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endocrine:drugs:prednisone [2026/02/12 19:53] – created andrew2393cnsendocrine:drugs:prednisone [2026/02/12 20:03] (current) – andrew2393cns
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-====== Prednisone ======+====== Prednisolone ======
  
 ===== Classification ===== ===== Classification =====
-  * Systemic Glucocorticoid +  * Intermediate-acting glucocorticoid 
-  * Synthetic corticosteroid+  * Active form of prednisone
  
 Parent class: Parent class:
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 ---- ----
  
-===== Mechanism of Action =====+===== Key Point ===== 
 +Prednisolone is the active metabolite of [[endocrine:drugs:prednisone|Prednisone]].
  
-Prednisone is converted in the liver to its active form, prednisolone. +Preferred in severe hepatic impairment.
- +
-It: +
- +
-  * Binds intracellular glucocorticoid receptors +
-  * Alters gene transcription +
-  * ↓ Pro-inflammatory cytokines (IL-1, IL-2, IL-4, IL-5, IL-6, TNF-α) +
-  * ↓ Eosinophils +
-  * ↓ T-cell activation +
-  * ↓ Prostaglandins and leukotrienes (via phospholipase A2 suppression) +
- +
-Full signaling pathway: +
-  * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling]] +
- +
-Net effect: +
-  Broad anti-inflammatory and immunosuppressive activity.+
  
 ---- ----
  
-===== Pharmacokinetics ===== +===== Clinical Uses ===== 
- +Same as prednisone: 
-  * Oral administration +  * [[respiratory:clinical:asthma|Asthma]] 
-  * Prodrug (converted to prednisolone in liver) +  * Autoimmune disorders 
-  * Hepatic metabolism +  * Severe inflammatory disease
-  * Renal excretion of metabolites +
-  * Duration: intermediate acting +
- +
-Caution in severe hepatic impairment (may require prednisolone instead). +
- +
----- +
- +
-===== Indications ===== +
- +
-Used across many inflammatory conditions: +
- +
-  * [[respiratory:clinical:asthma|Asthma]] (exacerbations) +
-  * [[allergy:clinical:urticaria_angioedema|Urticaria]] +
-  * [[allergy:clinical:anaphylaxis|Anaphylaxis]] (adjunct) +
-  * [[rheumatology:clinical:rheumatoid_arthritis|Rheumatoid Arthritis]] +
-  * [[gastroenterology:clinical:ibd|Inflammatory Bowel Disease]] +
-  * Autoimmune diseases +
-  * Transplant rejection +
- +
-Not first-line for acute bronchospasm (no immediate bronchodilation). +
- +
----- +
- +
-===== Dosing ===== +
- +
-Highly condition-specific. +
- +
-Examples: +
- +
-  * Asthma exacerbation: 40–60 mg daily (short course) +
-  * Autoimmune disease: variable dosing +
-  * Physiologic replacement: lower dosing +
- +
-Morning dosing preferred to mimic natural cortisol rhythm. +
- +
----- +
- +
-===== Adverse Effects ===== +
- +
-==== Short-Term Use ==== +
- +
-  * Hyperglycemia +
-  * Mood changes +
-  * Insomnia +
-  * Fluid retention +
-  * Increased appetite +
- +
-==== Long-Term Use ==== +
- +
-  * HPA axis suppression +
-  * Osteoporosis +
-  * Cushingoid appearance +
-  * Muscle wasting +
-  * Increased infection risk +
-  * Hypertension +
-  * Peptic ulcer disease +
-  * Cataracts +
- +
-Mechanism: +
-  Systemic glucocorticoid effects on metabolism and immune function. +
- +
----- +
- +
-===== HPA Axis Suppression ===== +
- +
-Chronic prednisone suppresses ACTH production. +
- +
-Abrupt discontinuation may cause: +
- +
-  * Adrenal insufficiency +
-  * Hypotension +
-  * Fatigue +
-  * Adrenal crisis (severe cases) +
- +
-Taper required if: +
- +
-  * Used >2–3 weeks +
-  * Moderate/high doses +
-  * Cushingoid features present +
- +
-See: +
-  * [[endocrine:physiology:hpa_axis|HPA Axis Physiology]] +
- +
----- +
- +
-===== Drug Interactions ===== +
- +
-  * NSAIDs → ↑ GI bleeding risk +
-  * CYP3A4 inducers ↓ steroid levels +
-  * CYP3A4 inhibitors ↑ steroid levels +
-  * Live vaccines contraindicated in high-dose therapy+
  
 ---- ----
  
 ===== Clinical Pearls ===== ===== Clinical Pearls =====
- +  * Does not require hepatic activation. 
-  * Prednisone is a prodrug; prednisolone is active form. +  * Otherwise similar to prednisone.
-  * Morning dosing reduces adrenal suppression. +
-  * Short “burst” courses typically do not require taper. +
-  * Long-term therapy requires bone protection. +
-  * Treat inflammation — not immediate bronchospasm. +
- +
----- +
- +
-===== Steroid Potency Comparison ===== +
- +
-Prednisone has: +
- +
-  * Moderate glucocorticoid potency +
-  * Low mineralocorticoid activity +
- +
-Compare: +
-  * [[endocrine:drugs:dexamethasone|Dexamethasone]] (higher potency, no mineralocorticoid effect) +
-  * [[endocrine:drugs:hydrocortisone|Hydrocortisone]] (lower potency, more mineralocorticoid effect) +
- +
----- +
- +
-===== Related Pages ===== +
- +
-  * [[endocrine:drug_classes:corticosteroids|Corticosteroids]] +
-  * [[endocrine:physiology:glucocorticoid_signaling|Glucocorticoid Signaling]] +
-  * [[respiratory:clinical:asthma|Asthma]]+
endocrine/drugs/prednisone.txt · Last modified: by andrew2393cns