home Auditorium 8 The effect of prednisolone on the body. How long can you take Prednisolone? Self-administration of prednisolone

The effect of prednisolone on the body. How long can you take Prednisolone? Self-administration of prednisolone

Prednisolone is a synthetic dehydrogenated analogue of the glucocorticosteroid hormone hydrocortisone. The drug suppresses inflammatory processes, prevents the development of allergic reactions, has an immunosuppressive and anti-shock effect, increases the reactivity of beta-adrenergic receptors to adrenaline and norepinephrine synthesized in the body. The effect of prednisolone one way or another covers almost the entire body, because specific cytoplasmic glucocorticosteroid receptors are found in many organs and tissues. By interacting with them, the drug becomes part of a complex that enhances protein synthesis, including enzymes that control vital processes. The anti-inflammatory effect of prednisolone is due to the suppression of the release of inflammatory mediators by eosinophils and mastocytes; inducing the reproduction of lipomodulins and reducing the number of mast cells that synthesize hyaluronic acid; decreased permeability of capillary walls; stabilization of lysosomal membranes and organelle membranes. Prednisolone acts on all parts of inflammation: it suppresses the formation of inflammatory mediators prostaglandins at the level arachidonic acid, inhibits the production of pro-inflammatory cytokines, increases the resistance of cell membranes to the effects of unfavorable factors. The “hand” of prednisolone can be clearly seen in the ongoing changes in the metabolism of proteins, carbohydrates, and lipids. Thus, at the level of protein metabolism, the drug reduces the amount of globulins in the blood, stimulates the synthesis of albumins in the kidneys and liver, suppresses the synthesis and promotes the breakdown of proteins in muscle tissue. As part of fat metabolism, prednisolone stimulates the formation of triglycerides and higher fatty acids, redistributes areas of fat accumulation in favor of the abdomen, shoulder girdle and face, and causes hypercholesterolemia. Effect of the drug on carbohydrate metabolism is expressed in an increase in the absorption of carbohydrates from the gastrointestinal tract, activation of glucose-6-phosphatase (as a result of which glucose flows more intensively from the liver into the blood), activation of gluconeogenesis, promoting the development of hyperglycemia.

As for water-electrolyte metabolism, here prednisolone manifests itself by retention of sodium and water in the body, increased elimination of potassium, decreased absorption of calcium in the gastrointestinal tract, “washing out” of calcium from bone tissue and an increase in its excretion by the kidneys, a decrease in bone mineral density. The immunosuppressive effect of the drug is associated with the regression it causes lymphoid tissue, suppressing the differentiation and proliferation of lymphocytes, preventing the migration of B cells and the interaction of B and T lymphocytes, inhibiting the release of cytokines, suppressing the synthesis of antibodies. The antiallergic effect of prednisolone is due to the suppression of the synthesis and release of allergy mediators, inhibition of histamine secretion by mastocytes and basophils, a decrease in the number of free basophils, inhibition of the proliferation of lymphoid and connective tissue, a decrease in the number of T- and B-lymphocytes, desensitization of effector cells in relation to allergy mediators, suppression of antibody formation .

Prednisolone is available in the form of tablets, injection solution, and ointment for external use. The dosage regimen of the drug and the duration of the drug course are established by the doctor in individually, based on the indications and severity of the disease. The daily dose is recommended to be taken at a time, taking into account the intensity of secretion of endogenous glucocorticosteroids in the time interval from 6 to 8 am. High daily dose It can be divided into several doses, taking most of the drug in the morning. Before starting pharmacotherapy, the patient should be examined to identify contraindications. This examination should include a cardiac examination, chest x-ray, examination of the gastrointestinal and urogenital tract, visual organs, blood picture, glucose and electrolyte levels in the blood.

Pharmacology

Prednisolone is a synthetic glucocorticosteroid drug, a dehydrated analogue of hydrocortisone. It has anti-inflammatory, anti-allergic, immunosuppressive, anti-shock effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

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

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

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

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

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

Water-electrolyte metabolism: retains sodium and water in the body, stimulates the excretion of potassium (mineralocorticoid activity), reduces the absorption of calcium from the gastrointestinal tract, causes “leaching” of calcium from the bones and increases its renal excretion, reduces the mineralization of bone tissue.

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

The 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, suppression of the development of lymphoid and connective tissue, a decrease in the number of T- and B-lymphocytes, mast cells , reducing the sensitivity of effector cells to allergy mediators, suppressing antibody formation, changing the body’s immune response.

For obstructive diseases respiratory tract the effect is due mainly to inhibition of inflammatory processes, prevention or reduction of the severity of edema of the mucous membranes, reduction of eosinophilic infiltration of the submucosal layer of the bronchial epithelium and deposition of circulating immune complexes in the bronchial mucosa, as well as inhibition of erosion and desquamation of the mucosa. 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 (ACTH) and secondarily the synthesis of endogenous glucocorticosteroids.

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

Pharmacokinetics

When taken orally, prednisolone is well absorbed from the gastrointestinal tract. Cmax in the blood is reached 1-1.5 hours after oral administration. Up to 90% of the drug binds to plasma proteins: transcortin (cortisol-binding globulin) and albumin. Prednisolone is metabolized in the liver, partially in the kidneys and other tissues, mainly by conjugation with glucuronic and sulfuric acids. Metabolites are inactive.

It is excreted in the bile and kidneys by glomerular filtration and is 80-90% reabsorbed by the tubules. 20% of the dose is excreted unchanged by the kidneys. T1/2 from plasma after oral administration is 2-4 hours.

Release form

30 pcs. - bottles (1) - cardboard packs.

Dosage

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

It is recommended to take the entire daily dose of the drug once or twice the daily dose every other day, taking into account circadian rhythm endogenous secretion of glucocorticosteroids in the interval from 6 to 8 am. A high daily dose can be divided into 2-4 doses, with a larger dose taken in the morning. The tablets should be taken orally during or immediately after meals with a small amount of liquid.

In acute conditions and as replacement therapy for adults, an initial dose of 20-30 mg/day is prescribed, the maintenance dose is 5-10 mg/day. If necessary, the initial dose can be 15-100 mg/day, maintenance - 5-15 mg/day.

For children, the initial dose is 1-2 mg/kg body weight/day in 4-6 doses, maintenance dose is 300-600 mcg/kg/day.

Upon receipt therapeutic effect the dose is gradually reduced - 5 mg, then 2.5 mg at intervals of 3-5 days, first canceling later doses. With long-term use of the drug, the daily dose should be reduced gradually. Long-term therapy should not be stopped suddenly! The maintenance dose is discontinued more slowly the longer the glucocorticosteroid therapy is used.

