GCS for injection

Active substance

Release form, composition and packaging

Injection transparent, colorless or slightly yellowish or greenish-yellowish.

Excipients: nicotinamide, sodium metabisulfite, disodium edetate, sodium hydroxide, water for injection.

1 ml - ampoules (3) - plastic trays (1) - cardboard boxes.

pharmachologic effect

Synthetic glucocorticoid drug, dehydrogenated analogue. It has anti-inflammatory, antiallergic, immunosuppressive effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

Interacts with specific cytoplasmic receptors (receptors for GCS are found in all tissues, especially in the liver) to form a complex that induces the formation of proteins (including enzymes that regulate vital processes in cells.)

Protein metabolism: reduces the amount of globulins in, increases the synthesis of albumins in the liver and kidneys (with an increase in the albumin/globulin ratio), reduces the synthesis and increases protein catabolism in muscle tissue.

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (fat accumulation occurs mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase (increased flow from the liver into the blood); increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases (activation of gluconeogenesis); promotes the development of hyperglycemia.

Water-electrolyte metabolism: retains Na + and water in the body, stimulates the excretion of K + (mineralocorticoid activity), reduces the absorption of Ca 2+ from the gastrointestinal tract, reduces bone mineralization.

The anti-inflammatory effect is associated with inhibition of the release of inflammatory mediators by eosinophils and mast cells; inducing the formation of lipocortins and reducing the number of mast cells that produce hyaluronic acid; with a decrease in capillary permeability; stabilization of cell membranes (especially lysosomal) and organelle membranes. Acts on all stages of the inflammatory process: inhibits the synthesis of prostaglandins at the level of arachidonic acid (lipocortin inhibits phospholipase A2, suppresses the liberation of arachidonic acid and inhibits the biosynthesis of endoperoxides, leukotrienes, which contribute to inflammation, allergies, etc.), the synthesis of “pro-inflammatory cytokines” (interleukin 1, tumor necrosis factor alpha, etc.); increases the resistance of the cell membrane to the action of various damaging factors.

The immunosuppressive effect is caused by the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B cells and the interaction of T and B lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and decreased antibody formation.

Prednisolone is metabolized in the liver, partially in the kidneys and other tissues, mainly by conjugation with glucuronic and sulfuric acids. Metabolites are inactive.

It is excreted in bile and urine by glomerular filtration and is 80-90% reabsorbed by the tubules. 20% of the dose is excreted unchanged by the kidneys. T1/2 from plasma after intravenous administration 2-3 hours.

Indications

Prednisolone is used for emergency therapy in conditions that require a rapid increase in the concentration of corticosteroids in the body:

— shock conditions (burn, traumatic, surgical, toxic, cardiogenic) - in case of ineffectiveness of vasoconstrictors, plasma-substituting drugs and other symptomatic therapy;

- allergic reactions (acute severe forms), blood transfusion shock, anaphylactic shock, anaphylactoid reactions;

- cerebral edema (including due to a brain tumor or associated with surgery, radiation therapy or head trauma);

- bronchial asthma (severe form), status asthmaticus;

- systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis);

- acute adrenal insufficiency;

- thyrotoxic crisis;

- acute hepatitis, hepatic coma;

- reduction of inflammatory phenomena and prevention of cicatricial contractions (in case of poisoning with cauterizing liquids).

Contraindications

For short-term use for health reasons, the only contraindication is hypersensitivity to prednisolone or the components of the drug.

In children during the growth period, GCS should be used only according to absolute indications and under the particularly careful supervision of the attending physician.

WITH caution the drug should be prescribed for the following diseases and conditions:

- gastrointestinal diseases - gastric and duodenal ulcers, esophagitis, gastritis, acute or latent peptic ulcers, recently created intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis;

- pre- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination;

— immunodeficiency states (including AIDS or HIV infection);

- diseases of the cardiovascular system (including recent myocardial infarction - in patients with acute and subacute myocardial infarction, the necrosis focus may spread, slowing down the formation of scar tissue and, as a result, rupture of the heart muscle), severe chronic heart failure, arterial hypertension, hyperlipidemia);

- endocrine diseases - diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, obesity (III - IV stage);

- severe chronic renal and/or liver failure, nephrourolithiasis;

— hypoalbuminemia and conditions predisposing to its occurrence;

- systemic osteoporosis, myasthenia gravis, acute psychosis, poliomyelitis (except for the form of bulbar encephalitis), open- and closed-angle glaucoma;

- pregnancy.

Dosage

The dose of Prednisolone and duration of treatment are determined by the doctor individually depending on the indications and severity of the disease.

Prednisolone is administered intravenously (drip or stream) or intramuscularly. The intravenous drug is usually administered first as a stream, then as a drip.

At acute adrenal insufficiency single dose 100-200 mg for 3-16 days.

At bronchial asthma the drug is administered depending on the severity of the disease and the effectiveness of complex treatment from 75 to 675 mg per course of treatment from 3 to 16 days; in severe cases, the dose can be increased to 1400 mg per course of treatment or more with a gradual dose reduction.

At status asthmaticus Prednisolone is administered at a dose of 500-1200 mg/day, followed by a decrease to 300 mg/day and transition to maintenance doses.

At thyrotoxic crisis 100 mg of the drug is administered in a daily dose of 200-300 mg; if necessary, the daily dose can be increased to 1000 mg. The duration of administration depends on the therapeutic effect, usually up to 6 days.

At shock resistant to standard therapy, At the beginning of therapy, Prednisolone is usually administered as a bolus, after which it is switched to drip administration. If blood pressure does not increase within 10-20 minutes, repeat the injection of the drug. After recovery from the shock state, drip administration is continued until blood pressure stabilizes. A single dose is 50-150 mg (in severe cases - up to 400 mg). The drug is re-administered after 3-4 hours. The daily dose can be 300-1200 mg (with subsequent dose reduction).

At acute hepatic-renal failure(for acute poisoning, in the postoperative and postpartum periods, etc.), Prednisolone is administered at 25-75 mg/day; if indicated, the daily dose can be increased to 300-1500 mg/day and higher.

At rheumatoid arthritis and systemic lupus erythematosus Prednisolone is administered in addition to systemic administration of the drug at a dose of 75-125 mg/day for no more than 7-10 days.

At acute hepatitis Prednisolone is administered at 75-100 mg/day for 7-10 days.

At poisoning with cauterizing liquids with burns of the digestive tract and upper respiratory tract Prednisolone is prescribed at a dose of 75-400 mg/day for 3-18 days.

If intravenous administration is not possible, Prednisolone is administered intramuscularly in the same doses. After relief of the acute condition, Prednisolone tablets are prescribed orally, followed by a gradual reduction in the dose.

With long-term use of the drug, the daily dose should be reduced gradually. Long-term therapy should not be stopped suddenly!

Side effects

The frequency of development and severity of side effects depends on the duration of use, the size of the dose used and the ability to comply with the circadian rhythm of prescribing Prednisolone.

