Prednisolone Latin name. Prednisolone solution: instructions for use. Application restrictions

The medical preparation Prednisolone belongs to the group of synthetic glucocorticoids, which has all the properties inherent in the compounds of this group. Long-term use of the drug in high doses causes side effects of Prednisolone.

Prednisolone is a hormonal drug

The drug is prescribed only in emergency cases, when the main therapy does not lead to the proper result, or the treatment begins to take a protracted character. With an ineffective clinical picture, the appointment is carried out in a short course using high doses of the drug. Prolonged use of a large volume of Prednisolone can cause a protein deficiency in the blood plasma, which threatens to toxic release of free progesterone. The reasons why Prednisolone is classified as a group of hormonal drugs:

1. A deficiency of progesterone in the plasma protein, as a rule, leads to impaired growth and sexual development of adolescents during maturation, or at a transitional age.
2. Prednisolone causes in patients with diabetes mellitus.
   In addition, the drug is capable of simultaneous actions to enhance the decay and neoplasm of fat cells deposited in tissues, which leads to a transient process of obesity.
3. An excess of Prednisolone leads to a violation of mineral metabolism, since the drug is able to remove potassium from the body, thereby reducing myocardial contractility. This leads to myocardial infarction and the risk of a heart attack.
4. Prednisolone removes calcium from the body, which leads to osteoporosis, or thinning of the bones. The bones become brittle and may break from slight bruising.
5. The action of the drug in the cells of the body retains water and sodium, causing severe swelling.

The release of the drug Prednisolone is carried out in various forms, according to the formulation: powder, injection solution, injection-suspension, oral liquid, oral suspension, oral syrup, oral tablets, dissolving tablets for oral use.

Clinical observations of the action of Prednisolone

In patients who received an average of 10 mg per day of the drug Prednisolone for several months, 50% less infection with infectious diseases was recorded compared with patients who received an average of 20 mg per day of the drug. Significantly fewer episodes of aseptic necrosis were noted, with a trend towards fewer complications in patients with low doses of the drug.

Prednisolone - release form: solution for injection

At the same time, side effects of Prednisolone were observed, manifested when using minimal doses, but their manifestation was presented in small quantities. Doses greater than 10 mg per day have been associated with an increase in side effects in a significant subset of patients. Side effects from taking Prednisolone can be divided into those associated with short-term therapy, lasting up to three weeks, and manifestations after long-term therapy, conducted over three weeks.

Short-term courses of the drug included effects associated with increased accumulation of sodium weight parts and fluid accumulation. These may include hyperglycemia, glucose intolerance, hypokalemia, gastrointestinal disturbances with ulceration, and reversible depression of the hypothalamic-pituitary-adrenal axis. On the part of the psychomotor and nervous system, patients experienced a sharp change in mood - from euphoria to insomnia.

Among patients taking high doses of prednisolone, frequent cases of nervousness, anxiety, mania of several modifications, catatonia, depression, delusions, hallucinations and aggressive behavior have been reported.

Long-term use of the drug led to such long-term side effects as a depressed appearance and confusion, hirsutism or virilism, impotence, menstrual irregularities, cataracts and increased intraocular pressure, the development of glaucoma, myopathy, osteoporosis, up to compression fractures of the spine.

Metabolic side effects of prednisolone

When monitoring the metabolic side effects of the action of Prednisolone, hypernatremia, hypokalemia, fluid retention in the body, a negative nitrogen balance and an increased concentration of urea nitrogen in the blood were registered. In the course of research, it turned out that glucocorticoids significantly reduce the secretion of thyrotropin.

Side effects on the cardiovascular system

Prednisolone: ​​release form - ointment

On the part of the cardiovascular system, hypertensive syndrome, persistent heart failure due to long-term storage of fluid in cells, as well as a direct effect of vascular contraction were observed. Studies have shown that patients may develop systolic hypertension. It turned out to be susceptible to 12% of the total number of observed patients. As it turned out, hypertension was associated with long-term corticosteroid therapy and, the researchers believe, due to fluid retention. In some cases, changes in blood pressure occurred due to the advanced age of patients.

Side effects on the endocrine system

On the part of the endocrine system, side effects included glucose tolerance and hyperglycemia. Diabetes, as a symptom, can develop in people prone to this disease, or suffering from a heredity factor. Hypothalamic-pituitary-adrenal suppression may be extended up to a calendar year after long-term therapy with prednisolone. The observed effect of the manifestation of Itsenko-Cushing's disease was most likely associated with the therapy of a chronic disease. In addition, hirsutism or virilism, impotence, and menstrual irregularities may also be a reflection of prednisolone therapy for chronic conditions.

Corticosteroid therapy can induce glucose intolerance by decreasing sugar utilization in liver tissues and increasing glucose output. Patients on long-term therapy may exhibit significantly higher serum glucose levels if the test was taken on the day of taking prednisolone. For example, it has been observed in patients with diabetes mellitus requiring treatment with a modified diet using glucose-regulating and hypoglycemic drugs.

Adrenal suppression may persist for up to twelve months after long-term corticosteroid therapy. Adrenal suppression can be reduced by reducing the use of corticosteroids to once a day or every other day. Perdnisolone treatment may be used as adjunctive corticosteroid therapy during times of stress, infectious disease, surgery, or serious injury.

Side effects on the gastrointestinal tract

On the part of the gastrointestinal tract, side effects from the use of Prednisolone included gastrointestinal disorders, nausea, vomiting, and the occurrence of peptic ulcer. There were also manifestations of pancreatitis, and in isolated cases, the manifestation of gastrointestinal bleeding and perforation of the walls of the stomach. The most common side effect of Prednisolone is gastrointestinal upset, with nausea, vomiting, indigestion, and anorexia. Rare, researchers suggest, have been associated with long-term corticosteroid therapy.

Side effects on the musculoskeletal system

On the part of the musculoskeletal system during corticosteroid therapy, manifestations of myopathy were observed in the form of weakness and exhaustion of the proximal limbs and muscle belt. As a rule, such processes are reversible after cessation of therapy. Corticosteroids inhibit calcium absorption in the intestine. The resulting increase in urinary calcium excretion leads to bone resorption and bone loss. Bone loss of more than 3% in one year was a demonstration of taking Prednisolone at the appointment of 10 mg of the drug per day.

Postmenopausal women are especially at risk for bone density loss. Elderly patients, 16% of the total number of people studied, received corticosteroids for 5 years. These people are at risk for spinal compression fractures because they have experienced bone loss. Studies have shown bone loss in women with concomitant therapy with prednisolone 7.5 mg daily plus tamoxifen occurring within two years of drug initiation.

Side effects affecting the musculoskeletal system included myopathy, osteoporosis, spinal compression and fractures, and avascular necrosis of the bone. Aseptic necrosis is the most common factor in damage to the femoral head.

Side effects on the organs of vision

Prednisolone - release form: tablets

From the side of the visual system, there is an increase in eye pressure and the development of cataracts. In kidney transplant patients who were prescribed prednisolone at a dosage of 10 mg per day, 33% of patients developed posterior subcapsular cataracts. The median time for cataract development is 26 months. In this case, the cataract developed in less than a year. An increase in intraocular pressure was observed in 5% of patients. Also, glaucoma was included in the side effect on the part of the organs of vision.

Other manifestations of side effects

Other side effects included:

1. Syndrome of withdrawal of glucocorticoids. It is observed as a result of an abrupt cessation of taking Prednisolone. Typically causes adrenal suppression syndrome.
2. Rheumatoid arthritis, or glucocorticoid withdrawal syndrome. The syndrome may occur after discontinuation of corticosteroids. Its manifestation is not associated with adrenal insufficiency.
3. Patients experience anorexia, vomiting, lethargy, headache, fever, arthralgia, myalgia, and the effect of postural hypotension. Symptoms resolve with reinstatement of corticosteroid therapy.
4. Psychiatric side effects include psychosis, behavioral changes, and pseudotumor.
5. Hematologic side effects include thrombocytopenia, lymphopenia, and platelet changes resulting from thrombolic events.

The drug Prednisolone is a very serious drug, prescribed in the most severe cases, when general therapy is unable to resolve the situation. But due to the fact that long-term use of the drug can lead to very aggravating consequences, Prednisolone is prescribed symptomatically, in a short course and not for a very short period.

Personal experience in the use of glucocorticosteroids (corticosteroids) will be shared with you in the video:

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Compound

active substance: 1 ml of the solution contains prednisototkg for prednisolone - 30 mg;

Excipients: sodium hydrogen phosphate anhydrous, sodium dihydrogen phosphate dihydrate, propylene glycol, water for injection.

Basic physical and chemical properties: clear colorless or almost colorless solution.

Pharmacotherapeutic group

Corticosteroids for systemic use. Glucocorticoids. ATX code H02A B06.

Pharmacological properties .

Pharmacodynamics.

It has anti-inflammatory, anti-allergic, immunosuppressive, anti-shock and anti-toxic effects.

In relatively large doses, it inhibits the activity of fibroblasts, the synthesis of collagen, reticuloendothelium and connective tissue (inhibition of the proliferative phase of inflammation), delays synthesis and accelerates protein catabolism in muscle tissue, but increases its synthesis in the liver.