In case of stressful effects (infection, allergic reaction, trauma, surgery, mental overload), in order to avoid exacerbation of the underlying disease, the dose of prednisolone should be temporarily increased (by 1.5-3, and in severe cases - by 5-10 times).

Overdose

The side effects described above may increase. It is necessary to reduce the dose of prednisolone. Treatment is symptomatic.

Interaction

The simultaneous administration of prednisolone with inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) leads to a decrease in its concentration.

Co-administration of prednisolone with diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B may lead to increased excretion of potassium from the body.

The simultaneous administration of prednisolone with sodium-containing drugs leads to the development of edema and increased blood pressure.

Co-administration of prednisolone with amphotericin B increases the risk of developing heart failure.

The simultaneous administration of prednisolone with cardiac glycosides worsens their tolerability and increases the likelihood of developing ventricular extrasystole (due to hypokalemia).

Simultaneous administration of prednisolone with indirect anticoagulants- prednisolone enhances the anticoagulant effect of coumarin derivatives.

The simultaneous administration of prednisolone with anticoagulants and thrombolytics increases the risk of bleeding from ulcers in the gastrointestinal tract.

The simultaneous administration of prednisolone with ethanol and NSAIDs increases the risk of erosive and ulcerative lesions in the gastrointestinal tract and the development of bleeding (in combination with NSAIDs in the treatment of arthritis, it is possible to reduce the dose of glucocorticosteroids due to the summation of the therapeutic effect).

The simultaneous administration of prednisolone with paracetamol increases the risk of hepatotoxicity (induction of liver enzymes and the formation of a toxic metabolite of paracetamol).

The simultaneous administration of prednisolone with acetylsalicylic acid accelerates its elimination and reduces its concentration in the blood (when prednisolone is discontinued, the level of salicylates in the blood increases and the risk of side effects increases).

The simultaneous administration of prednisolone with insulin and oral hypoglycemic drugs and antihypertensive drugs reduces their effectiveness.

The simultaneous administration of prednisolone with vitamin D reduces its effect on the absorption of Ca 2+ in the intestine.

The simultaneous administration of prednisolone with growth hormone reduces the effectiveness of the latter, and with praziquantel - its concentration.

The simultaneous administration of prednisolone with m-anticholinergics (including antihistamines and tricyclic antidepressants) and nitrates increases intraocular pressure.

The simultaneous administration of prednisolone with isoniazid and mexiletine increases the metabolism of isoniazid and mexiletine (especially in “fast” acetylators), which leads to a decrease in their plasma concentrations.

Co-administration of prednisolone with carbonic anhydrase inhibitors and amphotericin B increases the risk of developing osteoporosis.

The simultaneous administration of prednisolone with indomethacin - displacing prednisolone from its connection with albumin, increases the risk of developing its side effects.

The simultaneous administration of prednisolone with ACTH enhances the effect of prednisolone.

The simultaneous administration of prednisolone with ergocalciferol and parathyroid hormone prevents the development of osteopathy caused by prednisolone.

The simultaneous administration of prednisolone with cyclosporine and ketoconazole - cyclosparine (inhibits metabolism) and ketoconazole (reduces clearance) increases toxicity.

The appearance of hirsutism and acne is facilitated by the simultaneous use of other steroid hormonal drugs (androgens, estrogens, anabolic steroids, oral contraceptives).

The simultaneous administration of prednisolone with estrogens and oral estrogen-containing contraceptives reduces the clearance of prednisolone, which may be accompanied by an increase in the severity of its therapeutic and toxic effects.

Concomitant administration of prednisolone with mitotane and other inhibitors of adrenal function may necessitate an increase in the dose of prednisolone.

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

With simultaneous use of prednisolone with antipsychotics (neuroleptics) and azathioprine, the risk of developing cataracts increases.

The simultaneous administration of antacids reduces the absorption of prednisolone.

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

When used concomitantly with immunosuppressants, the risk of developing infections and lymphoma or other lymphoproliferative disorders associated with the Epstein-Barr virus increases.

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

Increases (with long-term therapy) the content of folic acid.

Hypokalemia caused by glucocorticosteroids can increase the severity and duration of muscle blockade due to muscle relaxants.

In high doses, it reduces the effect of somatropin.

Side effects

The incidence and severity of side effects depends on the duration of use, the size of the dose used and the ability to comply with the circadian rhythm of prednisolone administration. When using prednisolone, the following may occur:

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

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

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

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

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

From the metabolic side: increased excretion of calcium, hypocalcemia, increased body weight, negative nitrogen balance (increased breakdown of proteins), increased sweating.

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

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

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

Allergic reactions: skin rash, itching, anaphylactic shock.

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

Indications

Contraindications

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

The drug contains lactose. Patients with rare diseases should not take the drug hereditary diseases such as lactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

Features of application

Use during pregnancy and breastfeeding

During pregnancy (especially in the first trimester) it is used only for health reasons.

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

Use for liver dysfunction

Carefully

severe chronic liver failure.

Use for renal impairment

Carefully

severe chronic renal disease, nephrourolithiasis.

Use in children

absolute indications

special instructions

Before starting treatment (if impossible due to the urgency of the condition, during treatment), the patient should be examined to identify possible contraindications. Clinical examination should include examination of the cardiovascular system, x-ray examination of the lungs, examination of the stomach and duodenum, urinary system, and organs of vision; control of blood formula, glucose and electrolytes in blood plasma. During treatment with prednisolone (especially long-term), observation by an ophthalmologist, monitoring of blood pressure, water and electrolyte balance, as well as peripheral blood patterns and blood glucose levels are necessary.

In order to reduce side effects, antacids can be prescribed, as well as increasing the intake of potassium in the body (diet, potassium supplements). Food must be rich in proteins, vitamins, with limited fat, carbohydrates and table salt.

The effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis.

The drug may worsen existing emotional instability or psychotic disorders. If a history of psychosis is indicated, prednisolone in high doses is prescribed under the strict supervision of a physician.

IN stressful situations during maintenance treatment (eg surgical operations, trauma or infectious diseases), the dose of the drug should be adjusted due to the increased need for glucocorticosteroids.

Patients should be closely monitored for a year after the end of long-term prednisolone therapy due to possible development relative insufficiency of the adrenal cortex in stressful situations.

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

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

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

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

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

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

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

Prednisolone in patients with latent infectious kidney diseases and urinary tract can cause leukocyturia, which may have diagnostic value.

