prednisone

Prednisone is used for many different autoimmune diseases and inflammatory conditions, including asthma, gout, COPD, CIDP, rheumatic disorders, allergic disorders, ulcerative colitis and Crohn's disease, granulomatosis with polyangiitis, adrenocortical insufficiency, hypercalcemia due to cancer, thyroiditis, laryngitis, severe tuberculosis, hives, eczema, lipid pneumonitis, pericarditis, multiple sclerosis, nephrotic syndrome, sarcoidosis, to relieve the effects of shingles, lupus, myasthenia gravis, poison oak exposure, Ménière's disease, autoimmune hepatitis, giant cell arteritis, the Herxheimer reaction that is common during the treatment of syphilis, Duchenne muscular dystrophy, uveitis, and as part of a drug regimen to prevent rejection after organ transplant.{{EMedicine|article|172356|Autoimmune Hepatitis|treatment}}{{cite book | chapter=Corticosteroids | date=30 May 2014 | pmid=31643719 | chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK548400/ | title=LiverTox: Clinical and Research Information on Drug-Induced Liver Injury | url=https://www.ncbi.nlm.nih.gov/books/NBK547852/ | access-date=19 March 2020 | id=NBK548400 }}

Prednisone has also been used in the treatment of migraine headaches and cluster headaches and for severe aphthous ulcer.{{cite book | vauthors = Wackym PA, Snow JB |title=Ballenger's Otorhinolaryngology: Head and Neck Surgery |date=2017 |publisher=PMPH USA |isbn=9781607951773 |page=1185 |url=https://books.google.com/books?id=CFwrAwAAQBAJ&pg=PA1185 }} Prednisone is used as an antitumor drug.{{cite web | publisher = U.S. National Library of Medicine | work = Medical Subject Headings. | url = https://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?mode=&term=Antineoplastic+Agents,+Hormonal | title = Antineoplastic Agents, Hormonal | date = 2009 | access-date = 11 November 2010 }}

Prednisone is often also prescribed as a form of treatment for sudden sensorineural hearing loss (SSNHL).{{Cite web |date=22 May 2015 |title=Steroid Treatments Equally Effective Against Sudden Deafness |url=https://www.nih.gov/news-events/nih-research-matters/steroid-treatments-equally-effective-against-sudden-deafness |access-date=9 May 2022 |website=National Institutes of Health (NIH) |language=EN}}

Prednisone can be used in the treatment of decompensated heart failure to increase renal responsiveness to diuretics, especially in heart failure patients with refractory diuretic resistance with large doses of loop diuretics.{{cite journal | vauthors = Riemer AD | title = Application of the newer corticosteroids to augment diuresis in congestive heart failure | journal = The American Journal of Cardiology | volume = 1 | issue = 4 | pages = 488–496 | date = April 1958 | pmid = 13520608 | doi = 10.1016/0002-9149(58)90120-6 }}{{cite journal | vauthors = Newman DA | title = Reversal of intractable cardiac edema with prednisone | journal = New York State Journal of Medicine | volume = 59 | issue = 4 | pages = 625–633 | date = February 1959 | pmid = 13632954 }}{{cite journal | vauthors = Zhang H, Liu C, Ji Z, Liu G, Zhao Q, Ao YG, Wang L, Deng B, Zhen Y, Tian L, Ji L, Liu K | title = Prednisone adding to usual care treatment for refractory decompensated congestive heart failure | journal = International Heart Journal | volume = 49 | issue = 5 | pages = 587–595 | date = September 2008 | pmid = 18971570 | doi = 10.1536/ihj.49.587 | doi-access = free }}{{cite journal | vauthors = Liu C, Liu G, Zhou C, Ji Z, Zhen Y, Liu K | title = Potent diuretic effects of prednisone in heart failure patients with refractory diuretic resistance | journal = The Canadian Journal of Cardiology | volume = 23 | issue = 11 | pages = 865–868 | date = September 2007 | pmid = 17876376 | pmc = 2651362 | doi = 10.1016/s0828-282x(07)70840-1 }}{{cite journal | vauthors = Liu C, Chen H, Zhou C, Ji Z, Liu G, Gao Y, Tian L, Yao L, Zheng Y, Zhao Q, Liu K | title = Potent potentiating diuretic effects of prednisone in congestive heart failure | journal = Journal of Cardiovascular Pharmacology | volume = 48 | issue = 4 | pages = 173–176 | date = October 2006 | pmid = 17086096 | doi = 10.1097/01.fjc.0000245242.57088.5b | s2cid = 45800521 | doi-access = free }}{{cite journal | vauthors = Massari F, Mastropasqua F, Iacoviello M, Nuzzolese V, Torres D, Parrinello G | title = The glucocorticoid in acute decompensated heart failure: Dr Jekyll or Mr Hyde? | journal = The American Journal of Emergency Medicine | volume = 30 | issue = 3 | pages = 517.e5–517.10 | date = March 2012 | pmid = 21406321 | doi = 10.1016/j.ajem.2011.01.023 }} In terms of the mechanism of action for this purpose: prednisone, a glucocorticoid, can improve renal responsiveness to atrial natriuretic peptide by increasing the density of natriuretic peptide receptor type A in the renal inner medullary collecting duct, thereby inducing a potent diuresis.{{cite journal | vauthors = Liu C, Chen Y, Kang Y, Ni Z, Xiu H, Guan J, Liu K | title = Glucocorticoids improve renal responsiveness to atrial natriuretic peptide by up-regulating natriuretic peptide receptor-A expression in the renal inner medullary collecting duct in decompensated heart failure | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 339 | issue = 1 | pages = 203–209 | date = October 2011 | pmid = 21737535 | doi = 10.1124/jpet.111.184796 | s2cid = 1892149 }}