When using Prednisolone, the following may occur:

From the endocrine system: decreased glucose tolerance, steroid diabetes mellitus or manifestation of latent diabetes mellitus, suppression of adrenal function, Itsenko-Cushing syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, stretch marks), delayed sexual development in children.

From the digestive system: nausea, vomiting, pancreatitis, steroid ulcer of the stomach and duodenum, erosive esophagitis, gastrointestinal bleeding and perforation of the wall of the gastrointestinal tract, increased or decreased appetite, indigestion, flatulence, hiccups. In rare cases, increased activity of liver transaminases and alkaline phosphatase.

From the cardiovascular system: arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of heart failure, changes in the electrocardiogram characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle.

From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions.

From the senses: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral infections of the eyes, trophic changes in the cornea, exophthalmos, sudden loss of vision (with parenteral administration in the head, neck, nasal turbinates, scalp is possible deposition of drug crystals in the vessels of the eye).

From the side of metabolism: increased calcium excretion, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating.

Caused by mineralocorticoid activity: fluid and sodium retention (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

From the musculoskeletal system: slower growth and ossification processes in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur), rupture of muscle tendons, steroid myopathy, decreased muscle mass (atrophy).

From the skin and mucous membranes: delayed wound healing, petechiae, ecchymosis, skin thinning, hyper- or hypopigmentation, steroid acne, stretch marks, tendency to develop pyoderma and candidiasis.

Allergic reactions: skin rash, itching, anaphylactic shock, local allergic reactions.

Local for parenteral administration: burning, numbness, pain, tingling at the injection site, infection at the injection site, rarely - necrosis of surrounding tissues, scarring at the injection site; atrophy of the skin and subcutaneous tissue with intramuscular injection (injection into the deltoid muscle is especially dangerous).

Others: development or exacerbation of infections (the appearance of this side effect is facilitated by jointly used immunosuppressants and vaccination), leukocyturia, withdrawal syndrome.

Overdose

The side effects described above may increase.

It is necessary to reduce the dose of Prednisolone. Treatment is symptomatic.

Drug interactions

Pharmaceutical incompatibility of Prednisolone with other intravenously administered drugs is possible - it is recommended to administer it separately from other drugs (iv bolus, or through another dropper, as a second solution). When mixing a solution of prednisolone with heparin, a precipitate forms.

Simultaneous administration of prednisolone with:

inducers of liver microsomal enzymes(phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration;

diuretics(especially “thiazide” and carbonic anhydrase inhibitors) and amphotericin B - may lead to increased removal of K+ from the body and an increased risk of heart failure;

with sodium-containing drugs- to the development of edema and increased blood pressure;

cardiac glycosides- their tolerability worsens and the likelihood of developing ventricular extrasytolia increases (due to caused hypokalemia);

indirect anticoagulants- weakens (less often strengthens) their effect (dosage adjustment required);

anticoagulants and thrombolytics- the risk of bleeding from ulcers in the gastrointestinal tract increases;

ethanol and NSAIDs- the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding increases (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of GCS due to the summation of the therapeutic effect);

paracetamol - the risk of developing hepatotoxicity increases (induction of liver enzymes and the formation of a toxic metabolite of paracetamol);

- accelerates its elimination and reduces its concentration in the blood (when prednisolone is discontinued, the level of salicylates in the blood increases and the risk of side effects increases);

insulin and oral hypoglycemic drugs, antihypertensive drugs - their effectiveness decreases;

vitamin D - its effect on the absorption of Ca 2+ in the intestine decreases;

somatotropic hormone - reduces the effectiveness of the latter, and with praziquantel - its concentration;

M-anticholinergics(including antihistamines and tricyclic antidepressants) and nitrates- helps to increase intraocular pressure;

isoniazid and mexiletine- increases their metabolism (especially in “slow” acetylators), which leads to a decrease in their plasma concentrations.

Carbonic anhydrase inhibitors and loop diuretics may increase the risk of osteoporosis.

Indomethacin, displacing prednisolone from its connection with albumin, increases the risk of developing its side effects.

ACTH enhances the effect of prednisolone.

Ergocalciferol and parathyroid hormone prevent the development of osteopathy caused by prednisolone.

Cyclosporine and ketoconazole, by slowing down the metabolism of prednisolone, can in some cases increase its toxicity.

The simultaneous administration of androgens and steroidal anabolic drugs with prednisolone promotes the development of peripheral edema and hirsutism, and the appearance of acne.

Estrogens and oral estrogen-containing contraceptives reduce the clearance of prednisolone, which may be accompanied by an increase in the severity of its action.

Mitotane and other inhibitors of adrenal function may necessitate an increase in the dose of prednisolone.

When used simultaneously with live antiviral vaccines and against the background of other types of immunization, it increases the risk of viral activation and the development of infections.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when prednisolone is prescribed.

When used simultaneously with antithyroid drugs, the clearance of prednisolone decreases and with thyroid hormones increases.

special instructions

During treatment with Prednisolone (especially long-term), observation by an ophthalmologist, monitoring of blood pressure, water and electrolyte balance, as well as peripheral blood patterns and blood glucose levels are necessary.

In order to reduce side effects, antacids can be prescribed, as well as increasing the intake of K+ into the body (diet, potassium supplements). Food should be rich in proteins, vitamins, and limit the content of fats, carbohydrates and table salt.

The effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis. The drug may worsen existing emotional instability or psychotic disorders. If a history of psychosis is indicated, Prednisolone in high doses is prescribed under the strict supervision of a physician.

It should be used with caution in acute and subacute myocardial infarction - the necrosis focus may spread, the formation of scar tissue may slow down, and the heart muscle may rupture.

In stressful situations during maintenance treatment (for example, surgery, trauma or infectious diseases), the dose of the drug should be adjusted due to an increased need for GCS.

With sudden withdrawal, especially in the case of previous use of high doses, withdrawal syndrome may develop (anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness), as well as an exacerbation of the disease for which Prednisolone was prescribed.

During treatment with Prednisolone, vaccination should not be carried out due to a decrease in its effectiveness (immune response).

When prescribing Prednisolone for intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously treat with bactericidal antibiotics.

In children during long-term treatment with Prednisolone, careful monitoring of the dynamics of growth and development is necessary. Children who during the treatment period were in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

Due to the weak mineralocorticoid effect, Prekisolone is used in combination with mineralocorticoids for replacement therapy for adrenal insufficiency.

In patients with diabetes mellitus, blood glucose levels should be monitored and therapy adjusted if necessary.

X-ray monitoring of the osteoarticular system (images of the spine, hand) is indicated.

Prednisolone in patients with latent infectious diseases of the kidneys and urinary tract can cause leukocyturia, which may have diagnostic significance.

Prednisolone increases the content of 11- and 17-hydroxyketocorticosteroid metabolites.