Prednisolone increases the content of 11- and 17-oxyketocorti metabolites. In Addison's disease, simultaneous administration of barbiturates should be avoided - there is a risk of developing acute adrenal insufficiency (Addisonian crisis).

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

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

Important: description of the drug Prednisolone is not intended for prescribing treatment without the participation of a doctor.

Instructions for use:

Pharmacological properties

Pharmacodynamics

It has anti-inflammatory, antiallergic, immunosuppressive, antishock and antitoxic effects. In relatively large doses inhibits the activity of fibroblasts, the synthesis of collagen, reticuloendothelium and connective tissue (inhibition of the proliferative phase of inflammation), delays the synthesis and accelerates the catabolism of protein in muscle tissue, but increases its synthesis in the liver.

The antiallergic and immunosuppressive properties of the drug are due to 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, suppression of antibody production.

The antishock effect of the drug is due to an increase in the vascular response to endo- and exogenous vasoconstrictor substances, with 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 the stimulation of protein synthesis processes in the liver and the acceleration of inactivation of endogenous toxic metabolites and xenobiotics in it, as well as with an increase in the stability of cell membranes, incl. hepatocytes.

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 release of insulin. Inhibits the uptake of glucose by fat cells, which leads to activation of lipolysis.

However, due to increased insulin secretion, lipogenesis is stimulated, which promotes fat accumulation. Reduces calcium absorption in the intestine, increases its leaching from bones and excretion by the kidneys.

Suppresses the release of adrenocorticotropic hormone and b-lipotropin by the pituitary gland, and therefore, with long-term use, the drug can contribute to the development of functional insufficiency of the adrenal cortex.

The main factors limiting long-term prednisone therapy are osteoporosis and Itsenko-Cushing 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 threshold for convulsive readiness. Stimulates excess secretion of hydrochloric acid and pepsin in the stomach, which may contribute to the development of peptic ulcers.

Pharmacokinetics

When administered intramuscularly, it is absorbed into the blood quickly, however, compared to achieving maximum level In the blood, the pharmacological effect of the drug is significantly delayed and develops within 2-8 hours.

In plasma, most of 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 albumin is observed, which can cause an increase in the free fraction of prednisolone and, as a consequence, the manifestation of its toxic effect when using normal 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 glucuronidated or sulfated and excreted by the kidneys in the form of conjugates.

About 20% of prednisolone is excreted from the body unchanged by the kidneys; a small part is excreted in bile. In liver diseases, the metabolism of prednisolone slows down and the degree of its binding to plasma proteins decreases, which leads to an increase in the half-life of the drug.

Indications for use of Prednisolone

Intramuscular, intravenous administration

Systemic connective tissue diseases

systemic lupus erythematosus,
dermatomyositis,
scleroderma,
periarteritis nodosa,
Bekhterev's disease.

Hematological diseases

Skin diseases

Replacement therapy

Addison's crisis.

Emergency conditions

severe forms of nonspecific 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 injection

chronic polyarthritis,
osteoarthritis of large joints,
rheumatoid arthritis,
post-traumatic arthritis,
arthrosis

Directions for use and doses

Mixing and simultaneous use of prednisolone with other drugs in the same infusion system or syringe is not allowed! The drug is prescribed for intravenous, intramuscular or intra-articular administration. The dose of prednisolone depends on the severity of the disease.

For the treatment of adults, the daily dose is 4-60 mg intravenously or intramuscularly. For children, the drug is prescribed intramuscularly (deep into the gluteal muscle) strictly according to indications and under the supervision of a physician: children aged 6-12 years – 25 mg/day, over 12 years – 25–50 mg/day.

The duration of use and the number of injections of the drug are determined individually. For Addison's disease, the daily dose for adults is 4-60 mg intravenously or intramuscularly.

In severe forms of ulcerative colitis, 8-12 ml/day (240-360 mg Prednisolone) for 5-6 days, in severe forms of Crohn's disease - 10-13 ml/day (300-390 mg Prednisolone) for 5 -7 days.

In emergency situations, prednisolone is administered intravenously, slowly (over about 3 minutes) or drip, at a dose of 30-60 mg.

If intravenous infusion is difficult, the drug is administered intramuscularly, deeply. With this method of administration, the effect develops more slowly. If necessary, the drug is re-administered intravenously or intramuscularly at a dose of 30-60 mg every 20-30 minutes. In some cases, an increase in the indicated dose is allowed, which is decided by the doctor individually in each specific case.

For adults, the dose of intra-articular prednisolone is 30 mg for large joints, 10-25 mg for medium-sized joints and 5-10 mg for small joints. The drug is administered every 3 days. The course of treatment is up to 3 weeks.

Features of application

For 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 dosage regimen of the latter.

In patients with thrombocytopenic purpura, the drug is used only intravenously. After cessation of treatment, withdrawal syndrome, adrenal insufficiency, and exacerbation of the disease for which prednisolone was prescribed may occur.

If, after finishing treatment with prednisolone, functional adrenal insufficiency is observed, 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 over 7-10 days).

Because of the risk of developing hypercortisolism, a new course of treatment with cortisone, after a previous long-term treatment with prednisone over several months, should always be started with low initial doses (except in acute life-threatening conditions).

Electrolyte balance should be monitored especially carefully during combined use prednisolone with diuretics. At long-term treatment In order to prevent hypokalemia with prednisolone, 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, observation by an ophthalmologist is necessary. If there is a history of psoriasis, prednisolone in high doses is used with extreme caution. If there is a history of psychosis or seizures, prednisolone should be used only in minimal effective doses.

Also prescribed with caution after a recent myocardial infarction (in patients with acute, subacute myocardial infarction, expansion of the focus of necrosis, slowdown in the formation of scar tissue, and rupture of the heart muscle are possible).

It is prescribed with particular caution for liver failure, conditions that cause the occurrence of hypoalbuminemia, and obesity of the 3rd - 4th degree. Women during menopause need to undergo research regarding possible occurrence osteoporosis.

When treated with glucocorticoids over a long period of time, it is recommended to regularly monitor arterial pressure, determine the level of glucose in urine and blood, conduct a stool test for occult blood, tests for blood clotting indicators, x-ray monitoring of the spine.

Before starting treatment with glucocorticoids, a thorough examination of the gastrointestinal tract should be performed to exclude gastric and duodenal ulcers.

Side effects

Development of severe adverse reactions depends on the dose and duration of treatment. Adverse reactions usually develop with long-term treatment with the drug. Over a short period, the risk of their occurrence is unlikely.