The antiallergic and immunosuppressive properties of the drug are due to the inhibition of the development of lymphoid tissue with its involution during long-term use, a decrease in the number of circulating T- and B-lymphocytes, inhibition of mast cell degranulation, and suppression of antibody production.

The anti-shock effect of the drug is due to an increase in the vascular response to endo- and exogenous vasoconstrictor substances, with the restoration of the sensitivity of vascular receptors to catecholamines and an increase in their hypertensive effect, as well as a delay in the excretion of sodium and water from the body.

The antitoxic effect of the drug is associated with stimulation of protein synthesis processes in the liver and acceleration of the inactivation of endogenous toxic metabolites and xenobiotics in it, as well as with an increase in the stability of cell membranes, incl. hepatocytes. It enhances the deposition of glycogen in the liver and the synthesis of glucose from the products of protein metabolism. An increase in blood glucose levels activates the secretion of insulin. It inhibits the uptake of glucose by fat cells, which leads to the activation of lipolysis. However, due to the increase in insulin secretion, lipogenesis is stimulated, which contributes to the accumulation of fat.

Reduces calcium absorption in the intestines, increases its leaching from bones and excretion by the kidneys. It suppresses the release of adrenocorticotropic hormone and β-lipotropin by the pituitary gland, and therefore, with prolonged use, the drug may contribute to the development of functional insufficiency of the adrenal cortex.

The main factors limiting long-term therapy with prednisolone are osteoporosis and Itsenko-Cushing's syndrome. Prednisolone inhibits the secretion of thyroid-stimulating and follicle-stimulating hormones.

In high doses, it can increase the excitability of brain tissue and help lower the seizure threshold.

Stimulates excess secretion of hydrochloric acid and pepsin in the stomach, and therefore may contribute to the development of peptic ulcers.

Pharmacokinetics

When administered intramuscularly, it is rapidly absorbed into the blood, however, compared with reaching the maximum level in the blood, the pharmacological effect of the drug is significantly delayed and develops in 2-8 hours. In blood plasma, most prednisolone binds to transcortin (cortisol-binding globulin), and when the process is saturated, to albumin. With a decrease in protein synthesis, a decrease in the binding capacity of albumins is observed, which can cause an increase in the free fraction of prednisolone and, as a result, the manifestation of its toxic effect when using conventional therapeutic doses. The half-life in adults is 2-4 hours, in children it is shorter. Biotransformed by oxidation mainly in the liver, as well as in the kidneys, small intestine, bronchi. Oxidized forms are glucuronized or sulfated and excreted in the form of conjugates by the kidneys. About 20% of prednisolone is excreted from the body by the kidneys unchanged; a small part is excreted in the bile.

In liver diseases, the metabolism of prednisolone slows down and the degree of its binding to blood plasma proteins decreases, which leads to an increase in the half-life of the drug.

Clinical Characteristics

Indications.

Intramuscular, intravenous administration: systemic connective tissue diseases: systemic lupus erythematosus, dermatomyositis, scleroderma, periarteritis nodosa, ankylosing spondylitis;

hematological diseases: acute hemolytic anemia, lymphogranulomatosis, granulocytopenia, thrombocytopenic purpura, agranulocytosis, various forms of leukemia;

skin diseases: common eczema, erythema multiforme exudative, pemphigus vulgaris, erythroderma, exfoliative dermatitis, seborrheic dermatitis, psoriasis, alopecia, adrenogenital syndrome;

replacement therapy: Addison's crisis;

emergency conditions: severe forms of non-specific ulcerative colitis and Crohn's disease, shock (burn, traumatic, surgical, anaphylactic, toxic, transfusion), status asthmaticus, acute adrenal insufficiency, hepatic coma, severe allergic and anaphylactic reactions, hypoglycemic reactions;

Intra-articular administration: chronic polyarthritis, osteoarthritis of large joints, rheumatoid arthritis, post-traumatic arthritis, arthrosis;

Contraindications

Hypersensitivity to the components of the drug; peptic ulcer of the stomach and duodenum, osteoporosis, Itsenko-Cushing's disease, tendency to thromboembolism, renal failure, arterial hypertension, viral infections (including viral lesions of the eyes and skin), decompensated diabetes mellitus, vaccination period (at least 14 days before and after preventive immunization), lymphadenitis after BCG vaccination, active tuberculosis, glaucoma, cataracts, productive symptoms in mental illness, psychosis, depression; systemic mycosis, herpetic diseases, syphilis, severe myopathy (with the exception of myasthenia gravis), poliomyelitis (with the exception of the bulbar-encephalitic form), pregnancy and lactation.

For intra-articular injections - infections at the injection site.

Interaction with other medicinal products and other forms of interaction

Anticoagulants: when used simultaneously with glucocorticoids, the effect of anticoagulants may increase or decrease. Parenteral administration of prednisolone causes the thrombolytic effect of vitamin K antagonists (fluindione, acenocoumarol).

Salicylates and other non-steroidalanti-inflammatorydrugs: the simultaneous use of salicylates, indomethacin and other non-steroidal anti-inflammatory drugs may increase the likelihood of ulceration of the gastric mucosa. Prednisolone reduces the level of salicylates in the blood serum, increasing their renal clearance. Caution is required when reducing the dose of prednisolone with prolonged simultaneous use.

Hypoglycemic drugs: Prednisolone partially inhibits the hypoglycemic effect of oral hypoglycemic agents and insulin.

liver enzyme inducers, for example, barbiturates, phenytoin, pyryramidone, carbamazepine and rimfampicin increase the systemic clearance of prednisolone, thus reducing the effect of prednisolone by almost 2 times.

InhibitorsCYP3 A4, for example, erythromycin, clarithromycin, ketoconazole, diltiazem, aprepitant, itraconazole, and oleandomycin increase the elimination and plasma levels of prednisolone, which enhances the therapeutic and side effects of prednisolone.

Estrogen may potentiate the effect of prednisone by slowing down its metabolism. It is not recommended to adjust the dose of prednisolone in women using oral contraceptives, which contribute not only to an increase in the half-life, but also to the development of an atypical immunosuppressive effect of prednisolone.

Fluoroquinolones: simultaneous use can lead to damage to the tendons. Amphotericin, diuretics and laxatives: prednisolone may increase the excretion of potassium from the body in patients who receive these drugs at the same time. Immunosuppressants: Prednisolone has active immunosuppressive properties, which may cause an increase in therapeutic effects or the risk of various adverse reactions when used simultaneously with other immunosuppressants. Only some of them can be explained by pharmacokinetic interactions. Glucocorticoids increase the antiemetic efficacy of antiemetic drugs that are used concomitantly in therapy with anticancer drugs that cause vomiting.

Corticosteroids can increase the concentration of tacrolimus in the blood plasma when they are used simultaneously; when they are canceled, the concentration of tacrolimus in the blood plasma decreases.

Immunization: glucocorticoids may reduce the effectiveness of immunization and increase the risk of neurological complications. The use of therapeutic (immunosuppressive) doses of glucocorticoids with live virus vaccines may increase the risk of developing viral diseases. During therapy with the drug, emergency-type vaccines can be used.

Anticholinesterase agents: in patients with myasthenia gravis, the use of glucocorticoids and anticholinesterase agents can cause muscle weakness, especially in patients with myasthenia gravis.

cardiac glycosides: increases the risk of developing glycoside intoxication.

Other: Two serious cases of acute myopathy have been reported in elderly patients who took doxocarium chloride and high doses of prednisolone. With long-term therapy, glucocorticoids may reduce the effect of somatotropin.

Cases of acute myopathy have been described with the use of corticosteroids in patients who are simultaneously receiving treatment with neuromuscular blockers (for example, pancuronium).

With the simultaneous use of prednisolone and cyclosporine, cases of seizures have been noted. Since the simultaneous administration of these drugs causes mutual inhibition of metabolism, it is likely that convulsions and other side effects associated with the use of each of these drugs as monotherapy may occur more often when they are used simultaneously. Simultaneous use may cause an increase in the concentration of other drugs in the blood plasma.

Antihistamine drugs reduce the effect of prednisone.

With the simultaneous use of prednisolone with antihypertensive drugs, the effectiveness of the latter may decrease.

Application features

In infectious diseases and latent forms of tuberculosis, the drug should be prescribed only in combination with antibiotics and anti-tuberculosis drugs. If it is necessary to use prednisolone while taking oral hypoglycemic drugs or anticoagulants, it is necessary to adjust the dosing regimen of the latter. In patients with thrombocytopenic purpura, the drug should be used only intravenously.

After discontinuation of treatment, withdrawal syndrome, adrenal insufficiency, as well as an exacerbation of the disease, in connection with which prednisolone was prescribed, may occur. If functional adrenal insufficiency is observed after the end of treatment with prednisolone, the use of the drug should be resumed immediately, and the dose reduction should be carried out very slowly and with caution (for example, the daily dose should be reduced by 2-3 mg for 7-10 days). Because of the risk of developing hypercortisolism, a new course of cortisone treatment after a previous long-term treatment with prednisolone for several months should always be started with low initial doses (except in acute life-threatening conditions).

The electrolyte balance should be especially carefully monitored when prednisone is used in combination with diuretics. With long-term treatment with prednisone, in order to prevent hypokalemia, it is necessary to prescribe potassium supplements and an appropriate diet due to a possible increase in intraocular pressure and the risk of developing subcapsular cataracts.