Pregnancy and lactation

During pregnancy (especially in the first trimester) it is used only for health reasons. With long-term therapy during pregnancy, the possibility of impaired fetal growth cannot be excluded. If used in the third trimester of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

List B. The drug should be stored at a temperature not exceeding 25°C out of the reach of children. Shelf life - 3 years. Do not use after the expiration date stated on the package.

The instructions for use of Prednisolone indicate that this is a hormonal agent of medium duration of action, intended for local and systemic use in the treatment of various severe pathologies and acute, life-threatening conditions.

Prednisolone - description of the drug

Prednisolone is a synthetic analogue of the hormone hydrocortisone, which is produced in the body by the adrenal cortex. The drug exhibits the following therapeutic effect:

• fights inflammation;
• relieves shock conditions;
• prevents the release of exudate;
• exhibits antitoxic effect;
• has an immunosuppressive effect.

Prednisolone prevents the development of allergic reactions. In cases where undesirable reactions have already appeared, it allows you to quickly relieve unpleasant symptoms, eliminate itching, redness and rashes. The drug is able to suppress inflammation, relieve swelling, and have an anti-shock effect, which helps to avoid serious complications and reduce the likelihood of death.

The drug is prescribed for severe pathologies and dangerous conditions accompanied by severe inflammation, bronchospasm, and copious exudate. Prednisolone prevents the development, suppresses the proliferation of cells in the damaged area, and prevents the formation of scar tissue.

In clinical practice, all therapeutic effects of a hormonal drug are important (except immunosuppressive, aimed at artificially suppressing immunity). This property of the drug is considered as an adverse reaction. The advantage of the synthetic hormone is that the effect of its use develops after 5-7 minutes, which allows you to quickly eliminate spasm of the respiratory tract, swelling and normalize the patient’s condition.

Good to know

Prednisolone is a strong drug, so it is advisable to use it only in severe cases, when other, weaker medications do not provide the expected therapeutic effect or life-threatening emergency situations arise (for example, anaphylactic shock).

Additionally, Prednisolone exhibits the following properties:

• activates protein metabolism in;
• increases the concentration of glucose in the blood;
• reduces protein concentration in plasma and tissues by activating its breakdown;
• interferes with the absorption of potassium in the intestines;
• reduces seizure activity;
• promotes the redistribution of fat, as a result of which it is deposited on the face and in the shoulder girdle area;
• has a stimulating effect on the brain;
• retains sodium and fluid in the body;
• inhibits the production of thyroid-stimulating hormones and its own hydrocortisone produced by the adrenal glands.

Such properties of the drug serve as the basis for side effects that appear during treatment, so they need to be adequately assessed and taken into account during Prednisolone therapy.

Forms of the drug

The pharmaceutical industry produces hormonal drugs in several forms:

• Prednisolone tablets (1 mg and 5 mg);
• Prednisolone in ampoules 30 mg/ml (solution for injection);
• eye drops (0.5%);
• prednisolone ointment (0.5%).

Prednisolone is produced by different pharmaceutical companies; accordingly, the same form of the drug, in addition to the main component, may contain different excipients. Therefore, before using the medication, you need to carefully study the composition and the instruction leaflet, which lists in detail all the components of the medicine.

Indications

Prednisolone is prescribed for the treatment of severe diseases accompanied by dangerous symptoms. The ointment form helps with skin diseases, drops are used in ophthalmic practice, solution and tablets are used for pathological processes in internal organs, allergic manifestations, and autoimmune diseases.

Tablets and intramuscular injections of Prednisolone are prescribed for the treatment of the following pathologies:

• inflammatory lesions of joints in acute and chronic form;
• systemic connective tissue diseases;
• allergic diseases, acute and chronic;
• cerebral edema;
• diseases of the hematopoietic system;
• skin diseases (eczema, neurodermatitis, dermatitis);
• lung diseases;
• autoimmune kidney damage;
• inflammatory eye diseases (uveitis, optic neuritis);
• pathologies (thyroiditis);
• ulcerative lesions of the gastrointestinal tract;
• chronic inflammatory liver diseases (hepatitis of various etiologies).

Prednisolone tablets can be prescribed to alleviate the condition during treatment with cytostatics, for multiple myeloma, as a means of preventing the rejection of organs and tissues after transplantation.

The main indications for prescribing IM and IV injections of Prednisolone are:

• severe course of bronchial asthma;
• acute allergic reactions, accompanied by massive swelling, bronchospasm, painful, itchy rashes;
• thyrotoxic crisis;
• shock conditions of various origins (traumatic, burn, cardiogenic, toxic, anaphylactic);
• swelling of the brain;
• adrenal or liver failure in acute form, hepatic coma;
• myocardial infarction;
• intoxication with vinegar essence or alkali.

Prednisolone solution is also used for administration inside a diseased joint for rheumatism, arthrosis, polyarthritis or osteoarthritis of large joints.

Prednisolone ointment is used in the treatment of dermatitis (atopic, allergic, seborrheic), eczema, lichen, psoriasis, neurodermatitis. This remedy is prescribed for alopecia (baldness), manifestations of toxicoderma, lupus erythematosus, and is used as part of the complex treatment of tendovaginitis, bursitis, and sciatica.

Eye drops are used in ophthalmology for inflammatory eye diseases of a non-infectious nature (iritis, uveitis, iridocyclitis, including allergic nature, keratitis, blepharitis). Used for eye inflammation caused by surgery or injury.

As you can see, the list of conditions for which Prednisolone is used is very extensive. In general, the drug in tablet form is used to treat chronic diseases, while injections are given to relieve acute conditions that increase the risk of severe complications or pose a threat to life.

Instructions for use

The annotation for the drug states that the dosage of Prednisolone and the treatment regimen are selected by the doctor taking into account the type of pathology, severity of symptoms, general condition of the patient and possible contraindications.

How to take Prednisolone?

Treatment with Prednisolone is carried out strictly according to indications and under the supervision of a physician. It is recommended to take the daily dose of Prednisolone once, preferably in the morning (from 6 to 8), immediately after breakfast.

This is due to the circadian rhythms of glucocorticosteroid secretion, which is most active in the morning, therefore, the effectiveness of taking the drug at this time will be the best. The tablets should be swallowed whole and washed down with a small amount of liquid. If you cannot take the medicine in the morning, you need to do it before 12 o'clock. Another option is to take most of the daily dose in the morning, the rest before 12 noon.

In the treatment of severe pathologies, the initial dose is from 50 to 75 mg; as the condition improves, the dose is gradually reduced to 1-3 tablets per day. For the treatment of chronic conditions, the standard dosage of the drug is 4 to 6 tablets per day.

When asked how many days to take Prednisolone, doctors answer that the duration of taking the medicine depends on the type of pathology, the severity of the symptoms and the patient’s individual response to the drug. A standard course takes on average 6 days, in some cases it can last for several weeks.