At high doses, it may be used to prevent rejection following an organ transplant.

File:Periportal hepatosteatosis intermed mag.jpg of fatty liver, as may be seen due to long-term prednisone use. Trichrome stain.]]

Short-term side effects, as with all glucocorticoids, include high blood glucose levels (especially in patients with diabetes mellitus or on other medications that increase blood glucose, such as tacrolimus) and mineralocorticoid effects such as fluid retention.{{Cite news|url=http://www.mayoclinic.org/steroids/art-20045692?pg=2|title=Prednisone and other corticosteroids: Balance the risks and benefits |publisher=Mayo Clinic|access-date=7 April 2017}} The mineralocorticoid effects of prednisone are minor, which is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly.

It can also cause depression or depressive symptoms and anxiety in some individuals.{{cite web | url = https://www.drugs.com/prednisone.html | title = Prednisone Information | work = Drugs.com }}{{cite web | url = https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601102.html#side-effects | title = Prednisone | work = MedlinePlus Drug Information }}

Long-term side effects include Cushing's syndrome, steroid dementia syndrome,{{cite journal | vauthors = Wolkowitz OM, Lupien SJ, Bigler ED | title = The "steroid dementia syndrome": a possible model of human glucocorticoid neurotoxicity | journal = Neurocase | volume = 13 | issue = 3 | pages = 189–200 | date = June 2007 | pmid = 17786779 | doi = 10.1080/13554790701475468 | s2cid = 39340010 }} truncal weight gain, glaucoma and cataracts, diabetes mellitus type 2, and depression upon dose reduction or cessation.{{Cite news |url= https://www.betterhealth.vic.gov.au/health/healthyliving/steroids |title=Steroids | date = April 2016 | publisher = Australian Department of Health & Human Services |access-date=14 June 2018 }} Long-term steroids can also increase the risk of osteoporosis, but research has found that few of these people were taking medications to protect bones.{{Cite journal |date=21 June 2022 |title=Polymyalgia rheumatica: treatment reviews are needed |url=https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/ |access-date=5 August 2022 |website=NIHR Evidence |doi=10.3310/nihrevidence_51304 |s2cid=251774691 |language=en-GB|url-access=subscription }}{{cite journal | vauthors = Sokhal BS, Hider SL, Paskins Z, Mallen CD, Muller S | title = Fragility fractures and prescriptions of medications for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study | journal = Rheumatology Advances in Practice | volume = 5 | issue = 3 | pages = rkab094 | date = 2021 | pmid = 34988356 | pmc = 8712242 | doi = 10.1093/rap/rkab094 }} Prednisone also results in leukocytosis.{{cite book | vauthors = Miller NR, Walsh FB, Hoyt WF |title=Walsh and Hoyt's Clinical Neuro-ophthalmology |date=2005 |publisher=Lippincott Williams & Wilkins |isbn=9780781748117 |page=1062 |url=https://books.google.com/books?id=9RA2ZOPRuhgC&pg=PA1062 }}