Infections and infestations

Increased sensitivity to bacterial, viral, fungal infections, their severity with masking of symptoms, opportunistic infections.

Blood system 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 clotting may increase, which leads to thrombosis and thromboembolism.

Endocrine system and metabolism

Suppression 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 tolerance to carbohydrates, increased need for insulin and oral hypoglycemic drugs, hyperlipidemia, negative nitrogen and calcium balance, increased appetite, impaired mineral metabolism and electrolyte balance, hypokalemic alkalosis, hypokalemia, possible fluid and sodium retention in the body.

Mental disorders

Irritability, euphobia, depression, suicidal tendencies, insomnia, unstable 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 disc in children.

Nervous system

Increased intracranial pressure, epileptic seizures, peripheral neuropathies, paresthesia, dizziness, headache, autonomic disorders.

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.

The cardiovascular system

Myocardial rupture due to myocardial infarction, arterial hypo- or hypertension, bradycardia, combined ventricular arrhythmia, asystole (due to rapid administration drug), atherosclerosis, thrombosis, vasculitis, heart failure, peripheral edema.

The immune system

Allergic reactions that cause anaphylactic shock with a fatal outcome, angioedema, allergic dermatitis, changes in reaction to skin tests, relapse of tuberculosis, immunosuppression.

Gastrointestinal tract

Nausea, bloating, bad taste in the mouth, dyspepsia, peptic ulcers with perforation and bleeding, esophageal ulcer, esophageal candidiasis, pancreatitis, gallbladder perforation, stomach bleeding, local ileitis and ulcerative colitis. During the use of the drug, an increase in ALT, AST and alkaline phosphatase may be observed, which is usually not important and is reversible after discontinuation of the drug.

Leather

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

Musculoskeletal system

Proximal myopathy, osteoporosis, tendon rupture, muscle weakness, atrophy, myopathy, fractures of the spine and long bones, aseptic osteonecrosis. Urinary system: increased risk of urolith formation and Instructions for use: leukocytes and red blood cells in the urine without obvious kidney damage.

Are common

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

With abrupt withdrawal of the drug, withdrawal syndrome is possible, the severity of symptoms depends on the degree of adrenal atrophy, headache, nausea, pain in the adrenal glands are observed. abdominal cavity, dizziness, anorexia, weakness, mood changes, lethargy, fever, myalgia, arthralgia, rhinitis, conjunctivitis, skin pain, 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, leucoderma), skin atrophy, sterile abscesses, rarely - lipoatrophy.

Interaction with other drugs

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

Salicylates and other non-steroidal anti-inflammatory drugs: Concomitant use of salicylates, indomethacin and other non-steroidal anti-inflammatory drugs may increase the likelihood of gastric ulcers. Prednisolone reduces the level of salicylates in the blood serum, increasing their renal clearance.

Caution is necessary when reducing the dose of prednisolone during long-term concomitant use. Hypoglycemic drugs: Prednisolone partially inhibits the hypoglycemic effect of oral hypoglycemic agents and insulin. Hepatic enzyme inducers, for example, barbiturates, phenytoin, pyramidone, carbamazepine and rifampicin increase the systemic clearance of prednisolone, thereby reducing the effect of prednisolone by almost 2 times.

CYP3A4 inhibitors, such as erythromycin, clarithromycin, ketoconazole, diltiazem, aprepitant, itraconazole and oleandomycin, increase the elimination and plasma levels of prednisolone, which increases the therapeutic and side effects of prednisolone.

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

Fluoroquinolones: Concomitant use may cause tendon damage. Amphotericin, diuretics and laxatives: Prednisolone may increase potassium excretion in patients receiving these drugs concomitantly.

Immunosuppressants: Prednisolone has active immunosuppressive properties, which may cause an increase in therapeutic effects or the risk of developing various adverse reactions when used simultaneously with other immunosuppressants.

Only some of them can be explained by pharmacokinetic interactions. Glucocorticoids increase the antiemetic effectiveness of antiemetic drugs that are used in parallel during therapy with anticancer drugs that cause vomiting.

Corticosteroids may increase plasma concentrations of tacrolimus when used concomitantly; when they are discontinued, plasma concentrations of tacrolimus decrease. 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. Emergency vaccines may be used during drug therapy.

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

Others: Two serious cases of acute myopathy have been reported in elderly patients who took doxocarium chloride and high-dose 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 transmission blockers (for example, pancuronium).

Cases of seizures have been reported with the simultaneous use of prednisolone and cyclosporine. Because coadministration of these drugs causes mutual inhibition of metabolism, it is likely that seizures and other side effects associated with the use of each of these drugs as monotherapy may occur more frequently when administered concomitantly.

Concomitant use may cause an increase in plasma concentrations of other drugs. Antihistamines reduce the effect of prednisolone. When prednisolone is used simultaneously with antihypertensive drugs, the effectiveness of the latter may be reduced.

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 form tuberculosis, glaucoma, cataracts, productive symptoms with mental illness, psychosis, depression; systemic mycosis, herpetic diseases, syphilis, severe myopathy (except for myasthenia gravis), poliomyelitis (except for the bulbar-encephalitic form), pregnancy and lactation. For intra-articular injections – infections at the injection site.

Overdose

Symptoms

In case of 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, possible development of symptoms of hypercortisolism: weight gain, development of edema, arterial hypertension, glucosuria, hypokalemia.

In children with an overdose, suppression of the hypothalamic-pituitary-adrenal system, Itsenko-Cushing syndrome, decreased excretion of growth hormone, and increased intracranial pressure is possible. There is no specific antidote.

Treatment

Stopping the use of the drug symptomatic therapy, if necessary, correction of electrolyte balance.

Questions and answers about the drug "Prednisolone"

Question:Hello, our daughter is 5 years old. We were admitted to the hematology department with a diagnosis of hemorrhagic vasculitis in the very mild form(only rash on legs). At the hospital they gave me a deep bath and injected him with heparin. Thank God the stains are almost gone. When I was discharged, I was prescribed prednisolone 3.5 tablets per day for 2 weeks, followed by a decrease. After 10 days, we abruptly stopped giving it, as the child began to gain weight. We haven't drunk for 3 days now. The child feels fine. We were scared that there might be consequences due to a sudden refusal. Please tell me, if the child feels fine for the 3rd day, should we be afraid of anything?