As the condition improves, the dose is reduced by 5 mg every 2 days, bringing it to the minimum. You should not stop taking the drug abruptly, so as not to cause withdrawal syndrome. It is recommended to take Prednisolone at a minimum dose for another 2 days and only after that the medicine is finally discontinued.

Injections

Intravenous injections are done by drip and jet. Jet injection is indicated for the relief of acute conditions, which allows for a quick therapeutic effect. After the crisis has passed, the patient is given an IV. To do this, Prednisolone is mixed with saline and injected into a vein at a rate of 15 drops per minute.

Intramuscular injections are made according to standard rules, that is, the solution is injected into the area of ​​the buttocks or the upper third of the shoulder, after pre-treating the skin with an antiseptic. The dosage of the drug and the duration of treatment for various conditions are determined by a specialist.

In acute conditions, the solution is instilled into the conjunctival sac after 2 hours (1-2 drops). As the condition improves, the eyes are instilled after 6 hours, then they switch to three times a day. After surgery, Prednisolone can be instilled into the eyes 3-5 days after surgery.

The ointment form of the drug can be used for no more than 14 days, applying a thin layer to the affected areas up to 3 times a day. When a positive result is achieved, use of the drug is stopped immediately.

Prednisolone ointment should not be applied under a bandage, as this method of application can provoke excessive penetration of active substances into the bloodstream and cause systemic adverse reactions.

Prednisolone for children

Prednisolone is a powerful hormonal drug that often causes unwanted side effects during use. The question naturally arises, is it possible to take Prednisolone for children?

The doctor must calculate the dosage of medication for a child individually, taking into account the age and severity of the condition. The therapeutic dose of Prednisolone in tablet form is calculated from the ratio of 1-2 mg/kg, the maintenance dose is 0.25-0.5 mg/kg.

For injections, the dosage is determined taking into account the age and weight of the child and is 3 mg/kg for children from 2 months to a year and 2 mg/kg for children from 1 year to 14 years. When treating acute conditions, the drug is administered intramuscularly, very slowly, over 3 minutes. If the need arises, then after half an hour, the solution can be re-administered in the same dose.

Tablets and injections are prescribed to children only in cases of urgent need, when attempts to treat severe pathology with other medications do not work or life-threatening conditions arise. In this case, the drug should be used intermittently (three days on/four days off). With this treatment regimen, the risk of stopping the child’s growth and development is reduced.

The ointment form and eye drops are used in the same doses as in the treatment of adult patients. In this case, you should avoid applying the ointment under the bandage so as not to create conditions for excessive absorption of the drug into the skin.

Contraindications

When using Prednisolone systemically for a short period of time and for health reasons, the only limitation is hypersensitivity to the active substance and other components. In other cases, the doctor must take into account the conditions in which the use of hormonal agents is prohibited.

Tablets, IM, IV and intra-articular injections should not be prescribed for the following conditions:

• active phase of viral, fungal, bacterial infection (varicella, systemic mycoses, tuberculosis, etc.);
• ulcerative lesions of the gastrointestinal tract;
• arterial hypertension;
• heart failure (chronic), history of myocardial infarction;
• diabetes;
• endocrine pathologies (hypothyroidism, thyrotoxicosis, high obesity);
• severe renal or liver failure, kidney stones;
• osteoporosis, poliomyelitis;
• immunodeficiency states;
• the period before the introduction of the vaccine and after vaccinations;
• myasthenia gravis;
• acute mental states;
• focus of infection in the joint;
• tissue necrosis;
• previous arthroplasty;
• increased bleeding;
• joint instability, osteoarthritis.

The ointment form of the drug should not be used for skin lesions, if the causative agents are fungi, bacteria, skin tuberculosis and syphilis, a tumor process, or the presence of acne.

Drops should not be prescribed for purulent, viral or fungal eye infections, damage to the cornea, including after removal of a foreign object, glaucoma, or eye tuberculosis.

A general contraindication to the use of hormonal agents is pregnancy and lactation. Prescription of Prednisolone during pregnancy is permissible only for health reasons, since the medication exhibits a teratogenic effect. The active substances of the drug can penetrate into mother's milk. Therefore, breastfeeding is stopped for the duration of treatment, and the child is transferred to artificial formula.

Side effects

Like most hormonal drugs, Prednisolone can cause serious side effects:

• Cardiovascular and hematopoietic system- increased blood pressure, problems with blood clotting, thrombosis. The appearance of arrhythmia, bradycardia (up to cardiac arrest), weakness, and fatigue is noted.
• Metabolism- increased blood sugar levels, swelling due to water and sodium retention, decreased potassium levels, weight gain.
• Endocrine system- developmental and growth retardation in children, adrenal insufficiency, Cushing's syndrome, exacerbation of diabetes mellitus.
• Digestive system- nausea, vomiting, flatulence, hiccups, loss of appetite. In rare cases, erosive and ulcerative processes, gastrointestinal bleeding, and pancreatitis develop.
• Nervous system- high intracranial pressure, migraine, dizziness, blurred vision, increased sweating. In severe cases - insomnia, disorientation in space, convulsions, hallucinations, manifestations of manic-depressive psychosis.
• Skin- slow healing of damage, thinning and atrophy of the skin, erythema, changes in pigmentation, abscess, the appearance of acne. In case of allergic reactions - manifestations of dermatitis, skin rashes, hyperemia. In severe cases - anaphylactic shock.

The use of ointment can provoke a burning sensation, itching, irritation, excessive dryness and atrophy of the skin, and cause excess hair growth.

The use of eye drops may be accompanied by side effects such as increased intraocular pressure, damage to the optic nerve, decreased visual acuity and narrowing of visual fields, pain in the eyes, increased risk of corneal perforation and the addition of viral and fungal infections.

Analogs

The following drugs are structural analogs of Prednisolone based on the active substance:

• Medopred;
• Prednisolone Nycomed;
• Prednislon Ferein;
• Sol-Decortin.

Good to know

The decision to replace Prednisolone with analogues is made by the attending physician.

Price

Average prices for Prednisolone in pharmacies are as follows:

1. Prednisolone tablets 5 mg (100 pcs.) - from 120 rubles;
2. Prednisolone in ampoules (25 pcs) - from 280 rubles;
3. Prednisolone ointment (10g) - from 35 rubles
4. Eye drops (10ml) - from 60 rubles.

Modern pharmacology offers a number of antihistamines, a wide spectrum of which has a targeted effect on the human body.

Such drugs include modern Prednisolone, which is approved for use even by children.

General information about the drug

Prednisolone is a glucocorticosteroid hormonal medication used strictly as prescribed by a doctor for the treatment of allergic reactions and anaphylactic shock in children. It is a second choice drug and is used in cases where non-steroidal anti-inflammatory drugs are not effective enough. The weakly active agent can be taken systemically and locally.

The active component in the composition of the drug is a natural analogue of hydrocortisone (adrenal hormone). The medicine has a number of healing properties, including anti-shock, anti-inflammatory and antihistamine.

