Indications for Use
- Systemic connective tissue diseases (SLE, scleroderma, periarteritis nodosa, dermatomyositis, rheumatoid arthritis).
- Acute and chronic inflammatory joint diseases: arthritic and psoriatic arthritis, osteoarthritis (including posttraumatic), arthritis, scapulohumeral periarthritis, ankylosing spondylitis (Bechterew's disease), juvenile arthritis, Still's syndrome in adults, bursitis, nonspecific tenosynovitis, epicondylitis and synovitis .
- Acute rheumatism, rheumatic carditis, small chorea.
- Bronchial asthma, asthmatic status.
- Acute and chronic allergic diseases: allergic reactions to drugs and food products, serum sickness, urticaria, allergic rhinitis, angioedema, drug exanthema, pollinosis.
- Skin diseases: pemphigus, psoriasis, eczema, atopic dermatitis, diffuse atopic dermatitis; Stevens-Johnson).
- Cerebral edema (including against the background of a brain tumor or associated with surgery, radiation therapy or head injury) after prior parenteral administration.
- Allergic diseases of the eye: allergic corneal ulcers, allergic forms of conjunctivitis.
- Inflammatory diseases of the eye: sympathetic ophthalmia, severe sluggish anterior and posterior uveitis, optic neuritis.
- Primary or secondary adrenal insufficiency (including condition after removal of the adrenal glands).
- Congenital adrenal hyperplasia.
- Kidney diseases of autoimmune genesis (including acute glomerulonephritis); nephrotic syndrome.
- Subacute thyroiditis.
- Blood diseases of the organs of hematopoiesis: agranulocytosis, panmielopathy, autoimmune hemorrhage, acute lymphoid and myeloid leukemia, lymphogranulomatosis, thrombocytopenic purpura, secondary thrombocytopenia in adults, erythroblastopenia (erythrocytic anatomy, secondary thrombocytopenia in adults, erythroblastopenia (erythrocytic anatomy, secondary thrombocytopenia in adults, erythroblastopenia (erythrocytic anatomy)
- Interstitial lung diseases: acute alveolitis, pulmonary fibrosis, sarcoidosis II-III stage.
- Tuberculous meningitis, pulmonary tuberculosis, aspiration pneumonia (in combination with specific chemotherapy).
- Berylliosis, Leffler syndrome (not amenable to other therapies).
- Lung cancer (in combination with cytostatics).
- Multiple sclerosis.
- Diseases of the digestive tract: ulcerative colitis, Crohn's disease, local enteritis.
- Hepatitis, hypoglycemic states.
- Prevention of graft rejection.
- Hypercalcemia on the background of cancer, nausea and vomiting during cytostatic therapy.
For short-term use of the drug for "life" indications, the only contraindication is hypersensitivity to the components of the drug.
- With caution. Parasitic and infectious diseases of a viral, fungal or bacterial nature (currently or recently transferred, including recent contact with a patient): herpes simplex, herpes zoster (viremic phase), chicken pox, measles; amebiasis, strongyloidiasis (established or suspected); systemic mycosis; active and latent tuberculosis. The use of the drug in severe infectious diseases is permissible only against the background of specific therapy.
- The post-vaccination period (a period of 8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination. Immunodeficiency states (including AIDS or HIV infection).
- Diseases of the gastrointestinal tract: peptic ulcer of the stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, a newly created intestinal anastomosis, nonspecific 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 focus of necrosis may spread, slowing the formation of scar tissue and, consequently, cardiac muscle rupture), decompensated CHF, hypertension, hyperlipidemia).
- Endocrine diseases: diabetes mellitus (including impaired carbohydrate tolerance), thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease.
- Severe chronic renal and / or liver failure, nephroluritiasis.
- Hypoalbuminemia and conditions predisposing to its occurrence.
- Systemic osteoporosis, myasthenia gravis, acute psychosis, obesity (stage III-IV), poliomyelitis (with the exception of the form of bulbar encephalitis), open-and-close-angle glaucoma, pregnancy, lactation.
Indications and dosage
Prednisone is prescribed to patients for the following indications:
- Ankylosing spondylitis
- Inflammatory changes in the spinal cord and membranes Noninfectious arthritis
- Edematous processes of the vertebrae and its structures
- Severe pain in the spine Injuries to the joints and nerves of the spine
- Osteochondrosis Lack of effectiveness of spinal treatment with other medicines
Prednisone should be taken orally, swallowing whole and drinking plenty of fluids. Initially, the drug must be taken on 20-30 mg per day to achieve a therapeutic effect (improvement in the patient's condition). Then gradually reduce the dosage to 5-10 mg per day. In extreme cases, the initial dosage can be increased to 50-100 mg per day, and supporting up to 15 mg per day. The maximum daily dosage is 100 mg, single dose - 15 mg.
For children, the drug is prescribed depending on the weight of the patient - 1-2 mg per kg per day, divided into 4-5 doses. Maintenance dosage - 300-600 mcg per kg per day.
The course of treatment is individual and varies from 1 week to several months. The abolition of the drug must be made gradually reducing the daily intake.