Source:

{{div col}}

• Steroid myopathy
• Increased blood sugar for individuals with diabetes
• Difficulty in regulating emotion
• Difficulty in maintaining linear thinking
• Weight gain due to increased appetite
• Immunosuppression
• Corticosteroid-induced lipodystrophy (moon face, central obesity)
• Depression, mania, psychosis, or other psychiatric symptoms
• Unusual fatigue or weakness
• Mental confusion
• Memory and attention dysfunction (steroid dementia syndrome)
• Muscle atrophy{{cite journal | vauthors = Schakman O, Gilson H, Kalista S, Thissen JP | title = Mechanisms of muscle atrophy induced by glucocorticoids | journal = Hormone Research | volume = 72 | issue = Suppl 1 | pages = 36–41 | date = November 2009 | pmid = 19940494 | doi = 10.1159/000229762 | doi-broken-date = 9 December 2024 | s2cid = 21997662 }}
• Blurred vision
• Abdominal pain
• Peptic ulcer
• Painful hips or shoulders
• Steroid-induced osteoporosis
• Stretch marks
• Osteonecrosis – same as avascular necrosis
• Insomnia
• Severe joint pain
• Cataracts or glaucoma
• Anxiety
• Black stool
• Stomach pain or bloating
• Severe swelling
• Mouth sores or dry mouth
• Avascular necrosis
• Hepatic steatosis
• Hiccups and burping
• Weakening and breakage of tendons

{{div col end}}

Source:

{{div col|colwidth=15em}}

• Nervousness
• Acne
• Skin rash
• Appetite gain
• Hyperactivity
• Increased thirst
• Frequent urination
• Diarrhea
• Reduced intestinal flora
• Leg pain/cramps
• Sensitive teeth
• Headache
• Induced vomiting

{{div col end}}

Adrenal suppression will begin to occur if prednisone is taken for longer than seven days. Eventually, this may cause the body to temporarily lose the ability to manufacture natural corticosteroids (especially cortisol), which results in dependence on prednisone. For this reason, prednisone should not be abruptly stopped if taken for more than seven days; instead, the dosage should be gradually reduced. This weaning process may be over a few days if the course of prednisone is short but may take weeks or months{{Cite news |url=https://www.medicinenet.com/steroid_withdrawal/article.htm |title=Steroid Drug Withdrawal Symptoms, Treatment & Prognosis |work=MedicineNet |access-date=14 June 2018 }} if the patient had been on long-term treatment. Abrupt withdrawal may lead to an Addisonian crisis. For those on chronic therapy, alternate-day dosing may preserve adrenal function and thereby reduce side effects.{{cite web |url=http://www.uspharmacist.com/NewLook/CE/glucocort/lesson.htm |title=Therapeutic and Adverse Effects of Glucocorticoids | vauthors = Bello CS, Garrett SD |work=U.S. Pharmacist Continuing Education Program |archive-url=https://web.archive.org/web/20080711145809/http://www.uspharmacist.com/NewLook/CE/glucocort/lesson.htm |archive-date=11 July 2008}}

Glucocorticoids act to inhibit feedback of both the hypothalamus, decreasing corticotropin-releasing hormone (CRH), and corticotrophs in the anterior pituitary gland, decreasing the amount of adrenocorticotropic hormone (ACTH). For this reason, glucocorticoid analogue drugs such as prednisone down-regulate the natural synthesis of glucocorticoids. This mechanism leads to dependence in a short time and can be dangerous if medications are withdrawn too quickly. The body must have time to begin synthesis of CRH and ACTH and for the adrenal glands to begin functioning normally again.

Prednisone may start to result in the suppression of the hypothalamic–pituitary–adrenal (HPA) axis if used at doses 7–10 mg or higher for several weeks. This is approximately equal to the amount of endogenous cortisol produced by the body every day. As such, the HPA axis starts to become suppressed and atrophy. If this occurs the patient should be tapered off prednisone slowly to give the adrenal gland enough time to regain its function and endogenous production of steroids.