During treatment, especially long-term treatment, an ophthalmologist's supervision is necessary. When indicating a history of psoriasis, prednisolone in high doses should be used with extreme caution.

If there is a history of psychosis, convulsions, prednisolone should be used only in the minimum effective doses.

Prednisolone should be used with extreme caution in children.

With extreme caution, prescribe in immunodeficiency states (including AIDS). or HIV infection). Also, use with caution after a recent myocardial infarction (in patients with acute, subacute myocardial infarction, it is possible to expand the focus of necrosis, slow down the formation of scar tissue, and rupture the heart muscle).

With particular caution, it is prescribed for liver failure, conditions that cause the occurrence of hypoalbuminemia, obesity of III-IV degree.

Women during menopause need to undergo research regarding the possible occurrence of osteoporosis.

In the liver with glucocorticoids for a long time, it is recommended to regularly monitor blood pressure, determine the level of glucose in the urine and blood, conduct an analysis of feces for occult blood, analyzes of blood coagulation indicators, X-ray control of the spine. Before starting treatment with glucocorticoids, a thorough examination of the gastrointestinal tract should be carried out to exclude peptic ulcer of the stomach and duodenum.

Application during pregnancypregnancy or breastfeeding

During pregnancy, the drug should not be used.

If necessary, the use of the drug during lactation is recommended to stop breastfeeding.

The ability to influence the reaction rate when driving or dother mechanisms

Patients treated with prednisolone should refrain from potentially hazardous activities that require increased attention to the speed of mental and motor reactions.

Special patient groups

Elderly age

With prolonged therapy, muscle atrophy, muscle pain or weakness, delayed wound healing, atrophy of the bone protein matrix leading to osteoporosis, vertebral compression fractures, aseptic necrosis of the femoral head or humeral head, pathological fractures of long tubular bones can be observed. Particularly serious complications may occur in elderly and debilitated patients.

Before starting glucocorticoid therapy in postmenopausal women, it should be taken into account that such patients are particularly prone to osteoporosis.

Use with caution in patients with osteoporosis.

Liver dysfunction

In patients with cirrhosis, an increase in the effect of glucocorticoids is observed.

Violations of the function by check.

Apply with caution.

Method of applicationvalues ​​and doses

The dose of the drug and the duration of treatment is set by the doctor individually, depending on the indications and severity of the disease.

Prednisolone is administered intravenously (drip or jet) or intramuscularly. Intravenously, the drug is usually administered first by jet, then by drip.

In acute adrenal insufficiency, a single dose of the drug is 100-200 mg, daily 300-400 mg.

In severe allergic reactions, Prednisolone is administered in a daily dose of 100-200 mg for 3-16 days.

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

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

With a thyrotoxic crisis, 100 mg of the drug is administered at 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.

In shock resistant to standard therapy, prednisolone is usually administered by bolus at the beginning of therapy, after which it is switched to drip administration. If within 10-20 minutes the blood pressure does not increase, repeat the jet administration of the drug. After removing from the state of shock, 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).

In acute hepatic and renal insufficiency (with acute poisoning, in the postoperative and postpartum periods, etc.), Prednisolone is administered at a dose of 25-75 mg / day; if indicated, the daily dose can be increased to 300-1500 mg / day and above.

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

In acute hepatitis, Prednisolone is administered at a dose of 75-100 mg / day for 7-10 days.

In case of poisoning with caustic fluids 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 stopping the acute condition, Prednisolone is prescribed orally in tablets, followed by a gradual decrease in the dose.

With prolonged use of the drug, the daily dose should be reduced gradually.

Long-term therapy should not be stopped abruptly!

Children

Use in children over 6 years of age only as directed and under medical supervision. The doctor determines the doses and duration of therapy individually, depending on the age and severity of the course of the disease. With prolonged use in children, growth retardation is possible, therefore, it is necessary to limit the use of minimal doses for certain indications for the shortest possible time. The benefit of treatment should outweigh the potential risk of adverse reactions.

Overdose

In case of an overdose, nausea, vomiting, bradycardia, arrhythmia, increased symptoms of heart failure, cardiac arrest are possible; hypokalemia, increased blood pressure, muscle cramps, hyperglycemia, thromboembolism, acute psychosis, dizziness, headache, hypercortisolism symptoms may develop: weight gain, edema development, arterial hypertension, glucosuria, hypokalemia. In children with an overdose, inhibition of the hypothalamic-pituitary-adrenal system, Itsenko-Cushing's syndrome, decreased excretion of growth hormone, and increased intracranial pressure are possible.

There is no specific antidote.

Treatment: discontinuation of the drug, symptomatic therapy, if necessary, correction of the electrolyte balance.

Adverse reactions

The development of severe adverse reactions depends on the dose and duration of treatment. Adverse reactions usually develop with prolonged treatment with the drug. Over a short period, the risk of their occurrence is unlikely.

Infections and infestations: hypersensitivity to bacterial, viral, fungal infections, their severity with masking symptoms, opportunistic infections.

From the blood and lymphatic system: an increase in the total number of leukocytes with a decrease in the number of eosinophils, monocytes and lymphocytes. The mass of lymphoid tissue decreases. Blood coagulation may increase, which leads to thrombosis, thromboembolism.

From the endocrine system and metabolism: depression of the hypothalamic-pituitary-adrenal system, growth retardation in children and adolescents, menstrual irregularities, impaired secretion of sex hormones (amenorrhea), postmenopausal bleeding, cushingoid face, hirsutism, weight gain, decreased carbohydrate tolerance, increased need for insulin and oral sugar-lowering drugs, hyperlipidemia, negative balance of nitrogen and calcium, increased appetite, impaired mineral metabolism and electrolyte balance, hypokalemic alkalosis, hypokalemia, fluid and sodium retention in the body is possible.

Mental disorders: irritability, euphobia, depression, suicidal tendencies, insomnia, labile mood, increased concentration, psychological dependence, mania, hallucinations, exacerbation of schizophrenia, dementia, psychosis, anxiety, sleep disturbance, epileptic seizures, cognitive dysfunction (including amnesia and impaired consciousness), increased intracranial pressure, which is accompanied by nausea and swelling of the optic nerve head in children.

From the nervous system: increased intracranial pressure, epileptic seizures, peripheral neuropathy, paresthesia, dizziness, headache, autonomic disorders.

From the side of the organs of vision: increased intraocular pressure, glaucoma, swelling of the optic nerve, cataracts, thinning of the cornea and sclera, exacerbation of eye viral and fungal infections, exophthalmos.

From the side of the cardiovascular system: myocardial rupture due to myocardial infarction, arterial hypo- or hypertension, bradycardia, combined ventricular arrhythmia, asystole (due to rapid administration of the drug), atherosclerosis, thrombosis, vasculitis, heart failure, peripheral edema.

In patients with acute myocardial infarction - the spread of necrosis, slowing down the formation of the scar.

From the immune system: allergic reactions that cause fatal anaphylactic shock, angioedema, allergic dermatitis, changes in reaction to skin tests, relapse of tuberculosis, immunosuppression, hypersensitivity reactions, including rash, skin itching.

From the gastrointestinal tract: nausea, bloating, bad taste in the mouth, dyspepsia, peptic ulcers with perforation and bleeding, esophageal ulcer, esophageal candidiasis, pancreatitis, gallbladder perforation, gastric bleeding, local ileitis and ulcerative colitis.

During the use of the drug, there may be an increase in ALT, AST and alkaline phosphatase, which is usually not significant and is reversible after discontinuation of the drug.

From the side of the skin: delayed regeneration, skin atrophy, formation of hematomas and atrophic skin streaks (striae), telangiectasia, acne, acne, hirsutism, microhemorrhages, ecchymosis, purpura, hypo- or hyperpigmentation, post-steroid panniculitis, which is characterized by the appearance of erythematosis, hot subcutaneous thickening for 2 weeks after discontinuation of the drug, Kaposi's sarcoma.

From the musculoskeletal system: proximal myopathy, osteoporosis, tendon rupture, muscle weakness, atrophy, myopathy, fractures of the spine and long bones, aseptic osteonecrosis.

From the urinary system: increased risk of urolith formation and the content of leukocytes and erythrocytes in the urine without obvious damage to the kidneys.

General: malaise, persistent hiccups when using the drug in high doses, adrenal insufficiency, which leads to arterial hypotension, hypoglycemia and death in stressful situations, such as surgery, trauma or infection, if the dose of prednisolone is not increased.

With a sharp withdrawal of the drug, withdrawal syndrome is possible, the severity of symptoms depends on the degree of adrenal atrophy, headache, nausea, abdominal pain, dizziness, anorexia, weakness, mood changes, lethargy, fever, myalgia, arthralgia, rhinitis, conjunctivitis, skin pain syndrome, weight loss. In more severe cases - severe mental disorders and increased intracranial pressure, steroid pseudorheumatism in patients with rheumatism, death.

Reactions at the injection site: pain, burning, pigmentation changes (depigmentation, leukoderma), skin atrophy, sterile abscesses, rarely lipoatrophy.

1 ml of the drug in 1 ml glass ampoules with a break ring. 5 ampoules of the drug are put into a blister from a polyvinyl chloride film, which is covered

a pack of cardboard box (chrome-ersatz).