Answer: Dangerous consequences that occur after stopping Prednisolone therapy include: return of pathological symptoms, including pain syndrome; headache; sudden fluctuations in body weight; worsening mood; digestive disorders. In this case, it is recommended to resume taking the drug, and then, under the supervision of a doctor, gradually reduce the single and daily dosages. Monitor the child's condition; if it worsens, contact your doctor.

Question:Hello. Red rashes with white dots appeared on the skin, like nettles. What can happen from the raspberries eaten last evening, but what happens on nervous soil. They prescribed us to drink Zodak at home, drink Enterosgel and a diet. And there in the hospital I got an injection with uprastin and prednisolone. That’s actually the question, suprastin is understandable, but why prednisolone?

Answer: Hello. Prednisolone is used to relieve shock and severe allergic reactions.

Question:Hello! My child is 7 months old. fell ill with the flu, or an acute respiratory infection (during a flu epidemic) with all the symptoms. At the children's clinic they told me that to alleviate the condition and relieve spasm of the larynx, I need to inject no-shpu. Together with no-shpa we were injected with prednisolone. At that time I didn’t know what kind of drug it was, because... I haven't encountered him. The nurse said that it was an anti-inflammatory, not an antibiotic - and I agreed. In the evening the child had a stomach ache, cramping pain and there was foamy diarrhea. Now there is no diarrhea, but he still poops differently than before. The smell is somewhat sour and the consistency of the stool is thinner than before. I’ve read a lot about prednisolone on the Internet and now I’m afraid that maybe it’s increased stomach acidity. Tell me why this injection is dangerous for my child and how I can minimize its consequences. Of course, I’m not going to wave my fists after a fight, especially since it’s my own fault - I didn’t know what prednisolone was and gave an injection of a medicine unknown to me. Threatening condition the child did not have one. We were then prescribed the antibiotic agumetin, it seems, but we didn’t drink it, and we got better without it.

Answer: The doctors did everything right. Prednisolone injection, a single injection, does not produce any side effects. Moreover, the child had indications for its administration. Abnormal bowel movements and abdominal pain are associated with the disease itself and are not a side effect of the drug. Now you need to do a coprocytogram and take a probiotic, for example, acipol (1 capsule 2 times a day - 10 days) to normalize stool.

Question:Hello. Please tell me, I have the following problem: after giving birth, problems began with the joints in my hands, they became inflamed and painful. I went through a bunch of examinations, but no diagnosis was made. I even took tests for Le cells, but they were not confirmed. I was prescribed to take prednisolone 2 tablets a day. The pain went away and the swelling in the joints subsided; periodically in spring and autumn the joints in the hands become inflamed, but after a week everything goes away. Can I replace prednisolone with a lighter drug? And how to gradually stop taking it altogether?

Answer: Prednisolone should be discontinued gradually. Start doing it like this: On even days, take 2 tablets as before, on odd days – 1.5 tablets. And so on for 3 weeks. Then for another 3 weeks: on even days, take 2 tablets as before, on odd days – 1 tablet. The next 3 weeks: even - 2 tablets. Odd numbered: 1/2 tablet. The next 3 weeks: even - 2 tablets. Odd numbered: do not accept. The next 3 weeks: even - 1.5 tablets. Odd numbered: do not accept. The next 3 weeks: even - 1 tablet. Odd numbered: do not accept. In the future, do not take prednisolone, but take an infusion of licorice root for 3 weeks (licorice root is sold in a pharmacy), take it according to the instructions on the package. At this time, you can also start taking Wobenzym - 3 tablets 3 times a day for 2 months.

According to reviews, “Prednisolone” is the name of a drug that belongs to synthetic glucocorticoids (in other words, it is a hormonal drug). It is an analogue of "water-deprived" hydrocortisone. IN medical activities"Prednisolone" is used externally, orally in the form of tablets, eye drops or for intravenous (sometimes intramuscular) administration.

Characteristics of the active substance

Prednisolone is a crystalline powder, odorless and white in color (sometimes with a slight tint of yellow). Almost insoluble in water. But it is slightly soluble in alcohol, dioxane, chloroform and methanol. Its molecular weight is 360.444 g/mol.

pharmachologic effect

According to reviews, Prednisolone has anti-inflammatory, immunosuppressive, antiallergic, glucocortioid and anti-shock effects.

The substance interacts with special receptors in the cytoplasm of the cell and forms a specific complex that penetrates into the nucleus, binding to DNA and causing the expression of mRNA. Changes the formation of proteins on ribosomes that express the effects of cells. Accelerates the synthesis of lipocortin, which inhibits phospholipase A2, inhibits the biosynthesis of endoperoxide and the liberation of archidonic acid, essential for the body, as well as prostaglandins, leukotreins (promote the progression of inflammation, allergies and other processes of a pathological nature).

Stabilizes the membrane membrane of lysosomes, inhibits the synthesis of hyaluronidase (an enzyme that breaks down hyaluronic acid in a special way), reduces the production of lymphokines produced by lymphocytes. Affects the processes of alteration and exudation during inflammation, delays the spread of the inflammatory process.

Inhibits the migration of monocytes in areas of inflammation and limits the proliferation of connective tissue cells, which has an antiproliferative effect. Inhibits the process of formation of mucopolysaccharides, thereby preventing water from combining with plasma proteins in the rheumatic focus of inflammation.

Inhibits the intensity of destruction of peptide bonds, preventing the destruction of tissue and cartilage in rheumatoid arthritis.

In what cases is Prednisolone prescribed to children? Reviews confirm that the antiallergic effect of the drug is due to a decrease in the number of basophils, a decrease in the synthesis and secretion of mediators of an immediate allergic reaction. Promotes the development of lymphopenia and involution of lymphoid tissue, thereby causing immunosuppression.

Reduces the concentration of T-lymphocytes in the blood plasma and the production of immunoglobulins. Increases the breakdown and reduces the production of components of a complex of complex proteins, inhibits Fc receptors of immunoglobulins, inhibits the functions of macrophages and leukocytes. Increases the number of receptors and normalizes their sensitivity to a variety of physiological active substances body. This is confirmed by the instructions for use and reviews for Prednisolone ointment.

Reduces protein synthesis and its amount in the blood plasma, but at the same time accelerates its energy metabolism in muscle tissue. Promotes the production of fibrinogen, surfactant, erythropoietin, lipomodulin and enzyme proteins in the liver. It also promotes the redistribution of fat, the production of triglycerides and IVH. Increases the absorption of carbohydrates from the gastrointestinal tract, the activity of phosphoenolpyruvate kinase and glucose-6-phosphatase, which enhances gluconeogenesis and mobilizes glucose in the bloodstream.