The magnitude and speed of dose reduction in corticosteroid withdrawal should be determined on a case-by-case basis, taking into consideration the underlying condition being treated, and individual patient factors such as the likelihood of relapse and the duration of corticosteroid treatment. Gradual withdrawal of systemic corticosteroids should be considered in those whose disease is unlikely to relapse and have:

• received more than 40 mg prednisone (or equivalent) daily for more than one week
• been given repeat doses in the evening
• received more than three weeks of treatment
• recently received repeated courses (particularly if taken for longer than three weeks)
• taken a short course within one year of stopping long-term therapy
• other possible causes of adrenal suppression

Systemic corticosteroids may be stopped abruptly in those whose disease is unlikely to relapse who have received treatment for three weeks or less and who are not included in the patient groups described above.

During corticosteroid withdrawal, the dose may be reduced rapidly down to physiological doses (equivalent to prednisolone 7.5 mg daily) and then reduced more slowly. Assessment of the disease may be needed during withdrawal to ensure that relapse does not occur.{{Cite journal | vauthors = Iliopoulou A, Abbas A, Murray R |date=19 May 2013 |title=How to manage withdrawal of glucocorticoid therapy |journal=Prescriber |volume=24 |issue=10 |pages=23–29 |doi=10.1002/psb.1060|s2cid=72082017 }}

{{see also|Glucocorticoid#Pharmacology}}

Prednisone is a synthetic glucocorticoid used for its anti-inflammatory and immunosuppressive properties.{{cite journal | vauthors = Becker DE | title = Basic and clinical pharmacology of glucocorticosteroids | journal = Anesthesia Progress | volume = 60 | issue = 1 | pages = 25–31; quiz 32 | date =Spring 2013 | pmid = 23506281 | pmc = 3601727 | doi = 10.2344/0003-3006-60.1.25 }}{{cite web |title=Prednisone |url=https://www.drugbank.ca/drugs/DB00635 |website=DrugBank |access-date=29 January 2019}} Prednisone is a prodrug; it is metabolised in the liver by 11-β-HSD to prednisolone, the active drug. Prednisone has no substantial biological effects until converted via hepatic metabolism to prednisolone.{{Cite web |url=https://medlineplus.gov/druginfo/meds/a601102.html |title=Prednisone |work=MedlinePlus |publisher=NIH U.S. National Library of Medicine}}

Prednisone is absorbed in the gastrointestinal tract and has a half-life of 2–3 hours. it has a volume of distribution of 0.4–1 L/kg.{{cite journal | vauthors = Schijvens AM, Ter Heine R, de Wildt SN, Schreuder MF | title = Pharmacology and pharmacogenetics of prednisone and prednisolone in patients with nephrotic syndrome | journal = Pediatric Nephrology | volume = 34 | issue = 3 | pages = 389–403 | date = March 2019 | pmid = 29549463 | pmc = 6349812 | doi = 10.1007/s00467-018-3929-z | doi-access = free }} The drug is cleared by hepatic metabolism using cytochrome P450 enzymes. Metabolites are excreted in the bile and urine.

"Lodotra" is the brand name of an oral formulation, which releases prednisone four hours after ingestion. It is indicated for rheumatoid arthritis with morning stiffness. Taken at 10 p.m., it releases the drug at around 2 a.m. The plasmic peak level is reached at 4 a.m., which is considered to be the optimal time for relieving morning stiffness. The drug was approved in the European Union, in January 2009.{{cite web|url=http://www.nelm.nhs.uk/en/NeLM-Area/News/2009---January/08/Delayed-release-prednisone-Lodotra-approved-in-EU-for-treatment-of-rheumatoid-arthritis/|title=Delayed-release prednisone (Lodotra™) approved in EU for treatment of rheumatoid arthritis|vauthors=Wan Y|date=8 January 2009|access-date=22 November 2009|archive-date=9 July 2009|archive-url=https://web.archive.org/web/20090709195015/http://www.nelm.nhs.uk/en/NeLM-Area/News/2009---January/08/Delayed-release-prednisone-Lodotra-approved-in-EU-for-treatment-of-rheumatoid-arthritis/|url-status=dead}}{{cite journal | vauthors = Buttgereit F, Doering G, Schaeffler A, Witte S, Sierakowski S, Gromnica-Ihle E, Jeka S, Krueger K, Szechinski J, Alten R | title = Efficacy of modified-release versus standard prednisone to reduce duration of morning stiffness of the joints in rheumatoid arthritis (CAPRA-1): a double-blind, randomised controlled trial | journal = Lancet | volume = 371 | issue = 9608 | pages = 205–214 | date = January 2008 | pmid = 18207016 | doi = 10.1016/S0140-6736(08)60132-4 | s2cid = 6197980 }}

File:006035339lg Prednisone 20 MG Oral Tablet.jpg

The pharmaceutical industry uses prednisone tablets for the calibration of dissolution testing equipment according to the United States Pharmacopeia (USP).