On prescription.

Manufacturer

PJSC "BIOPHARMA", Ukraine; OOO FZ BIOPHARMA, Ukraine.

Manufacturer's location and address

Ukraine, 03680, Kyiv, st. N. Amosova, 9;

Ukraine, 09100, Kyiv region, Belaya Tserkov, st. Kyiv, 37.

Prednisolone is a synthetic hormonal drug that has a pronounced anti-inflammatory effect. This remedy can relieve unpleasant symptoms after 2 days, it would seem that this is a panacea for all diseases.

But there is a lot of controversy and debate about its use, referring to the side effects of this medicine. In this article, we will tell you why Prednisolone is taken, how it works, whether it is prescribed to children and pregnant women, what are the contraindications of the drug, and why it is dangerous.

Properties, action and use of the drug

If the drug is taken for a long time, then fibroblast activity is inhibited, the association of not only collagen, but also connective tissue decreases, protein in the muscles is destroyed, and protein synthesis in the liver increases.

Due to the inhibition of the growth of lymphocytes with prolonged use, the production of antibodies is suppressed, which positively affects the immunosuppressive and anti-allergic properties.

Due to the influence of the drug, the reaction of the vessels to the vasoconstrictor substance increases, because of this, the vascular receptors become more sensitive, the removal of salt and water from the body is stimulated, which affects the anti-shock effect of the drug.

In the liver, protein synthesis is stimulated, the stability of the cell membrane increases, which leads to a good antitoxic effect.

Due to the intake of Prednisolone, the synthesis of glucose by the liver is enhanced. Elevated blood glucose levels increase insulin production.

Prednisolone has the following effect:

It is important to take this remedy correctly, due to indiscriminate use, fat accumulation is observed, calcium absorption by the intestines worsens, its leaching from bones and excretion by the kidneys increase. A high dosage of the drug increases the excitability of the brain, reduces the threshold for convulsive readiness, stimulates an increased secretion of hydrochloric acid and pepsin by the stomach.

Many people are interested in the question of how long the drug works. The medicine produced in tablets, of course, needs more time to start working. Tablets have 2 types of dosage of 1 and 5 mg.

The action of Prednisolone begins from the moment when it enters the circulatory system from the gastrointestinal tract and forms a bond with proteins. If the blood contains a smaller amount of protein, then Prednisolone has a negative effect on the body as a whole, therefore, when treating with this remedy, regular blood monitoring is necessary.

On average, the drug has an active effect 1.5 hours after its use, which lasts for a day, after which it decomposes in the liver and is excreted by the kidneys and intestines. Prednisolone in injections with intramuscular injection begins to act after 15 minutes, with intravenous - for 3-5 minutes.

In tablets

The medicine in the form of tablets is effective in the following conditions:

Prednisolone helps with severe allergic diseases, such as:

1. Bronchitis.
2. Bronchial asthma.
3. Eczema.
4. Anaphylactic shock.

Prednisolone is taken for diseases that are associated with low production of corticosteroids, for example:

1. Violation of the adrenal glands.
2. Addison's disease.
3. adrenogenital syndrome.

Somatic indications for taking this drug:

In injections

Indications for the introduction of Prednisolone in injections are associated with severe conditions that require urgent care. Injections are administered both intramuscularly and intravenously in the following conditions:

1. Edema of the brain.
2. Shock state.
3. Adrenal insufficiency.
4. Toxic crisis.
5. Swelling of the larynx.
6. Poisoning.

Local application

Indications for local use are as follows:

Prednisolone during pregnancy should be used correctly only in cases where the need for use for a woman is higher than the possible risk to the baby. This agent passes through the placental barrier and affects the fetus, and the dosage is selected individually based on the patient's condition.

Indications for the appointment of Prednisolone for bronchitis

Prednisone helps well in chronic bronchitis, which is complicated by obstruction. Of course, this drug is a serious remedy, but when bronchodilator therapy does not work, then this drug is prescribed in tablets against the background of ongoing treatment with bronchodilator drugs.

In chronic bronchitis aggravated by fever, Prednisolone is used for quite a long time. Only then can you expect a successful result.

Many people are afraid to use this drug, of course, this is a serious medicine, but with its help you can quickly remove the obstruction and return to your usual lifestyle.

Dosage, side effects and contraindications of Prednisolone

However, it is important to drink most of it in the morning. In order for side effects to give a minimal effect on the gastrointestinal tract, you need to drink tablets during a meal, while drinking a small amount of water. The following recommendations must be observed:

The intervals between dose reduction should be no more than 3 days, if the use of the drug was prolonged, then the daily dose should decrease more slowly.

It is impossible to abruptly stop therapy with Prednisolone, the cancellation should occur more slowly than its appointment.

If during therapy with this agent there was an exacerbation of the disease, an allergic manifestation, surgery, stress load, then the dosage of the drug should be increased by 2-3 times, namely:

In critical situations, the injection can be repeated after half an hour.

Eye drops Prednisolone for adults is instilled 2 drops three times, for children 1 drop. Local application of the ointment is possible from 1 to 3 times with a thin layer on the damaged area of ​​the skin.

Prednisolone, like all drugs, has contraindications for its use, namely:

The drug has an effective effect on the body as a whole, but it is combined with a considerable number of undesirable effects. Below we consider the most famous side effects that affect many systems.

endocrine system

This remedy causes disturbances in the endocrine gland, manifested in the form of destruction of proteins that are used to produce glucose by the body, this has a negative effect on metabolic processes. Prolonged use of Prednisolone leads to a lack of protein in the blood. This causes the body to produce harmful progesterone.

If there is a lack of protein in the plasma, then the children experience a violation of growth and a failure in sexual development.

Against the background of endocrine system disorders, blood sugar levels rise, which, of course, negatively affects people with diabetes. At the same time, the formation of fats deposited in the tissues occurs, which leads to the appearance of excess weight.

There is a violation of the mineral balance, there is an excessive withdrawal of calcium and potassium, as a result of which there is an accumulation of salts and water. All this leads to the formation of edema, thinning of the bones. If you take Prednisolone for a long time, then in women there is a failure of the menstrual cycle, and in men there is a violation of sexual function.

Of cardio-vascular system

Disorders of the cardiovascular system. Due to the excretion of potassium from the body, the myocardium often suffers, which leads to a failure of the heart rhythm. A too slow rhythm may develop, leading to cardiac arrest, heart failure develops, and blood stasis in the vessels is formed. The situation is exacerbated by the retention of water and sodium in the body, which leads to the formation of more blood volume and increased stagnation.

nervous system

Often, while taking this drug, there is a violation of the nervous system, which leads to increased pressure, vasospasm. All this causes thrombosis - the main cause of strokes and heart attacks. Therefore, in people suffering from a heart attack, slow tissue scarring occurs.

Side effects from the nervous system affect the spasms of blood vessels, stagnation of blood vessels, which leads to headache, increased pressure in the brain, insomnia, convulsive phenomena, dizziness.

other systems

Long-term use of Prednisolone also has a negative effect on:

Prednisolone is a fairly serious drug, which is prescribed in difficult cases, when therapy with other methods does not give the desired results.

Due to the fact that it has many side effects, the drug should not be consumed for a long time. The dosage of the drug, the duration of the therapeutic course and the end time of the course should be carried out according to the formula developed for the individual patient, based on his characteristics of the organism.

Dosage form:  solution for intravenous and intramuscular administration Compound:

1 ml of the drug contains:

active substance: prednisolone sodium phosphate (in terms of prednisolone) 30 mg;

Excipients: sodium hydrogen phosphate (anhydrous sodium hydrogen phosphate) 0.5 mg, sodium dihydrogen phosphate dihydrate 0.35 mg, propylene glycol 150 mg, water for injection up to 1 ml.

Description:

Clear or slightly opalescent, colorless or slightly colored liquid.

Pharmacotherapeutic group:glucocorticosteroid ATX:  

H.02.A.B.06 Prednisolone

Pharmacodynamics:

Prednisolone is a synthetic glucocorticosteroid drug, a dehydrated analog of hydrocortisone. It has anti-inflammatory, anti-allergic, desensitizing, anti-shock, anti-toxic and immunosuppressive effects.

Suppresses the release of pituitary beta-lipotropin, but does not reduce the concentration of circulating beta-endorphin. It inhibits the secretion of thyroid-stimulating hormone (TSH) and follicle-stimulating hormone (FSH). Increases the excitability of the central nervous system (CNS), reduces the number of lymphocytes and eosinophils, increases - erythrocytes (stimulates the production of erythropoietins).

Interacts with cytoplasmic glucocorticosteroid (GSC) receptors and forms a complex that penetrates the cell nucleus and stimulates mRNA synthesis; the latter induces the formation of proteins, including lipocortin, mediating cellular effects. Lipocortin inhibits phospholipase A2, inhibits the release of arachidonic acid and inhibits the synthesis of endoperoxides, prostaglandins (Pg), leukotrienes, which promote inflammation, allergies, and more.

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

Lipid metabolism: increases the synthesis of higher fatty acids and triglycerides, redistributes fat (accumulation of fat occurs mainly in the area of ​​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 intake of glucose from the liver into the blood); increases the activity of phosphoenolpyruvate carboxylase and the synthesis of aminotransferases (activation of gluconeogenesis); contributes to the development of hyperglycemia.