Retains water and sodium, and also accelerates the excretion of potassium. Reduces the absorption of calcium in the intestines, while increasing excretion by the kidneys and leaching it from the bones.

Pharmacokinetics

"Prednisolone", according to reviews, has an anti-shock effect, activates the production of certain cells in bone marrow, increases the number of red blood cells and platelets in the blood, and also reduces the number of monocytes, lymphocytes, basophils and eosinophils.

When taken orally, the medicine is well and quickly absorbed from the gastrointestinal tract. 70-90% of the substance is in plasma in bound form: with albumin and transcortin. After ingestion maximum concentration substances in the blood plasma are observed after an hour and a half.

Metabolized in the liver by oxidation. The half-life of the substance from plasma is 120-240 minutes, from tissues - in the range from 20 to 34 hours. Less than 1% of the dose of the substance passes into the milk of a nursing woman. 20% of the substance is excreted unchanged by the kidneys.

Indications for use

According to reviews, Prednisolone is administered by intravenous or intramuscular infusion for:

acute allergic reaction;
bronchial asthma and status asthmaticus;
for the prevention and treatment of thyrotoxic reactions and thyrotoxic shock;
myocardial infarction;
acute adrenal insufficiency;
liver cirrhosis;
acute hepatitis;
poisoning with cauterizing liquids.

Prednisolone is administered by intra-articular injection for:

rheumatoid arthritis;
spondyloarthritis;
post-traumatic arthritis;
osteoarthritis.

Pills

In the form of Prednisolone tablets, according to reviews, it is prescribed for:

systemic connective tissue diseases;
chronic and acute inflammatory diseases of the joints: psoriatic and gouty arthritis, osteoarthritis, polyarthritis, juvenile arthritis, humeroscapular periarthritis, Still's syndrome in adults, synovitis and epicondylitis;
rheumatic fever and acute rheumatic carditis;
bronchial asthma;

acute and chronic allergies;
allergic reactions to food and medicines, angioedema, serum sickness, urticaria, allergic rhinitis, medicinal exanthema, hay fever;
skin diseases;
pemphigus, psoriasis, eczema, atopic dermatitis, diffuse neurodermatitis, contact dermatitis, toxicerma, seborrheic dermatitis, exfoliative dermatitis, malignant exudative erythema(Stevens-Johnson syndrome), cerebral edema after preliminary use in the form of intravenous or intramuscular injections;
adrenal insufficiency;
kidney diseases of autoimmune origin, nephrotic syndrome;
diseases of the hematopoietic organs: agranulocytosis, panmyelopathy, autoimmune hemolytic anemia, lymphogranulomatosis, myeloma, thrombocytopenic purpura, secondary thrombocytopenia in adults, erythroblastopenia;
lung diseases: acute alveolitis, pulmonary fibrosis, stage II-III sarcoidosis;
pulmonary tuberculosis, tuberculous meningitis, aspiration pneumonia;
berylliosis, Loeffler's syndrome;
lung cancer;
multiple sclerosis;
diseases of the gastrointestinal tract;
hepatitis;
prevention of transplant rejection reactions;
hypercalcemia due to cancer;
nausea and vomiting during cytostatic therapy;
allergic eye diseases;
inflammatory eye diseases.

This is confirmed by the instructions for use and reviews for Prednisolone. The price will be presented below.

Ointment

Prednisolone in ointment form is used for:

urticaria, atopic dermatitis, diffuse neurodermatitis, lichen simplex chronicus, eczema, seborrheic dermatitis, discoid lupus erythematosus, simple and allergic dermatitis, toxicerma, erythroderma, psoriasis, alopecia;
epicondelitis, tenosynovitis, bursitis, humeroscapular periarthritis, colloid scars, sciatica.

Drops

"Prednisolone" in the form of eye drops is prescribed for non-infectious inflammatory diseases of the anterior segment of the eye - iritis, uveitis, episcleritis, scleritis, conjunctivitis, parenchymal and discoid keratitis without damage to the corneal epithelium, allergic conjunctivitis, blepharoconjunctivitis, blepharitis, inflammatory processes after eye injuries and surgical intervention, sympathetic ophthalmia.

The price and reviews of Prednisolone are of interest to many. We will talk about them below.

Contraindications for use

Contraindications to systemic application serve:

This is confirmed by the instructions for use and reviews for Prednisolone.

Contraindications to intra-articular injections are:

infectious and inflammatory processes in the joint;
general infectious diseases;
“dry” joint;
pregnancy;
joint instability as an outcome of arthritis.

Contraindications for use on the skin are:

viral, bacterial and fungal skin diseases;
skin manifestations of syphilis;
lupus;
skin tumors;
acne vulgaris;
pregnancy.

Contraindications to the use of Prednisolone, according to reviews, in the form of eye drops may be:

fungal and viral eye diseases;
purulent corneal ulcer;
acute purulent conjunctivitis;
glaucoma;
trachoma.

Adverse reactions

The severity and frequency of adverse reactions depend on the duration and method of use of the drug. Basically, the following side effects may develop when using Prednisolone:

disruption of the menstrual cycle;
obesity, acne, hirsutism;
stomach ulcers and ulceration of the esophagus;
Itsenko-Cushing complex, osteoporosis;
hyperglycemia;
hemorrhagic pancreatitis;
psychical deviations;
increased blood clotting, weakened immunoglobulins.

This is confirmed by the instructions and reviews for Prednisolone.

Dosage and method of administration

The dosage is set depending on the method of use of the drug.

IN In the form of Prednisolone tablets, doctors recommend taking it once a day or a double dose every other day from 6 to 8 am. The total daily dose can be divided into several doses, and in the morning you should take the drug in a larger dosage. Prednisolone in tablet form should be taken during or after meals. Sudden termination course of treatment may lead to negative consequences, so you can't do that. The dosage of the drug should be increased by 1.5-3 times in acute stressful conditions. If the case is severe, then the dosage is increased by 5-10 times.

In acute cases of the disease, adults are prescribed 4-6 tablets (20-30 mg) per day. The dose that maintains the therapeutic effect is 1-2 tablets (5-10 mg) per day. For some diseases, an initial dose of 5-100 mg/day or as a maintenance dose may be prescribed. hormonal effect therapy - 5-15 mg/day.

As a rule, for children over three years of age, a dose of 1-2 mg per 1 kg of body weight per day, divided into several doses, is prescribed. The dose that maintains the therapeutic effect for children is about 0.5 mg per 1 kg of body weight. After achieving the effect, the dose should be reduced to 5 mg and then to 2.5 mg per day with a break of 3-5 days.