The activity of the active component is several times higher than that of the adrenal hormone.

Release form, composition and packaging

The drug is available in the form of tablets and injection solution. The tablets are white, round, and there is a risk. The tablet form of release contains auxiliary and active components, the intake of which, within reasonable limits, will not harm the child’s body.

The main component is prednisolone, the content of which in one tablet does not exceed 5 mg. Additional elements include:

• sugar of natural origin;
• industrial corn concentrate;
• silicon oxide;
• aliphatic carboxylic acid;
• sodium carboxymethylcellulose;
• sodium stearic salt.

The tablets are packaged in blister packs of 10 pieces. Blisters are sold in cardboard packages of 3/5/10 pieces. The boxes contain instructions for use and all the necessary markings:

• serial number;
• best before date;
• number of tablets;
• manufacturer information.

Injection

The injection solution is a colorless yellow, less often yellow-green liquid. The active ingredient is identical to what is contained in the pills. The content of prednisolone in 1 ml of solution does not exceed 30 mg. It is completely safe for children's bodies.

Auxiliary components:

• inorganic sodium pyrosulfite;
• caustic soda;
• vitamin nicotinic acid;
• organic sodium salt;
• water for injections.

The liquid is poured into a transparent glass container with a volume of 1 ml. The ampoules are placed in plastic trays and go on sale in cardboard boxes with all the necessary markings.

pharmachologic effect

Children's cells divide faster than adult cells, so the allergen spreads faster throughout the body of children . Under the influence of Prednisolone, tissue microphages and leukocytes reduce their own activity.

The relationship between the active component and cytoplasmic receptors has a beneficial effect on metabolic processes in the child’s body. In the process of interaction, inducers of protein synthesis are formed.

The allergic inhibitor helps reduce inflammatory processes in the human body and accelerates the synthesizing process of prostaglandin. Helps reduce the course of an allergic reaction, blocks the spread of allergic mediators. Prednisolone reduces the total number of basophil leukocytes in the blood.

The drug helps relieve skin rashes, itching and other manifestations of allergies in children in the shortest possible time.

Pharmacokinetics

Both forms of release are quickly absorbed into the blood and distributed throughout the tissues. The tablets are taken orally, the coating begins to dissolve in the oral cavity. As the tablet penetrates the small patient's stomach, the tablet disintegrates into its component parts.

The maximum therapeutic concentration in the blood is reached 20 minutes after taking the tablet and lasts for 2 hours.

The injection solution enters the bloodstream faster than the tablet. The active substance is distributed throughout tissue cells. Metabolized mainly in the liver and hepatic ducts.

Both dosage forms are excreted from the child’s body along with urine through the kidneys.

Mechanism of action

Glucocorticosteroid medication has a detrimental effect on allergens. It has the greatest activity against food and drug allergens. Under the influence of an allergen, histamine becomes more active and causes a reaction accompanied by a runny nose, swelling, itching and skin rashes in children.

When released into the blood, rednisolone helps to reduce neutrophils and basophils in the patient’s blood. The amount of histamine released is reduced by 1.5 times. With regular use, Prednisolone neutralizes the effect of histamine and gradually stops its release into the blood.

Mast cells located in the skin, under the influence of the drug, stop absorbing histamine. Prednisolone prevents the fusion of histamine and nerve receptors.

Indications

The drug in tablets is widely used for a number of diseases caused by various allergens. These include:

• allergies in children caused by food;
• allergies in children caused by medications;
• allergic non-infectious inflammation of the skin;
• reaction to protein whey;
• children's (chronic);
• contact in children;
• childhood allergy to pollen;
• allergic inflammation of the nasal mucosa;
• childhood urticaria;

The injection solution is used in emergency cases of anaphylactic shock or acute allergic attacks in a child.

Contraindications

The drug is strictly prohibited to be taken in a number of cases. Prednisolone for children can be prescribed only for health reasons. It is not recommended to give the medicine to children under 3 years of age.

The following diseases are considered absolute contraindications:

• diabetes;
• peptic ulcer;
• psychosis;
• thrombophlebitis;
• low blood pressure.

Admission is prohibited for children who have been diagnosed with hypersensitivity or individual intolerance to certain components of the drug.

Instructions for use

The tablets must be taken orally, without chewing and with plenty of liquid. The recommended dose directly depends on the child's weight. The correct dosage can be calculated based on 400 mcg of the drug per 1 kilogram of weight. The daily dose should not exceed 2 mg. It must be divided into 5 steps. You need to take the medicine every 2-3 hours.

The injection solution is allowed to be used only in emergency cases. The drug is injected slowly into the gluteal muscle. In a critical situation, children under 1 year of age are given no more than 1 mg/kg of body weight. Children over 12 months and under 14 years of age are given 2 mg/kg.

Overdose

Overdose increases the risk of side effects. Dose-dependent auxiliary allergic reactions can be removed by gradually reducing the daily dose of the drug.

If a gradual reduction in the dose does not relieve the small patient of dose-dependent side effects, it is necessary to immediately stop taking the medication and seek help from a specialist.

Adverse reactions

There may be a risk of side effects when taking this medication. These include:

• lack of coordination;
• headache;
• skin rashes;
• loss of appetite;
• vomit;
• arrhythmia.

A sudden development or exacerbation of infectious diseases in children can be regarded as an adverse reaction.

Drug interactions

The drug has high pharmacological activity and helps to enhance or weaken the therapeutic effect of most medications on the child’s body. If necessary, complex therapy with Prednisolone and other drugs should be studied by a specialist.

special instructions

Before starting to take an antihistamine, it is recommended to undergo all necessary tests. It is necessary to regularly measure the level of glucose in the child's blood and urine. Vaccination while taking medication is prohibited.

If treatment with Prednisolone is suddenly stopped, there is a risk of a number of ailments:

• loss of appetite;
• gagging;
• asthenia;
• lack of coordination.

If you suddenly stop taking the drug, kidney failure may occur. To eliminate it, a course of treatment with hormones is necessary.

Hello, dear readers. Today we will talk about how childhood allergies are treated with the hormonal drug Prednisolone.

In what forms and dosages can the doctor prescribe the drug, for what allergic manifestations can Prednisolone be prescribed and what is its effectiveness.

Prednisolone for childhood allergies

Prednisolone treats serious forms of allergies in children. This is a hormonal agent characterized by immunomodulatory, antihistamine and anti-inflammatory properties.

Doctors prescribe this medicine only when necessary, when it is not possible to cure a child’s allergies with non-hormonal drugs.

At the first sign of an allergy in a child, parents should immediately contact a specialist.

After diagnosis, the allergist will choose a treatment method. If a doctor prescribes Prednisolone, he will also recommend what form the medicine should be used in: tablets, injection solutions, ointments, drops (suspensions) for the eyes.