Prednisone is a synthetic pregnane corticosteroid and derivative of cortisone and is also known as δ¹-cortisone or 1,2-dehydrocortisone or as 17α,21-dihydroxypregna-1,4-diene-3,11,20-trione.{{cite book| vauthors = Elks J |title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA1013|date=14 November 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=1013–}}{{cite book|title=Index Nominum 2000: International Drug Directory|url=https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA871|date=January 2000|publisher=Taylor & Francis|isbn=978-3-88763-075-1|pages=871–}}

The first isolation and structure identifications of prednisone and prednisolone were done in 1950 by Arthur Nobile.{{cite journal | vauthors = Wainwright M | title = The secret of success: Arthur Nobile's discovery of the steroids prednisone and prednisolone in the 1950s revolutionised the treatment of arthritis | journal = Chemistry in Britain | volume = 34 | issue = 1 | date = 1998 | pages = 46 | oclc = 106716069 }}{{cite web| title = Inventor Profile: Arthur Nobile |work = National Inventors Hall of Fame|url= http://www.invent.org/hall_of_fame/355.html |url-status=dead |archive-url= https://web.archive.org/web/20120612062323/http://www.invent.org/hall_of_fame/355.html |archive-date=12 June 2012}}{{cite web | title = Arthur Nobile | work=New Jersey Inventors Hall of Fame |url= http://www.stevens.edu/njinvent/2000/inductees_2000/nobile.html |url-status=dead |archive-url=https://web.archive.org/web/20110901232600/http://www.stevens.edu/njinvent/2000/inductees_2000/nobile.html | archive-date = 1 September 2011}} The first commercially feasible synthesis of prednisone was carried out in 1955 in the laboratories of Schering Corporation, which later became Schering-Plough Corporation, by Arthur Nobile and coworkers.{{cite book | title = Merck Index | edition = 14th | page = 1327 | date = 2006 | publisher = Merck & Co. Inc | isbn = 978-0-911910-00-1 }} They discovered that cortisone could be microbiologically oxidized to prednisone by the bacterium Corynebacterium simplex. The same process was used to prepare prednisolone from hydrocortisone.{{cite journal | vauthors = Herzog HL, Nobile A, Tolksdorf S, Charney W, Hershberg EB, Perlman PL | title = New antiarthritic steroids | journal = Science | volume = 121 | issue = 3136 | pages = 176 | date = February 1955 | pmid = 13225767 | doi = 10.1126/science.121.3136.176 | bibcode = 1955Sci...121..176H }}

The enhanced adrenocorticoid activity of these compounds over cortisone and hydrocortisone was demonstrated in mice.

Prednisone and prednisolone were introduced in 1955 by Schering and Upjohn, under the brand names Meticorten{{cite web | title = Meticorten: FDA-Approved Drugs | work = U.S. Food and Drug Administration (FDA) | url = https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=009766 | archive-url = https://web.archive.org/web/20170430051138/https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=009766 | url-status = dead | archive-date = 30 April 2017 }} and Delta-Cortef,{{cite web | title = Delta-Cortef: FDA-Approved Drugs | work = U.S. Food and Drug Administration (FDA) | url = https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=009987 }} respectively.

{{Reflist}}

{{Glucocorticoids}}

{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}

{{Orexigenics}}

{{Glucocorticoid receptor modulators}}

{{Mineralocorticoid receptor modulators}}

{{Portal bar | Medicine}}

{{Authority control}}

Category:Antiasthmatic drugs

Category:Appetite stimulants

Category:CYP3A4 inducers

Category:Glucocorticoids

Category:Mineralocorticoids

Category:Prodrugs

Category:Triketones

Category:World Health Organization essential medicines

Category:Wikipedia medicine articles ready to translate