Water-electrolyte exchange: retains sodium ions and water in the body, stimulates the excretion of potassium ions (mineralocorticoid activity), reduces the absorption of calcium ions from the gastrointestinal tract, reduces the mineralization of bone tissue.

Anti-inflammatory effect 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.

Immunosuppressive effect due to the involution of lymphoid tissue caused by the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of the migration of B-lymphocytes and the interaction of T- and B-lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and a decrease in antibody formation.

Antiallergic effect develops as a result of a decrease in 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, T- and B-lymphocytes, mast cells; suppression of the development of lymphoid and connective tissue, reducing the sensitivity of effector cells to allergy mediators, inhibition of antibody production, changes in the body's immune response.

For obstructive airways disease the action is mainly due to the inhibition of inflammatory processes, the prevention or decrease in the severity of edema of the mucous membranes, the decrease in eosinophilic infiltration of the submucosal layer of the bronchial epithelium and the deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucous membrane. Increases the sensitivity of beta-adrenergic receptors of small and medium-sized bronchi to endogenous catecholamines and exogenous sympathomimetics, reduces the viscosity of mucus by reducing its production.

Suppresses the synthesis and secretion of adrenocorticotropic hormone and secondarily - the synthesis of endogenous glucocorticosteroids.

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

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

Pharmacokinetics:

Up to 90% of prednisolone binds to plasma proteins: transcortin (corticosteroid-binding globulin) and albumin.

Prednisolone is metabolized in the liver, partly in the kidneys and other tissues, mainly by conjugation with glucuronic and sulfuric acids. Metabolites are inactive. Excreted through the intestines and kidneys by glomerular filtration and 80-90% reabsorbed by the tubules, 20% of the dose is excreted by the kidneys unchanged. The plasma half-life after intravenous administration is 2-3 hours.

Indications:

Prednisolone is taken for emergency therapy in conditions requiring a rapid increase in the concentration of glucocorticosteroids in the body:

Shock (burn, traumatic, surgical, toxic, cardiogenic) - with the ineffectiveness of vasoconstrictors, plasma-substituting drugs and other symptomatic therapy;

Allergic reactions (acute severe forms), hemotransfusion shock, anaphylactic shock, anaphylactoid reactions;

Cerebral edema (including against the background of a brain tumor or associated with surgery, radiation therapy, or head trauma);

Bronchial asthma (severe form), astatic status;

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

Acute adrenal insufficiency;

thyrotoxic crisis;

Acute hepatitis, hepatic coma;

Reducing inflammation and preventing cicatricial narrowing (in case of poisoning with caustic fluids).

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 period of growth, glucocorticosteroids should be used only according to absolute indications and under the most careful supervision of the attending physician.

Carefully:

The drug should be prescribed for the following diseases and conditions:

Diseases of the gastrointestinal tract - peptic ulcer of the stomach and duodenum, esophagitis, gastritis, acute or latent peptic ulcer, 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 acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV infection);

Diseases of the cardiovascular system (including recent

myocardial infarction - in patients with acute and subacute myocardial infarction, a focus of necrosis may spread, a slowdown in the formation of scar tissue and, as a result, a rupture of the heart muscle), decompensated chronic heart failure, arterial hypertension,

hyperlipidemia);

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

Severe chronic renal and / or liver failure,

nephrourolithiasis;

Hypoalbuminemia and conditions predisposing to its occurrence;

Systemic osteoporosis, myasthenia gravis, acute psychosis, poliomyelitis (with the exception of the form of bulbar encephalitis), open and angle-closure glaucoma;

Pregnancy.

Pregnancy and lactation:

During pregnancy, the drug is used only in cases where the potential benefit to the mother outweighs the potential risk to the fetus.

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

Dosage and administration:

Intravenously, the drug is usually administered first by jet, repeated injections are carried out by drip.

The dose of the drug and the duration of treatment is set by the doctor individually, depending on the indications and severity of the disease.

In acute adrenal insufficiency a single dose of the drug is 100-200 mg, daily - 300-400 mg.

For severe allergic reactions prednisolone is administered at a daily dose of 100-200 mg for 3-16 days.

With bronchial asthma the drug is administered at a dose of 75 mg to 675 mg for a course of treatment from 3 to 16 days; in severe cases, the dose may be increased to 1400 mg per course of treatment or more with a gradual dose reduction.

For status asthmaticus administered at a dose of 500-1200 mg per day, followed by a decrease to 300 mg per day and the transition to maintenance doses.

With 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.

For shock refractory to standard therapy, at the beginning of therapy, they are usually injected in a jet, after which they switch to drip administration. If within 10-20 minutes the blood pressure does not increase, repeat the jet administration of the drug. After removing from the state of shock, drip administration is continued until blood pressure stabilizes. A single dose is 50-150 mg (in severe cases, up to 400 mg). Repeatedly the drug is administered after 3-4 hours. The daily dose can be 300-1200 mg (with subsequent dose reduction).

In acute hepatic-renal failure (with acute poisoning, in the postoperative and postpartum periods, etc.) enter 25-75 mg per day; if indicated, the daily dose can be increased to 300-1500 mg per day and above.

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

For acute hepatitis administered at 75-100 mg per day for 7-10 days. In case of poisoning with caustic fluids with burns of the digestive tract and upper respiratory tract, it is prescribed at a dose of 75-400 mg per day for 3-18 days.

If intravenous administration is not possible administered intramuscularly in the same doses. After stopping the acute condition, it is prescribed orally in tablets, followed by a gradual decrease in the dose. With prolonged use of the drug, the daily dose should be reduced gradually. Long-term therapy should not be stopped abruptly!

Children from 2 to 12 months - 2-3 mg / kg, from 1 to 14 years - 1-2 mg / kg intramuscularly; administered intravenously slowly (within 3 minutes). If necessary, this dose can be repeated after 20-30 minutes.

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 possibility of observing the circadian rhythm of prednisone administration.

From the endocrine system: reduced glucose tolerance, "steroidal" diabetes mellitus or manifestation of latent diabetes mellitus, adrenal suppression, Itsenko-Cushing's syndrome (moon face, pituitary-type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, muscle weakness, striae), delay 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, an increase in the 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 heart failure, changes in the electrocardiogram characteristic of hypokalemia, increased blood pressure, hypercoagulability, 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 side of the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased intracranial pressure, nervousness or anxiety, insomnia, dizziness, vertigo, cerebellar pseudotumor, headache, convulsions.

From the sense organs: 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, sudden loss of vision.

From the side of metabolism: increased excretion of calcium, 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: growth retardation and ossification processes 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, decreased muscle mass (atrophy).

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

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

Local reactions with 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 (especially dangerous is the introduction into the deltoid muscle).

When administered intravenously: arrhythmias, flushes of blood to the face, convulsions.

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

Overdose:

May increase dose-dependent side effects. It is necessary to reduce the dose of prednisolone.

Treatment: symptomatic.

Interaction:

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

Prednisolone increases the toxicity of cardiac glycosides (due to the resulting hypokalemia, the risk of developing arrhythmias increases).

Accelerates the excretion of acetylsalicylic acid, reduces its concentration in the blood (with the abolition of prednisolone, the concentration of salicylates in the blood increases and the risk of side effects increases).

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

Increases the metabolism of isoniazid, mexiletine (especially in "fast acetylators"), which leads to a decrease in their plasma concentrations.

Increases the risk of developing hepatotoxic reactions of paracetamol (induction of "liver" enzymes and the formation of a toxic metabolite of paracetamol).

Increases (with prolonged therapy) the content of folic acid. Hypokalemia caused by glucocorticosteroids can increase the severity and duration of muscle blockade against the background of muscle relaxants.

In high doses, it reduces the effect of somatropin.

Prednisolone reduces the effect of hypoglycemic drugs; enhances the anticoagulant effect of coumarin derivatives.

Weakens the effect of vitamin D on the absorption of calcium ions in the intestinal lumen.

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

Reduces the concentration of praziquantel in the blood.

Cyclosporine (inhibits metabolism) and (reduces clearance) increase toxicity.

Thiazide diuretics, carbonic anhydrase inhibitors, other glucocorticosteroids and amphotericin B increase the risk of hypokalemia, sodium-containing drugs - edema and increased blood pressure.

Non-steroidal anti-inflammatory drugs (NSAIDs) and increase the risk of ulceration of the mucous membrane of the gastrointestinal tract (GIT) and bleeding, in combination with non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect.

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

Amphotericin B and carbonic anhydrase inhibitors increase the risk of osteoporosis.

The therapeutic effect of glucocorticosteroids is reduced under the influence of phenytoin, barbiturates, ephedrine, theophylline, rifampicin and other inducers of microsomal liver enzymes (increased metabolic rate).

Mitotan and other inhibitors of adrenal function may necessitate an increase in the dose of glucocorticosteroids.

The clearance of glucocorticosteroids increases against the background of thyroid hormones.

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

Estrogens (including oral estrogen-containing contraceptives) reduce the clearance of glucocorticosteroids, prolong the half-life and their therapeutic and toxic effects.

The appearance of hirsutism and acne is facilitated by the simultaneous use of other steroid hormonal drugs - androgens, estrogens, anabolics, oral contraceptives.