In the form of an ointment, the hormonal drug "Prednisolone" is used externally for allergic rashes and itching. skin. The cream is applied several times a day in a thin layer. Also, Prednisolone ointment can be used in gynecology, but only in combination with antifungals and antibiotics. As a rule, the course of treatment with Prednisolone ointment ranges from 6 to 14 days. To maintain the therapeutic effect, the ointment is applied once a day.

In the form of an injection solution, the drug is administered intraarticularly, intravenously or intramuscularly under strict sterile conditions. For intra-articular administration of the drug, the recommended dose is 10 mg in small joints, and 25-50 mg in large joints. This injection can be repeated several times. If the therapeutic effect is insufficient, it is necessary to consider increasing the dose with your doctor.

For intravenous administration The recommended dose of the drug is 25 mg - to small affected parts of the body, and 50 - to larger parts of the body.

In the form of eye drops, apply 1-2 drops three times a day into the conjunctival sac. As a rule, the course of treatment with these eye drops is no more than two weeks.

special instructions

with long-term therapy, it is necessary to prescribe potassium supplements and diet in order to avoid the development of hypokalemia;
after the end of long-term therapy, doctors should monitor the patient for another year so that adrenal insufficiency does not develop;
Do not suddenly stop using the drug, because this can lead to anorexia, weakness, nausea, exacerbation of the disease and muscle pain;
It is prohibited to administer any vaccines during Prednisolone therapy;
not recommended to drive complex mechanisms and vehicles during the period of treatment with Prednisolone.

Price

Ampoules cost about 30 rubles, ointment - 70 rubles, tablets - about 100 rubles, drops - 100-200 rubles. It all depends on the city and the specific pharmacy.

Prednisolone injections are a drug with enhanced biological activity that is used in emergency situations. Injections of the drug can have antiallergic, anti-inflammatory and immunosuppressive effects.

The form of the drug used determines the speed of its effect and the likelihood of adverse reactions. Prednisolone tablets are prescribed for long-term therapy, and the drug in ampoules is used when delay is dangerous. When administered intramuscularly, the medicine begins to act after a quarter of an hour, when administered intravenously - after 3 minutes.

Prednisolone injections, according to the instructions for use, are prescribed under the following clinical circumstances:

Acute allergic manifestations;
Complication of diffuse toxic goiter threatening the patient's life;
Intractable attack of bronchial asthma;
Shock condition that is not amenable to prescribed treatment;
Renal and liver failure in an aggravated form;
Rheumatic ailments;
Hepatitis;
Pathology of the adrenal cortex;
Prevention of scar formation when damaged by cauterizing substances.

Besides emergency assistance, injections of the drug are included in complex treatment malignant neoplasms, chronic pulmonary, autoimmune and skin diseases, heart pathologies. Prednisolone injections are used in hematology and ophthalmological practice.

The dosage and duration of therapy should be determined by the doctor. It takes into account the severity of the disease, the patient’s health status, concomitant ailments and possible contraindications.

The average dose is 10-30 mg of the drug intramuscularly. From 30 to 200 mg is administered through an IV in emergency situations.

For children, the amount of medication is prescribed at the rate of 1-3 mg per 1 kg of body weight.

The drug is administered intravenously through a dropper or intramuscularly. After relief of the emergency condition, Prednisolone is taken in tablet form.

Contraindications

Prednisolone, according to the instructions for using intramuscular injections, is very effective, but has a whole list of contraindications and unwanted side effects. Injections are not prescribed if you are intolerant or hypersensitive to the ingredients of the medication. It is used with extreme caution:

In immunodeficiency conditions;
During the period of therapy and recovery from viral infectious diseases;
In patients with diseases of the digestive tract;
After administration of the vaccine;
Patients with pathologies of the cardiovascular and endocrine systems;
In case of renal failure.

Prednisolone injections for pregnant women and young children are prescribed solely based on vital signs under direct medical supervision. During the period of treatment with this medication breast-feeding must be interrupted. The drug is not prescribed to children under 3 months and elderly people over 70 years of age.

The following side effects were observed during Prednisolone therapy:

Muscular atrophy;
Weight gain;
Decreased ability of the body to process glucose;
Adrenal gland dysfunction;
Insulin-dependent diabetes mellitus;
Increase in intracranial and blood pressure;
Stomach or duodenal ulcer;
Sinus rhythm disturbance;
Inhibition of sexual development in adolescents,
Corneal pathologies;
Increased sweating;
Convulsions;
Migraine;
Sleep disorders;
Depression, confusion.

At the injection site, rashes, itching and other local allergic manifestations are possible.

Prednisolone is considered a synthetic substitute for cortisone and hydrocortisone, hormones that are secreted by the adrenal cortex.

How does the medicine work?

Prednisolone has several effects on the body:

anti-inflammatory;
antiexudative;
antiallergic;
antitoxic;
anti-shock.

When taken orally, in tablet form, it is well absorbed in the stomach and intestines. Prednisolone can cross the placenta and is found in breast milk.

Indications for the use of prednisolone

Prednisolone (photo)

Endocrinological diseases:

subacute thyroiditis;
congenital adrenal hyperplasia;
acute and chronic adrenal insufficiency.

Severe allergic conditions:

Rheumatic diseases:

arthritis (juvenile, rheumatoid, psoriatic, gouty);
myocarditis;
systemic lupus erythematosus;
systemic vasculitis;
systemic scleroderma;
dermatomyositis.

Skin diseases:

dermatitis (seborrheic, bullous, exfoliative);
pemphigus;
mycosis fungoides;
severe psoriasis;
eczema.

Blood diseases:

hemolysis;
Wergolf's disease (in adults);
aplastic anemia.

Liver diseases:

hepatitis (chronic, alcoholic).

Inflammatory joint diseases:

bursitis;
epicondylitis;
osteoarthritis.

Oncological diseases:

leukemia;
lymphoma;
prostate cancer;
myeloma.

Neurological diseases:

tuberculous meningitis;
exacerbation of multiple sclerosis;
myasthenia gravis.

Eye diseases:

Respiratory diseases:

symptomatic sarcoidosis;
bronchial asthma;
berylliosis;
pulmonary tuberculosis;
emphysema (chronic).

Other diseases:

acute pancreatitis;
heart failure;
pericarditis.

In addition, prednisolone is prescribed after organ and tissue transplantation to prevent transplant rejection.

Prednisolone release forms

pills different dosages;
ampoules with injection solution;
eye drops;
ointment.