The most important thing that parents should remember: the hormonal drug Prednisolone for children with allergies is prescribed exclusively by a specialist; self-medication is unacceptable.

Today, manufacturers produce this drug in tablet form, in the form of solutions that are injected into a muscle or into a vein, and powders, from which the desired solution can be prepared.

Also available are ointments for application to affected areas of the skin, eye drops or suspensions that eliminate eye swelling.

Tablets contain one or five milligrams of prednisolone, solutions contain thirty or fifteen milligrams of medication per milliliter of solution, prednisolone powders contain thirty milligrams per bottle, ointments and eye drops have a concentration of 0.5%.

Prednisolone: ​​how to take it for children

Prednisolone begins its therapeutic effect very quickly. It is used for different types of allergies (usually when the disease is severe), the form of the medication, the duration of the therapeutic course and dosage are selected by the allergist.

Treatment of allergies in children is usually complex: the complex of therapeutic measures also includes the drug Prednisolone.

Doctors try to prescribe the drug, starting with small doses. Doses are increased only in the absence of positive dynamics in the treatment of the disease.

The exception is severe conditions caused by allergies: in them the medicine is not given in the minimum, but immediately in the required dosage.

Pills

If a doctor prescribes Prednisolone for children with allergies, the dosage when using tablets is usually one to two milligrams of medication per kilogram of the child’s weight.

Your doctor will tell you how many times a day to take tablets. Sometimes you need to take the medicine 6 times a day. These are the starting doses.

Then they are gradually reduced, which is very important, since Prednisolone in any form cannot be stopped abruptly. The tablets are taken with or after meals.

The tablet form of the drug has a cumulative effect and is used for long therapeutic courses.

Injections

If injections are prescribed (deep into the buttock muscle), a single dose of Prednisolone in ampoules for a child is equal to one to two milligrams per kilogram of weight for children from two months to one year and two to three milligrams of prednisolone for children from one year to 14 years.

The drug can also be administered through an intravenous drip. If necessary, the prednisolone solution can be reintroduced after twenty-thirty minutes.

In this case, parents need to constantly monitor the child’s condition. If something worries you, you should immediately stop injecting and contact a specialist.

After the severe condition has resolved, the doctor will prescribe tablets with a gradual reduction in dose. Prednisolone in ampoules to relieve acute allergic symptoms in a child is used in situations where any delay is fraught with serious danger to the child’s health.

This form of the drug acts very quickly: after 15 minutes with an intramuscular injection and after 3-5 minutes when administered intravenously through a dropper.

Drops

If eye drops are prescribed to relieve swelling, the child usually puts one or two drops in each eye three times a day.

It is not recommended to use eye drops for children with allergies for more than a week.

Ointment

If Prednisolone ointment is prescribed, it is applied to the affected areas of the skin three times a day. The layer is usually thin.

For a small number of affected areas, the doctor will advise applying an occlusive dressing to obtain better effectiveness. The duration of the therapeutic course should be a maximum of three weeks.

In what cases should I take it?

In what cases is the drug Prednisolone remarkably effective:

• If the child has , prednisolone for children will bring the condition back to normal and eliminate acute allergic manifestations.
• If a child has it, the product will quickly relieve swelling and other allergic reactions.
• In the case of an acute, severe condition caused by an allergy (such as an asthma attack), prednisolone can literally save the child's life.

It is important for parents to remember that treatment with prednisone is carried out only under the strict supervision of a specialist.

Important to remember

1. The hormonal drug prednisolone is prescribed exclusively by an allergist for serious allergic symptoms, when the child cannot be cured with non-hormonal means.
2. The form of the medicine (tablets, solutions, ointments, drops, suspensions), dosage, and duration of the treatment course are prescribed by an allergist; using the hormonal medicine Prednisolone on your own is unacceptable for the treatment of childhood allergies.

See you in the next article!

GCS for oral use

Active substance

Prednisolone

Release form, composition and packaging

Pills white or almost white, flat-cylindrical, chamfered on both sides and engraved “P” on one side.

Excipients: colloidal silicon dioxide - 0.65 mg, potato starch - 1 mg, stearic acid - 1.2 mg, magnesium stearate - 1.5 mg, talc - 4.8 mg, - 10 mg, corn starch - 73 mg, lactose monohydrate - 102.85 mg.

100 pieces. - polypropylene bottles (1) - cardboard packs.

pharmachologic effect

GKS. Prednisolone is a synthetic glucocorticoid drug, a dehydrogenated analogue. It has anti-inflammatory, antiallergic, desensitizing, antishock, antitoxic and immunosuppressive effects.

Interacts with specific cytoplasmic receptors and forms a complex that penetrates the cell nucleus, stimulates the synthesis of matrix ribonucleic acid (mRNA); the latter induces the formation of proteins, incl. lipocortin, mediating cellular effects. Lipocortin inhibits phospholipase A2, suppresses the release of arachidonic acid and suppresses the synthesis of endoperoxides, prostaglandins, leukotrienes, which contribute to inflammation, allergies, etc.

Suppresses the release of ACTH by the pituitary gland and, secondarily, the synthesis of endogenous glucocorticoids. Inhibits the secretion of TSH and FSH.

Reduces the number of lymphocytes and eosinophils, increases the number of red blood cells (stimulates the production of erythropoietins).

Protein metabolism: reduces the amount of protein in (due to globulins) with an increase in the albumin/globulin ratio, increases the synthesis of albumins in the liver and kidneys; enhances protein catabolism in muscle tissue

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (fat accumulation mainly in the shoulder girdle, face, abdomen), leads to the development of hypercholesterolemia.

Carbohydrate metabolism: increases the absorption of carbohydrates from the gastrointestinal tract; increases the activity of glucose-6-phosphatase, leading to increased flow from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, leading to the activation of gluconeogenesis.

Water-electrolyte metabolism: retains sodium and water in the body, stimulates the excretion of potassium (mineralocorticoid activity), reduces the absorption of calcium from the gastrointestinal tract, “washes” calcium from the bones, and increases its excretion by the kidneys.

Anti-inflammatory effect associated with inhibition of the release of inflammatory mediators by eosinophils and mast cells, induction of the formation of lipocortin and a decrease in the number of mast cells producing hyaluronic acid; with a decrease in capillary permeability, stabilization of cell membranes and organelle membranes (especially lysosomal ones).

Antiallergic effect develops as a result of suppression of the synthesis and secretion of allergy mediators, inhibition of the release of histamine and other biologically active substances from sensitized mast cells and basophils, a decrease in the number of circulating basophils, suppression of the development of lymphoid and connective tissue, a decrease in the number of T- and B-lymphocytes, mast cells, a decrease sensitivity of effector cells to allergy mediators, inhibition of antibody formation, changes in the body's immune response.