Tricyclic antidepressants may increase the severity of depression caused by taking glucocorticosteroids (not indicated for the treatment of these side effects).

The risk of developing cataracts increases when used in combination with other glucocorticosteroids, antipsychotic drugs (neuroleptics), carbutamide and azathioprine.

Simultaneous administration with m-anticholinergics (including antihistamines, tricyclic antidepressants with m-anticholinergic activity), nitrates contributes to the development of an increase in intraocular pressure.

Special instructions:

During treatment with prednisolone (especially long-term), it is necessary to observe an ophthalmologist, control blood pressure, the state of water and electrolyte balance, as well as pictures of peripheral blood and blood glucose levels.

In order to reduce side effects, you can prescribe antacids, as well as increase the intake of potassium ions in the body (diet, potassium preparations). Food should be rich in proteins, vitamins, with limited content of fats, carbohydrates and salt.

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

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

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

With sudden cancellation, especially in the case of previous use of high doses, the development of a "withdrawal" syndrome (anorexia, nausea, lethargy, generalized musculoskeletal pain, general weakness) is possible, as well as an exacerbation of the disease for which it was prescribed. During treatment with prednisolone, vaccination should not be carried out due to a decrease in its effectiveness (immune response). When prescribing for intercurrent infections, septic conditions and tuberculosis, it is necessary to simultaneously treat with bactericidal antibiotics.

In children during the period of growth, glucocorticosteroids should be used only according to absolute indications and under the most careful supervision of the attending physician. Children who during the period of treatment were in contact with patients with measles or chickenpox are prescribed specific immunoglobulins prophylactically.

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

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

X-ray control of the osteoarticular system (spine, hand) is shown.

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

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

Influence on the ability to drive transport. cf. and fur.:

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Release form / dosage:

Solution for intravenous and intramuscular administration, 30 mg/ml.

Package:

1 ml solution in neutral glass ampoules.

10 ampoules with instructions for use and a knife for opening ampoules or an ampoule scarifier are placed in a cardboard box.

5 or 10 ampoules are placed in a blisters of polyvinyl chloride film or polyethylene terephthalate tape and aluminum foil or polyethylene-coated paper or without foil or without paper.

1 or 2 blister packs with instructions for use and a knife for opening ampoules or an ampoule scarifier are placed in a pack of cardboard.

When packing ampoules with a break ring or a break point, a knife for opening ampoules or an ampoule scarifier is not included.

Storage conditions:

In a place protected from light at a temperature not exceeding 15 ° C.

Keep out of the reach of children.

Best before date: Do not use after the expiry date stated on the package. Conditions for dispensing from pharmacies: On prescription Registration number: Close Instructions

One of the most commonly prescribed anti-inflammatory drugs is Prednisolone. In some cases, this tool is indispensable, and in some it can even save a person's life. They can treat both children and adults. Prednisolone is available in various dosage forms and dosages. And any patient should know not only about the advantages of the drug and its indications, but also its disadvantages and side effects.

Description

Prednisolone is a synthetic analogue of the adrenal hormone - hydrocortisone and has a similar effect to it. The main functions of the drug:

• anti-inflammatory,
• immunosuppressive,
• antiallergic,
• antishock.

The mechanism of action of the drug is still largely unknown. We can only say that it affects almost all stages of the inflammatory process, inhibits the synthesis of inflammatory mediators - cytokines and histamine, and prevents the migration of cells of the immune system.

Any drug that contains prednisolone acts on special glucocorticosteroid receptors located in various tissues. There are especially many such receptors in liver tissues.

Prednisolone reduces the permeability of cell walls and has a moderate vasoconstrictor effect. It also affects the metabolism of lipids, proteins, carbohydrates, sodium and calcium ions, retains water in the body.

The effect of the drug on protein metabolism is that it reduces the amount of albumin in plasma and increases their amount in the liver, reduces protein synthesis in muscle tissue.

The impact on lipid metabolism is to enhance the synthesis of higher fatty acids and triglycerides, redistribution of adipose tissue.

The effect on carbohydrate metabolism is expressed in increased absorption of glucose from the gastrointestinal tract, stimulating the flow of glucose from the liver into the blood. For these reasons, prednisone promotes hyperglycemia.

Prednisolone retains sodium in the body, but stimulates the excretion of potassium, reduces bone mineralization and slows down the absorption of calcium from the gastrointestinal tract.

The mechanism by which the anti-inflammatory effect of the drug is realized is versatile. First of all, prednisone prevents the release of inflammatory mediators from mast cells, reduces capillary permeability, and stabilizes cell membranes. In addition, prednisolone disrupts the synthesis of prostaglandins from arachidonic acid, cytokines (interleukins, a special protein - tumor necrosis factor).

Prednisolone also has an immunosuppressive effect. It prevents the interaction of various types of lymphocytes and their migration, reduces the intensity of the formation of antibodies, and blocks the release of interferons.

The antiallergic effect is explained by a decrease in the secretion of inflammatory mediators, inhibition of the release of histamine from mast cells, and suppression of the activity of lymphocytes in the blood. Prednisolone reduces the sensitivity of receptors in various tissues to inflammatory mediators.

The therapeutic effect of the drug in obstructive processes in the respiratory tract is explained by the effect on inflammatory processes, a decrease in swelling of the mucous membranes and mucus viscosity, and an increase in the sensitivity of adrenergic receptors to sympathomimetics.
In shock conditions, prednisolone increases blood pressure, reduces the permeability of vascular walls, has a membrane-protective effect, and activates liver enzymes involved in metabolic processes.

Also, the drug prevents the development of lymphoid and connective tissue.

Prednisolone in the form of an ointment, in addition to anti-inflammatory, anti-allergic and anti-edematous effects, also prevents itching.

In its anti-inflammatory activity, prednisolone is 4 times superior to hydrocortisone. However, prednisolone is not the strongest of the synthetic glucocorticosteroid hormones. In addition, it is 40% inferior to the natural adrenal hormone hydrocortisone in terms of mineralocorticoid activity.

The drug is able to inhibit the synthesis of corticotropin and endogenous glucocorticosteroids.

When taken orally in the form of tablets, the maximum plasma concentration is observed after 90 minutes, with intravenous administration - after 30 minutes. The active substance can be in the blood for a long time. The half-life is 200 minutes.

When should you take Prednisolone?

The scope of use of the drug is extremely wide, and it is often necessary to use it in various dosage forms in different situations. This means that not always the patient can freely switch from tablets to injections, and then, for example, to ointment.

In general, the drug is most often used to relieve symptoms of inflammatory processes of moderate and high severity. These processes can be localized in the following parts of the body:

• musculoskeletal system,
• blood system,
• lungs,
• gastrointestinal tract,
• muscle,
• nervous system,
• leather,
• eyes.

Also, one of the main areas of application of the drug is the fight against systemic allergic reactions, such as Quincke's edema and anaphylactic shock, especially when they take on a scale that threatens the functioning of the body. And the use of a medication in the form of an injection or taking a pill in a similar situation can save a person's life.

Another important area of ​​application of the drug, in which it is able to prevent the development of life-threatening processes, is anti-shock therapy. Prednisolone is often prescribed for various shock conditions. It can be cardiogenic, burn, surgical, toxic, traumatic shock. Here, Prednisolone is most often used in case of ineffectiveness of vasoconstrictors and other symptomatic therapy.

The drug is also used for such a dangerous complication as cerebral edema. This condition can occur as a result of trauma, infectious and inflammatory processes, surgical intervention.

Prednisolone is often prescribed for severe injuries, burns, including the gastrointestinal tract, and upper respiratory tract, and poisoning.

The drug is also used for severe bronchial asthma, systemic connective tissue diseases (systemic lupus erythematosus, scleroderma, rheumatoid arthritis).

Acute and chronic diseases of the joints, in which the doctor may prescribe Prednisolone:

• arthritis (gouty, psoriatic, juvenile),
• osteoarthritis (including post-traumatic),
• polyarthritis,
• humeroscapular periarthritis,
• ankylosing spondylitis,
• Still syndrome,
• bursitis,
• tenosynovitis,
• condylitis,
• synovitis

Prednisolone is often prescribed for skin diseases:

• pemphigus,
• eczema,
• dermatitis (contact, seborrheic, exfoliative, bullous herpetiformis),
• neurodermatitis,
• lyell syndrome,
• toxidermia,
• Stevens-Johnson syndrome.

Indications for taking the drug also include eye diseases of an allergic and inflammatory nature - allergic conjunctivitis, sympathetic ophthalmia, uveitis, optic neuritis. And the use of medication for such diseases helps not only to relieve swelling and inflammation, but often to avoid loss of vision.

Prednisolone is also prescribed for congenital adrenal hyperplasia, berylliosis, Lefler's syndrome, multiple sclerosis, thyrotoxicosis, acute hepatitis, hepatic coma, and severe kidney disease.

An extensive scope of the drug is diseases of the circulatory system and hematopoiesis. Diagnoses for which specialists may prescribe prednisolone include:

• agranulocytosis,
• panmyelopathy,
• (autoimmune hemolytic, erythrocytic, congenital hypoplastic),
• lymphocytic leukemia,
• myeloid leukemia,
• thrombocytopenia,
• lymphogranulomatosis.

