
  250. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-766. doi:10.1111/all.15090 [PubMed 34536239]
  251. Zuraw B. An overview of angioedema: clinical features, diagnosis, and management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 16, 2023.
Topic 9913 Version 563.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