In obstructive diseases of the respiratory tract, the action is based mainly on inhibition of inflammatory processes, inhibition of development or prevention of swelling of the mucous membranes, inhibition of eosinophilic infiltration of the submucosal layer of the bronchial epithelium and deposition of circulating immune complexes in the bronchial mucosa. Erosion and desquamation of the mucous membrane is inhibited. Prednisolone increases the sensitivity of β-adrenergic receptors of small and medium-sized bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by inhibiting or reducing its production.

Antishock and antitoxic effect is associated with an increase in blood pressure (due to an increase in the concentration of circulating catecholamines and restoration of the sensitivity of adrenergic receptors to them, as well as vasoconstriction), a decrease in the permeability of the vascular wall, membrane protective properties, and activation of liver enzymes involved in the metabolism of endo- and xenobiotics.

Immunosuppressive effect is caused by inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B cells and the interaction of T and B lymphocytes, inhibition of the release of cytokines (interleukin-1, interleukin-2; interferon gamma) from lymphocytes and macrophages and a decrease in the formation of antibodies.

Inhibits connective tissue reactions during the inflammatory process and reduces the possibility of scar tissue formation.

Pharmacokinetics

Suction and distribution

Absorption is high, Cmax in the blood after oral administration is achieved after 1-1.5 hours. In plasma, up to 90% of prednisolone is bound to proteins: transcortin (cortisol-binding globulin) and albumin.

Metabolism and excretion

Metabolized in the liver, kidneys, small intestine, bronchi. Oxidized forms are glucuronidated or sulfated. Metabolites are inactive. T 1/2 - 2-4 hours. Excreted through the intestines and kidneys by glomerular filtration and is 80-90% reabsorbed by the tubules. 20% is excreted unchanged by the kidneys.

Indications

Endocrine disorders:

• primary and secondary adrenal insufficiency (including the condition after removal of the adrenal glands);
• congenital adrenal hyperplasia;
• subacute thyroiditis;
• hypoglycemic conditions.

Systemic connective tissue diseases:

• rheumatoid arthritis;
• systemic lupus erythematosus;
• dermatomyositis;
• scleroderma;
• periarteritis nodosa.

Acute rheumatism, acute carditis, minor chorea.

Acute and chronic inflammatory diseases of the joints:

• glenohumeral periarthritis;
• ankylosing spondylitis (ankylosing spondylitis);
• gouty and psoriatic arthritis;
• osteoarthritis (including post-traumatic);
• polyarthritis;
• juvenile arthritis;
• Still's syndrome in adults;
• bursitis;
• nonspecific tenosynovitis;
• synovitis;
• epicondylitis.

Acute and chronic allergic diseases:

• allergic reactions to medications and foods;
• drug exanthema;
• serum sickness;
• hives;
• hay fever;
• angioedema;
• allergic rhinitis.

Bronchial asthma, status asthmaticus.

Diseases of the blood and hematopoietic system:

• autoimmune hemolytic anemia;
• acute lympho- and myeloid leukemia;
• lymphogranulomatosis,
• thrombocytopenic purpura;
• agranulocytosis;
• panmyelopathy;
• secondary thrombocytopenia in adults;
• erythroblastopenia (erythrocyte anemia);
• congenital (erythroid) hypoplastic anemia.

Skin diseases:

• pemphigus;
• eczema;
• psoriasis;
• exfoliative dermatitis;
• atopic dermatitis;
• diffuse neurodermatitis;
• contact dermatitis (affecting a large surface of the skin);
• toxicoderma;
• seborrheic dermatitis;
• toxic epidermal necrolysis (Lyell's syndrome);
• bullous dermatitis herpetiformis;
• malignant exudative erythema (Stevens-Johnson syndrome).

Allergic and inflammatory eye diseases:

• allergic corneal ulcers;
• allergic forms of conjunctivitis;
• sympathetic ophthalmia;
• severe sluggish anterior and posterior uveitis;
• Optic neuritis.

Gastrointestinal diseases:

• ulcerative colitis, Crohn's disease;
• hepatitis;
• local enteritis.

Lung cancer (in combination with cytostatic drugs).

Multiple myeloma.

Lung diseases:

• acute alveolitis;
• pulmonary fibrosis;
• sarcoidosis stage II-III.

Kidney diseases of autoimmune origin (including acute glomerulonephritis); nephrotic syndrome.

Tuberculous meningitis, pulmonary tuberculosis.

Aspiration pneumonia (in combination with specific chemotherapy).

Berylliosis, Loeffler's syndrome (not amenable to other therapy).

Multiple sclerosis.

Brain edema (including due to a brain tumor or associated with surgery, radiation therapy or head trauma) after prior parenteral use.

Prevention of graft rejection during organ transplantation.

Hypercalcemia due to cancer.

Nausea and vomiting during cytostatic therapy.

Contraindications

The only contraindication for short-term use for health reasons is hypersensitivity to prednisolone or the components of the drug.

In children during the growth period, GCS should be used only according to absolute indications and under especially careful supervision of the attending physician.

Carefully

Immunodeficiency conditions (including AIDS or HIV infection).

Gastrointestinal diseases: gastric and duodenal ulcers, esophagitis, gastritis, acute or latent peptic ulcers, newly formed intestinal anastomosis, ulcerative colitis with the threat of perforation or abscess formation, diverticulitis.

Diseases of the cardiovascular system, incl. recent myocardial infarction (in patients with acute and subacute myocardial infarction, the necrosis focus may spread, the formation of scar tissue may slow down and, as a result, the heart muscle will rupture), decompensated chronic heart failure, arterial hypertension, hyperlipidemia.

Endocrine diseases: diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease, obesity (III-IV degrees).

Severe chronic renal and/or liver failure, nephrourolithiasis.

Hypoalbuminemia and conditions predisposing to its occurrence.

Systemic osteoporosis, myasthenia gravis, acute psychosis, poliomyelitis (except for the form of bulbar encephalitis), open- and closed-angle glaucoma.

Dosage

The dose and duration of treatment are selected by the doctor individually, depending on the indications and severity of the disease.

Usually the daily dose is taken once or a double dose is taken every other day, in the morning, between 6 and 8 am.

A high daily dose can be divided into 2-4 doses, with a larger dose taken in the morning.

The tablets should be taken during or immediately after meals with a small amount of liquid.

At acute conditions and as replacement therapy adults prescribed at an initial dose of 20-30 mg/day, the maintenance dose is 5-10 mg/day. For some diseases (nephrotic syndrome, some rheumatic diseases) higher doses are prescribed. Treatment is stopped slowly, gradually reducing the dose. If there is a history of psychosis, high doses are prescribed under the strict supervision of a physician.

Doses for children: initial dose - 1-2 mg/kg/day in 4-6 doses, maintenance dose - 0.3-0. 6 mg/kg/day.

When prescribing, the daily secretory rhythm of glucocorticoids should be taken into account: most (or all) of the dose is prescribed in the morning.

Side effects

The incidence and severity of side effects depend on the duration of use, the size of the dose used and the ability to comply with the circadian rhythm of prednisolone administration.