Prednisolone is also prescribed for certain types of oncological diseases, for example, for lung cancer, multiple myeloma. In addition, the drug is useful in the treatment of complications of cancer, such as hypercalcemia. Prednisolone is also prescribed to reduce nausea and vomiting during treatment with cytostatic agents.

The ability of the drug to suppress the immune response is useful not only in the treatment of autoimmune diseases. Due to this feature, Prednisolone is prescribed to prevent rejection of transplanted donor organs.

One important circumstance should be noted - after all, many people forget about this minus of the drug. Despite the fact that the main purpose of Prednisolone is the fight against inflammation, this does not mean that the remedy will be effective in infectious diseases. Moreover, in case of diseases caused by bacteria or viruses, the drug is not recommended. Here it should be remembered that one of the properties of the drug is immune suppression. And the use of the drug can lead to the fact that bacteria and viruses in the body, exposed to Prednisolone, will feel at ease. Therefore, if the drug cannot be dispensed with in such a case, then it should be used as part of complex therapy, which should also include measures aimed at destroying pathogens, for example, taking antibiotics.

Often, Prednisolone is prescribed for replacement therapy, in case of insufficient functional activity of the adrenal glands. However, in this case, it should be borne in mind that the mineralocorticoid activity of the drug is lower than that of hydrocortisone. Therefore, a patient with insufficient adrenal function should be treated not only with prednisone, but also with mineralocorticoids.

Also, the remedy acts on the adrenal glands, inhibiting the production of their natural hormones. Therefore, with prolonged use of the drug, adrenal dysfunction can be observed, which becomes noticeable after the end of the intake. Over time, this usually goes away.

Tablets have the widest range of indications. They apply for:

• endocrine pathologies;
• connective tissue diseases, inflammation of the joints;
• rheumatism;
• chronic and acute allergic reactions;
• bronchial asthma, blood diseases, and the hematopoietic system;
• skin diseases;
• eye diseases;
• diseases of the gastrointestinal tract and lungs;
• beryllium;
• autoimmune kidney disease;
• cerebral edema (after parenteral therapy);
• for the prevention of vomiting during cytostatic therapy;
• to prevent transplant rejection.

Prednisolone in the form of injections is used for:

• shock conditions;
• allergic reactions, especially in severe and acute forms;
• swelling of the brain;
• connective tissue diseases, rheumatoid arthritis, systemic lupus erythematosus;
• severe form of bronchial asthma;
• thyrotoxic crisis;
• acute hepatitis, hepatic coma;
• acute adrenal insufficiency.

Prednisolone in the form of an ointment is mainly used in case of dermatological problems. These can be the following diseases:

• eczema,
• neurodermatitis,
• psoriasis,
• lupus erythematosus,
• dermatitis.

In this case, it is important that skin diseases are not caused by infectious causes. Otherwise, the medication can lead to suppression of the immune system and its use will only spur the development of the disease. That is why prednisolone in the form of an ointment is not prescribed for skin infections.

The drug in the form of drops is used in ophthalmology. Indications for the use of eye drops are:

• eye injury,
• keratitis,
• chronic allergic blepharoconjunctivitis,
• uveitis,
• sclerites,
• episcleritis,
• eye irritation in the postoperative period.

Release form

The pharmaceutical industry produces prednisolone in various forms, each of which is intended for use in certain diseases and situations in which the patient finds himself. For example, tablets are most suitable for the treatment of chronic inflammatory or allergic processes. For the treatment of skin diseases, it is best to use a local dosage form - ointment. For eye problems, special eye drops should be used. And in acute conditions, such as trauma, cerebral edema or anaphylactic shock, only injections can help - jet or drip.

Prednisolone tablets have two dosage options - 1 and 5 mg. The tablets also contain milk sugar, povidone, starch, stearic acid.

The solution for intravenous injection has a dosage of 30 and 15 mg per 1 ml. Some auxiliary substances can also be found in the composition of the solution:

• nicotinamide,
• sodium metabisulphite,
• disodium edetate,
• sodium hydroxide,
• water for injections.

Drops for use in eye diseases and ointment for the skin have a concentration of 0.5%. This means that 1 g of the drug contains 5 mg of the active substance. The composition of the ointment contains a number of auxiliary components:

• paraffin,
• methylparaben,
• stearic acid,
• emulsifier,
• propylparaben,
• glycerol,
• purified water.

Contraindications

The tool can not be used in all cases. However, here it is necessary to take into account the seriousness of the situation in which it is appointed. If we are talking about stopping a strong allergic reaction, such as anaphylactic shock, then all possible prohibitions fade into the background. After all, this is a life-threatening condition. Such indications are called vital. With vital indications, the only case when you can not take the remedy is its individual intolerance.

However, when it comes to long-term therapy with prednisolone, then situations where it cannot be taken are much more common. A fairly weighty list of contraindications should be attributed to the disadvantages of the drug.

As in the case of indications, contraindications for various dosage forms may not be the same. The list of contraindications for tablets and solution is the widest.

In general, the list of prohibitions is based on the types of effects that prednisone produces on the body. For example, despite the fact that the drug is prescribed for certain cardiovascular diseases, it cannot be used in acute or subacute myocardial infarction. This is due to the fact that prednisolone blocks the formation of scar tissue on the heart. As a result, the area of ​​necrosis on the heart may expand, and the heart may even rupture.

It should also be borne in mind that prednisolone affects the production of glucose in the body. This means that it can contribute to weight gain. Therefore, people with obesity should not use the remedy either. In addition, it stimulates the production of pepsin and hydrochloric acid in the stomach, which predetermines its prohibition in case of peptic ulcer of this organ and duodenum.

With caution, a remedy is prescribed in the form of tablets and a solution for:

• thyrotoxicosis;
• hypertension;
• renal and hepatic insufficiency;
• diabetes mellitus;
• Itsenko-Cushing's disease;
• obesity 3-4 degrees;
• systemic osteoporosis;
• psychosis, including history;
• poliomyelitis;
• glaucoma.

The disadvantage of the remedy (unlike other glucocorticosteroids) is that it is prohibited in violation of the metabolism of arachidonic acid.

Among the diseases of the gastrointestinal tract, in which the drug is prescribed with caution, include:

• gastritis,
• peptic ulcer of the stomach and duodenum,
• non-specific ulcerative colitis with the threat of perforation,
• esophagitis,
• peptic ulcer.

The drug should not be used in patients undergoing vaccination, as the weakening of the immune system caused by the drug may make it difficult to develop resistance to the disease against which the vaccine is directed. The prohibition period lasts for 2 months before vaccination and 2 weeks after this procedure.

Long-term use in children is also not recommended, since an excessive amount of prednisolone can adversely affect the formation of a young organism. In pediatric practice, the drug can only be used under strict medical supervision, in the minimum effective dose and in the shortest possible courses. In children, even local forms should be used with caution, since they enter the systemic circulation to a greater extent than in adults, due to the larger ratio of body area to its mass in children.

The number of contraindications for ointment and eye drops is less than for tablets and solution. And this is not surprising, because the medicine in the form of ointments and drops acts only at the local level, without penetrating into the systemic circulation. Therefore, there are much less disadvantages with this use of the drug.

However, Prednisolone ointment should not be used for:

• bacterial, viral and fungal skin lesions;
• tuberculosis;
• syphilis;
• skin tumors;
• acne;
• rosacea;
• open wounds;
• skin post-vaccination reactions;
• trophic ulcers.

Do not use the ointment for the treatment of infants (up to a year).

A woman should use the ointment with caution if she is pregnant or breastfeeding a child.

• increased intraocular pressure,
• keratitis caused by the herpes virus,
• viral diseases of the cornea and conjunctiva,
• eye infections,
• corneal epitheliopathy.

Due to the fact that the drug is not allowed in a large number of cases, before starting therapy, the patient should be examined for the presence of pathologies in which its use can lead to negative consequences. The study should include an examination of the cardiovascular system, stomach, urinary organs, eyes, blood tests (the amount of glucose and electrolytes), chest x-ray. During the period of therapy, periodic monitoring of electrolyte levels, blood pressure, glucose levels, and the state of the organs of vision is necessary. X-ray control of the condition of bones and joints is recommended.

Use during pregnancy and lactation

Many are probably interested in the question of whether it is possible to use the remedy during pregnancy. This is highly not recommended. The thing is that prednisolone, which is in its composition, penetrates into the body of the fetus, and as studies on animals have shown, it can produce a teratogenic effect, that is, negatively affect the development of the fetus. This effect is especially strong at the very beginning of pregnancy, in its first trimester. However, in other periods of pregnancy, the reception is also undesirable. In particular, in the third trimester, the fetus may develop adrenal atrophy.

However, in cases where a medication is indispensable, it is still prescribed to women who are expecting an addition to the family. But it should be remembered that during pregnancy, treatment must be carried out under the supervision of a doctor. After birth, a child whose mother took prednisolone may experience suppression of adrenal function.

Although a very small dose of the drug penetrates into breast milk (about 1% of the concentration in the blood), nevertheless, this is enough to have a negative effect on the body of the newborn. Therefore, in such cases, mothers are encouraged to stop breastfeeding.

Side effects

The drug affects various biochemical and physiological processes in the body. And this means that it affects various systems of the body and groups of organs.