GKS; has anti-inflammatory, anti-allergic, anti-shock and immunosuppressive effects. Reduces the amount of protein in the plasma, mainly globulins (with an increase in the albumin / globulin ratio); enhances catabolic processes in muscle tissue. Increases the synthesis of higher fatty acids and TG, redistributes fat - the accumulation of fat in the shoulder girdle, face, abdomen, hypercholesterolemia. Increases the absorption of carbohydrates from the digestive tract; increases the activity of glucose-6-phosphatase, increasing the flow of glucose from the liver into the blood; increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases, which leads to the activation of gluconeogenesis. Water-electrolyte metabolism - retains Na + and water in the body, stimulates K + excretion, reduces Ca2 + absorption from the gastrointestinal tract, vitamin D antagonist (“flushing out” Ca2 + from bones), increases Ca2 + excretion by the kidneys. The anti-inflammatory effect is due to the inhibition of the release of inflammatory mediators by eosinophils; induction of lipocortin formation and a decrease in the number of fat cells that produce hyaluronic acid (with a decrease in capillary permeability, stabilization of cell membranes and organelle membranes). The antiallergic effect is due to a decrease in the number of circulating basophils, which leads to a decrease in the release of mediators of immediate allergy; reduces the effect of allergy mediators on effector cells. The immunosuppressive effect is due to inhibition of the release of cytokines (interleukin1, interleukin2, interferon gamma) from lymphocytes and macrophages. Suppresses the activity of vitamin D, which leads to a decrease in the absorption of Ca2 + and an increase in its excretion; inhibits the synthesis and secretion of ACTH and secondary synthesis of endogenous corticosteroids.
The frequency of development and severity of side effects depends on the duration of use, the magnitude of the dose used and the ability to comply with the circadian rhythm of the appointment.
- From endocrine system:reduction of glucose tolerance, "steroid" diabetes or a manifestation of latent diabetes mellitus, adrenal suppression, Cushing's syndrome (moon face, obesity, pituitary type, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia gravis, striae) , delayed sexual development in children.
- On the part of the digestive system:nausea, vomiting, pancreatitis, "steroid" gastric and duodenal ulcer, 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 side of the cardiovascular system:arrhythmias, bradycardia (up to cardiac arrest); development (in predisposed patients) or increased severity of HF, ECG changes characteristic of hypokalemia, increased blood pressure, hypercoagulation, thrombosis. In patients with acute and subacute myocardial infarction - the spread of necrosis, slowing the formation of scar tissue, which can lead to rupture of the heart muscle.
- Nervous system disorders:delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, pseudotumor of the cerebellum, headache, convulsions.
- On the part of 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 eye, trophic changes of the cornea, exophthalmos.
- On the part of metabolism:increased excretion of Ca2 +, hypocalcemia, increased body weight, a negative nitrogen balance (increased protein breakdown), increased perspiration.
- Due to ISS activity, fluid retention and Na + (peripheral edema), hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).
- On the part of the musculoskeletal system:growth retardation and the process of ossification in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely, pathological bone fractures, aseptic necrosis of the head of the humerus and femur), muscle tendon rupture, "steroid" myopathy, reduction muscle mass (atrophy).
- On the part of the skin and mucous membranes:delayed wound healing, petechiae, ecchymosis, thinning of the skin, hyper- or hypopigmentation, steroid acne, stretch marks, a tendency to the development of pyoderma and candidiasis.
- Allergic reactions to the components of the drug:generalized (skin rash, itching, anaphylactic shock), local allergic reactions.
- Others:the development or exacerbation of infections (jointly used immunosuppressants and vaccination contribute to the occurrence of this side effect), leukocyturia, "withdrawal" syndrome.
Before starting treatment with a drug, it is necessary to conduct a CVS examination, an x-ray examination of the lungs, a study of the stomach and duodenum 12; urinary system, organs of vision. Before and during steroid therapy, it is necessary to monitor the complete blood count, glucose concentration in the blood and urine, and electrolytes in the plasma. During therapy during intercurrent infections, septic conditions, and tuberculosis, antibiotics are simultaneously treated. After drug withdrawal, relative insufficiency of the adrenal cortex persists for several months. If during this period there are stressful situations, appoint (according to indications) for a short period of GCS, if necessary in combination with the ISS. Children who have been in contact with measles or chicken pox during the treatment period are given specific Ig prophylactically.
With indications of psoriasis in the history of the drug in high doses prescribed under the strict supervision of a physician.
In children during the growth period, GCS should be used only if absolutely indicated and under the most careful supervision of the attending physician.
Reduces the effectiveness of insulin, oral hypoglycemic and antihypertensive drugs, anticoagulants; reduces the concentration of salicylates in the blood; reduces the concentration of praziquantel in the serum.
Rifampicin, phenytoin, barbiturates weaken the effect of the drug; hormonal contraceptives increase efficacy.
Increase the risk of side effects: NSAIDs (erosive and ulcerative lesions and bleeding from the gastrointestinal tract); androgens, estrogens, oral contraceptives, steroid anabolics (hirsutism, acne); antipsychotic drugs, bukarban, azathioprine (cataract); holinoblokatory, antihistamine drugs, tricyclic antidepressants, nitrates (increased intraocular pressure); diuretics (hypokalemia); cardiac glycosides (digitalis intoxication).
Interaction with other drugs and alcohol
Reduces the effectiveness of insulin, oral hypoglycemic and antihypertensive drugs, anticoagulants; reduces the concentration of salicylates in the blood; reduces the concentration of praziquantel in the serum. Rifampicin, phenytoin, barbiturates weaken the effect of prednisone; hormonal contraceptives increase efficacy. Increase the risk of side effects: NSAIDs (erosive and ulcerative lesions and bleeding from the gastrointestinal tract); androgens, estrogens, oral contraceptives, steroid anabolics (hirsutism, acne); antipsychotic drugs, bukarban, azathioprine (cataract); holinoblokatory, antihistamine drugs, tricyclic antidepressants, nitrates (increased intraocular pressure); diuretics (hypokalemia); cardiac glycosides (digitalis intoxication).
The risk of overdose increases with prolonged use of prednisone, especially in large doses. Symptoms: increased blood pressure, peripheral edema, increased side effects of the drug. Treatment of acute overdose: immediate gastric lavage or induction of vomiting, specific antidote not found. Treatment of chronic overdose: reduce the dose of the drug.