From the endocrine system: suppression of adrenal function, decreased glucose tolerance, “steroidal” diabetes mellitus or manifestation of latent diabetes mellitus, Itsenko-Cushing syndrome (moon-shaped face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, striae), growth retardation and delayed sexual development in children.

From the digestive system: oral candidiasis, nausea, vomiting, pancreatitis, “steroid” gastric and duodenal ulcers, erosive esophagitis, bleeding and perforation of the gastrointestinal tract, increased or decreased appetite, flatulence, hiccups. In rare cases, increased activity of liver transaminases and alkaline phosphatase.

From the cardiovascular system: increased blood pressure, arrhythmias, bradycardia; development (in predisposed patients) or increased severity of chronic heart failure, ECG changes characteristic of hypokalemia, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing down the formation of scar tissue, which can lead to rupture of the heart muscle.

From the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions.

From the senses: posterior subcapsular cataract, increased intraocular pressure with possible damage to the optic nerve, a tendency to develop secondary bacterial, fungal or viral eye infections, trophic changes in the cornea, exophthalmos.

From the side of metabolism: hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating.

Adverse reactions due to mineralocorticoid activity: fluid and sodium retention (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, weakness and fatigue).

From the musculoskeletal system: slower growth and ossification processes in children (premature closure of epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, aseptic necrosis of the head of the humerus and femur), rupture of muscle tendons, “steroid” myopathy, decreased muscle mass (atrophy).

From the skin and mucous membranes: delayed wound healing, petechiae, ecchymoses, skin thinning, hyper- or hypopigmentation, acne, stretch marks, tendency to develop pyoderma and candidiasis.

From the urinary system: frequent night urination, urolithiasis due to increased excretion of calcium and phosphate.

From the immune system: generalized (skin rash, skin itching, anaphylactic shock) and local allergic reactions.

Others: development or exacerbation of infections (the appearance of this side effect is facilitated by jointly used immunosuppressants and vaccination), leukocyturia.

Overdose

In case of overdose and adverse reactions occur, it is necessary to reduce the dose of prednisolone. There is no specific antidote, treatment is symptomatic. Monitoring of electrolyte levels in the blood is necessary.

Drug interactions

Phenobarbital, phenytoin, rifampicin, ephedrine, aminoglutethimide, aminophenazone (inducers of microsomal liver enzymes) reduce the therapeutic effect of glucocorticoid hormones.

Dose may need to be increased insulin and oral hypoglycemic drugs due to weakening of the hypoglycemic effect.

It is possible to both enhance and weaken the anticoagulant effect when taking indirect anticoagulants(dose adjustment required).

Anticoagulants and thrombolytics- the risk of bleeding from ulcers in the gastrointestinal tract increases.

Simultaneous administration androgens and anabolic steroid drugs with prednisolone promotes the development of peripheral edema and hirsutism, the appearance of acne.

Mitotane and other inhibitors of adrenal function may necessitate an increase in the dose of prednisolone.

live antiviral vaccines and against the background of other types of immunization, increases the risk of viral activation and the development of infections.

Immunosuppressants increase the risk of developing infections and lymphoma or other lymphoproliferative disorders associated with the Epstein-Barr virus.

Antipsychotics (neuroleptics) and azathioprine increase the risk of developing cataracts when prescribing prednisolone.

Simultaneous administration antacids reduces the absorption of prednisolone.

When used simultaneously with antithyroid drugs decreases, and with thyroid hormones- the clearance of prednisolone increases.

special instructions

Before starting treatment, the patient should be examined to identify possible contraindications. Clinical examination should include examination of the cardiovascular system, x-ray examination of the lungs, examination of the stomach and duodenum; urinary system, organ of vision. Before and during steroid therapy, it is necessary to monitor a general blood count, the concentration of glucose in the blood and urine, and electrolytes in the plasma.

During treatment with GCS, especially in high doses, vaccination is not recommended due to a decrease in its effectiveness.

Medium and high doses of GCS can cause an increase in blood pressure.

For tuberculosis, the drug can only be prescribed in conjunction with anti-tuberculosis drugs.

For intercurrent infections and septic conditions, simultaneous antibiotic therapy is necessary.

During long-term treatment with GCS, potassium should be prescribed to avoid hypokalemia.

In Addison's disease, the drug should not be taken simultaneously with barbiturates due to the risk of developing acute adrenal insufficiency (Addisonian crisis).

GCS may cause growth retardation in children and adolescents. Prescribing the drug every other day usually avoids or minimizes the likelihood of such a side effect.

In elderly patients, the frequency of adverse reactions increases.

With sudden withdrawal, especially in the case of high doses, GCS “withdrawal” syndrome occurs: decreased appetite, nausea, lethargy, generalized musculoskeletal pain, asthenia.

The likelihood of adrenal insufficiency as a result of taking the drug and associated complications can be reduced by gradually withdrawing the drug. After discontinuation of the drug, adrenal insufficiency can last for months, so in case of any stressful situation, hormonal therapy should be resumed during this period.

In hypothyroidism and liver cirrhosis, the effect of GCS may be enhanced.

Patients should be warned in advance that they and their loved ones should avoid contact with patients with chickenpox, measles, and herpes. In cases where systemic treatment with GCS is carried out or treatment with GCS was carried out in the next 3 months, and the patient was not vaccinated, specific immunoglobulins should be prescribed.

Treatment of GCS requires medical supervision for diabetes mellitus (including a family history), osteoporosis (the risk is higher during postmenopause), arterial hypertension, chronic psychotic reactions (GCS can cause mental disorders and increase emotional instability), a history of tuberculosis, glaucoma, steroid myopathy, gastric and duodenal ulcers, epilepsy, herpes simplex of the eye (danger of corneal perforation).

Due to the weak mineralocorticoid effect, prednisolone is used with mineralocorticoids for replacement therapy for adrenal insufficiency.

In patients with diabetes mellitus, blood glucose levels should be monitored and therapy adjusted if necessary.

Impact on the ability to drive vehicles and machinery

A similar effect of the drug is unknown.

Pregnancy and lactation

During pregnancy, the use of prednisolone is possible if the expected benefit to the mother outweighs the potential risk to the fetus.
In the first trimester of pregnancy, prednisolone is used only for health reasons.

With long-term therapy during pregnancy, the possibility of impaired fetal growth cannot be excluded. If used in the third trimester of pregnancy, there is a risk of atrophy of the adrenal cortex in the fetus, which may require replacement therapy in the newborn.

Since corticosteroids pass into breast milk, if it is necessary to use the drug during breastfeeding, it is recommended to stop breastfeeding.

Use in childhood

Treatment of children with GCS during the growth period is possible only according to absolute indications and with careful supervision of the attending physician.

Children with bronchial asthma are contraindicated in the use of prednisolone simultaneously with sympathomimetic aerosols.

Children receiving Prednisolone therapy and who have been in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

For impaired renal function

Use with caution in severe renal failure.