The main systems from which side effects may occur when taking the medication:

• cardiovascular,
• nervous
• gastrointestinal tract,
• respiratory system,
• endocrine.

From the side of the endocrine system, the following types of side effects are possible:

• decreased glucose tolerance,
• steroid diabetes,
• adrenal suppression,
• Itsenko-Cushing's syndrome,
• delayed sexual development in children.

From the gastrointestinal tract, the following negative phenomena are possible:

• nausea,
• vomit,
• decreased appetite,
• gastric and duodenal ulcer,
• dyspepsia,
• hiccups.

Side effects from the cardiovascular system:

• arrhythmias,
• bradycardia,
• changes in ECG parameters,
• arterial hypertension.

From the side of the psyche and nervous system, the following disorders are possible:

• euphoria,
• disorientation,
• hallucinations,
• affective insanity,
• paranoia,
• increased intracranial pressure,
• nervousness,
• dizziness,
• headache,
• convulsions.

The following pathological phenomena associated with the eyes may also be observed:

• increased intraocular pressure up to damage to the optic nerve;
• bacterial, viral, or fungal eye infections;
• trophic changes in the cornea;
• sudden loss of vision due to crystallization of the active substance in the vessels of the eyes after parenteral administration to the head;

In addition, against the background of taking the medication, the following pathologies associated with metabolic disorders occur:

• accelerate the excretion of potassium from the body,
• body weight gain,
• fluid and sodium retention in the body,
• weight loss.

When taking the medication, hypokalemia syndrome often occurs, which is expressed in arrhythmias, severe fatigue and weakness, and muscle pain. In children, ossification processes can slow down and growth slows down. Therefore, the attending physician should monitor the growth dynamics of the child in the case of long-term therapy.

Other side effects:

• osteoporosis,
• bone necrosis,
• increased sweating,
• tendon rupture,
• delayed wound healing
• steroid acne,
• skin rash,
• candidiasis,
• exacerbation of infections
• increased blood clotting.

In tablets and solution for injection, the likelihood of systemic side effects is much higher than in local forms - drops and ointments. In addition, with injections, such phenomena as pain, the development of infections and numbness at the injection site are possible. With intramuscular injection, atrophy of the subcutaneous tissue is possible.

When using the ointment, steroid acne, burning, itching, irritation and dryness of the skin may occur.

The most dangerous side effect that occurs with prolonged use of eye drops is an increase in intraocular pressure. For this reason, drops containing prednisolone are not recommended for more than 10 days. It is also possible to develop a posterior capsular cataract.

Of course, the number of cases when after taking the patient would have severe reactions is a small percentage. However, such a situation is possible, and you should be prepared for it.

Also, to ensure the minimum number of negative manifestations during therapy, the patient should adhere to a diet. The diet should include a minimum of fats, salt and carbohydrates, a large amount of proteins and vitamins.

After the end of long-term therapy within a year, the development of acute adrenal insufficiency is possible.

In old age, the number of adverse reactions increases.

An overdose when taking tablets or parenteral administration is manifested in an increase in side effects. Symptomatic therapy and gradual withdrawal of the drug are recommended. With an overdose of ointment and eye drops, hypersensitivity reactions are possible. In the case of an ointment, a complete cessation of the use of the product is possible.

Means in the form of tablets or solution for injection can cause side effects in the form of dizziness, so patients are not recommended to drive vehicles or perform work that requires concentration during the course of therapy. After instillation of the suspension into the eyes, lacrimation is possible, therefore, immediately after this procedure, the patient should also refrain from such activities.

Instructions for use

The standard daily dose in tablets for most diseases is 20-30 mg. This means that 4-6 tablets are allowed per day. Maintenance dose - 5-10 mg. In severe cases, a dose higher than the standard one, up to 100 mg / day, may be prescribed.

For children, the daily dosage is calculated based on body weight - 1-2 mg / kg. The received value is distributed on 4-6 receptions. As a maintenance dosage, a value calculated based on 0.3-0.6 mg / kg per day is used.

What time of day is best to take the tablets? If the dose is small, then all tablets are best taken in one morning dose. If the dose is significant, then it can be divided into 2-4 doses, with most of the daily dose taken in the morning. This circumstance is due to the fact that in humans, the release of the main dose of natural adrenal hormones occurs just in the morning. Thus, such a regimen does not allow the body to stray too much from the natural rhythm.

The tablets are best taken with or immediately after meals.

And a few more words should be said about how the medication should be stopped after its long use. The disadvantage of the drug is the effect of the withdrawal syndrome inherent in it. In no case should you abruptly stop taking the drug after a long course of treatment, since in this case a withdrawal syndrome and worsening of well-being may occur, as well as an exacerbation of the symptoms of the disease for which the therapy was prescribed. It is necessary to reduce the dose gradually, until the body gets used to the low doses of hormones supplied with the medication and switches to its own.

The method for reducing the dosage is as follows - a decrease in the amount of medication taken occurs every 3-5 days, and at the same time, 5 mg is deducted from the dosage, then 2.5 mg each. First of all, cancel the most recent receptions. The longer the period of therapy was, the slower it is necessary to carry out the procedure for reducing the dosage.

Injections

The dose is set by the doctor individually, depending on the severity of the disease and the patient's condition. The solution can be administered intravenously by drip, intravenous bolus, or intramuscularly. If therapy begins with a jet injection, then subsequently they switch to a drip form of administration.

In acute adrenal insufficiency, a single dose is 100-200 mg. The course of treatment is from 3 to 16 days.

In bronchial asthma, the daily dose can range from 75 to 675 mg. The course of treatment is also 3-16 days.

With a thyrotoxic crisis, the daily dose is 200-300 mg, in severe cases - up to 1000 mg. The duration of therapy is up to 6 days.

In shock conditions, a single dose is 50-150 mg, in severe cases - up to 400 mg. After the first injection, this procedure is repeated after 3-4 hours. The daily dose is 300-1200 mg.

In acute liver and kidney failure, the daily dose is 25-75 mg, in severe cases, 300-1500 mg per day should be used.

In rheumatoid arthritis and systemic lupus erythematosus, 75-125 mg per day should be used. The course of treatment is 7-10 days.

In acute hepatitis, the duration of the course is also 7-10 days, and the dose is 70-100 mg per day.

Burns of the digestive tract and upper respiratory tract require injections at a daily dosage of 75-400 mg. The duration of therapy is 3-18 days.

If prednisolone cannot be administered intravenously for any reason, then intramuscular administration is used in the same doses.

As in the case of taking tablets, the dose for parenteral administration is gradually reduced before cancellation. Abruptly interrupt the course of treatment is prohibited.

It is forbidden to mix prednisolone and other medicines in the same solution due to the high risk of pharmacological incompatibility.

Instructions for using the ointment

The ointment should be applied in a thin layer to the surface of the skin. Bandages can be used to enhance the effect. According to the instructions, the ointment is recommended to be applied 1-3 times a day, the duration of the course is 1-2 weeks. After the disappearance of the symptoms of the disease, prophylactic use of the ointment is allowed, but the treatment period should still not exceed 2 weeks. Places with thicker skin, as well as places from which the ointment is easily erased, are allowed to be lubricated more often than others.

The ointment should not be applied to the skin around the eyes due to the risk of developing cataracts.

Instructions for using eye drops

Drops should be instilled into the conjunctival sac. The standard dose is 1-2 drops in the affected eye. Drops should be applied 2-4 times a day. The duration of the course depends on the disease and is determined by the attending physician.

The opened bottle with drops should be used within a month.

drug interaction

Many medications and prednisone can cause side effects when taken together.

Phenobarbital, theophylline, ephedrine lead to a decrease in the concentration of the active substance in the body. Diuretics and prednisolone, taken together, lead to an acceleration of the withdrawal of potassium from the body. Medicines containing sodium contribute to edema and high blood pressure. The use of cardiac glycosides and prednisolone together increases the risk of ventricular extrasystoles.

Prednisolone enhances the effect of coumarin, other anticoagulants and thrombolytics, which can lead to massive bleeding and ulcers in the gastrointestinal tract. Also, the formation of ulcers in the gastrointestinal tract contributes to alcohol and NSAIDs. If the doctor prescribed any NSAIDs and prednisolone at the same time, then in this case the dose of prednisolone should be reduced. Indomethacin increases the risk of side effects of prednisone.

Prednisolone enhances the toxic effects of paracetamol on the liver, reduces the effectiveness of insulin, hypoglycemic and antihypertensive drugs.

With the combined use of prednisolone and anticholinergics, tricyclic antidepressants and nitrates, intraocular pressure may increase.

Other steroid drugs - estrogens, anabolics, androgens contribute to the occurrence of hirsutism and the appearance of acne. In addition, estrogens, including those contained in oral contraceptives, enhance the therapeutic effect of prednisolone, as well as its toxic effects on the body.

Drugs that reduce the activity of the adrenal glands may require an increase in the dose of the drug.

Live antiviral vaccines increase the risk of developing viral infections.

Antipsychotics and prednisolone used together increase the risk of developing cataracts.

The use of antacids and prednisolone leads to a decrease in its absorption.

Tricyclic antidepressants should not be used if prednisolone-related depression occurs, as they contribute to its aggravation.