Mode of application

Important! The use of prednisolone is prohibited without a doctor's prescription!

Before starting treatment, the doctor must carefully collect the patient’s medical history, that is, find out whether the patient has chronic diseases. In addition, the patient must take a blood and urine test, as well as monitor his blood pressure for several days to find out if he has hypertension.

Only after collecting all the necessary information can the doctor prescribe prednisolone to the patient. If a patient has diabetes, it is necessary to strictly monitor blood glucose levels and adjust the doses of antidiabetic drugs.

Application of tablet form

The dosage of prednisolone is determined by the doctor, individually for each patient. When treating with this drug, you must remember that you cannot suddenly stop taking the medication, as this may cause a worsening of the condition.

The tablets are taken during or after meals with a small amount of water.

Application of solution for injection

Intravenous and intramuscular injection– myocardial infarction, acute allergic reactions, attack of bronchial asthma, thyrotoxic crisis, acute adrenal insufficiency, acute liver and kidney failure, poisoning with acids and alkalis.

Intra-articular injection – arthritis, osteoarthritis.

Application of ointment

The ointment must be applied in a thin layer to the affected areas 3 times a day. The course of treatment will depend on the severity of the disease, but on average it is 7 – 10 days. In severe cases, the course of treatment may be increased.

Using eye drops

Drops are prescribed 3 times a day for iritis, conjunctivitis, blepharitis, eye injuries, keratitis and other non-infectious eye diseases.

Side effects

Prednisolone has side effects on many body systems:

Endocrine system - possible development of Itsenko-Cushing syndrome, sudden weight gain, increased blood sugar.
Digestive system– nausea, heaviness in the stomach, vomiting.
The cardiovascular system– increased blood pressure.
Metabolism – the formation of edema due to sodium retention in the body.
Skeletal system – development of osteoporosis.
Circulatory system– increased blood clotting.
Visual organs – development of glaucoma and cataracts.
Central nervous system- mental disorders.
The immune system– decreased immunity, poor wound healing.
On the skin (when using ointment) - the appearance of acne, itching, burning, dry skin, irritation.

Contraindications for use

For tablet forms and intramuscular injections:

pregnancy;
general infection;
previous arthroplasty;
severe periarticular osteoporosis;
infectious inflammatory process in the joint;
transarticular bone fracture;
pathological bleeding.

For eye drops:

glaucoma;
eye diseases caused by viruses and fungi;
eye tuberculosis;
trachoma;
purulent corneal ulcer;
period after removal foreign body corneas;
conjunctivitis (viral and purulent).

At diabetes mellitus the use of the drug should be under strict control of blood glucose levels. For tuberculosis and others infectious diseases treatment is carried out along with antibacterial therapy or anti-tuberculosis drugs.

Pregnancy and lactation

During pregnancy and lactation, the use of prednisolone should only be for health reasons. This is especially important in the 1st trimester of pregnancy.

special instructions

Long-term treatment with prednisolone requires a visit to the ophthalmologist, monitoring of blood pressure and blood counts. Since when taking the drug there is a decrease in potassium in the body, it is necessary to prescribe potassium supplements or a diet. To reduce side effects, anabolic steroids are prescribed.

If a person has Addison's disease, then it should be remembered that the simultaneous administration of barbiturates and prednisolone is not advisable.

After discontinuation of the drug, it is possible to develop adrenal insufficiency or exacerbation of the disease for which the use of prednisolone was prescribed.

Drug interactions

Prednisolone + anticoagulants = increased anticoagulant effect of anticoagulants.
Prednisolone + salicylates = high probability occurrence of bleeding.
Prednisolone + diuretics = deterioration of electrolyte metabolism.
Prednisolone + hypoglycemic drugs = decrease in the rate of decrease in blood sugar levels.
Prednisolone + cardiac glycosides = possible development of glycoside intoxication.
Prednisolone + rifampicin = decreased effect of rifampicin.
Prednisolone + antihypertensive drugs– decreased effect of antihypertensive drugs.
Prednisolone + barbiturates = decreased effect of prednisolone.
Prednisolone + hormonal contraceptives = enhancement therapeutic action prednisone.
Prednisolone + coumarin derivatives = weakening of the anticoagulant effect (reduced blood clotting).
Prednisolone + acetylsalicylic acid = reduction in the level of salicylates in the blood.
Prednisolone + m-anticholinergics = increased intraocular pressure.

Signs of a drug overdose

An overdose of prednisolone can occur with long-term use in large doses.

Blood pressure increases, swelling occurs and the side effects of the drug increase.

In case of acute poisoning, it is necessary to rinse the stomach, and in case of chronic poisoning, you simply need to reduce the dose.

There is no special antidote to prednisolone.

The use of prednisolone for joint diseases

Prednisolone is used for chronic infectious and inflammatory diseases with a severe course, which are accompanied by severe pain and swelling. Basically these are all types of arthritis and polyarthritis. The drug perfectly relieves pain and swelling.

Since this causes a sharp decrease in immunity, the patient is prescribed antibacterial therapy or antifungal agents. The prescribed treatment will depend on the causative agent of the disease. The use of prednisolone is usually prescribed for a short course. If the drug was prescribed for a long course, its withdrawal should be gradual.

In severe cases, intra-articular injections with prednisolone are prescribed. Such injections reduce pain and inflammation, relieve swelling.

Cost of prednisolone and its analogues

Prednisolone 100 tablets of 5 mg – 45 – 60 rubles.
Prednisolone 3 ampoules of 1 ml – 25 – 35 rubles.
Prednisolone ointment 0.5% 10 grams – 15 – 25 rubles.
Metypred 30 tablets of 4 mg – 175 – 200 rubles.
Metypred bottles 250 mg – 335 – 350 rubles.
Decortin N5.
Decortin N20.
Medopred.
Salt-decortin N25.

Prednisolone ointment

Indications for use

skin diseases of non-microbial origin;
eczema is a disease characterized by weeping and itchy inflammation;
dermatitis;
alopecia – complete or partial hair loss;
cracks.

Mode of application

When prescribing Prednisolone ointment, apply an even layer to the affected skin 3 times a day. The course of treatment depends on the disease and severity. When using ointments in children, the course of treatment should be no more than 7 days. In this case, it is necessary to exclude the use of warming and fixing bandages. Active substance absorbed into the blood and then leaves the body in urine and feces.

Side effects

Typically, side effects are rare when using ointment. In some cases, with prolonged use, itching, dry skin, and erythema may occur. All side effects do not require treatment and disappear after discontinuation of prednisolone.

Contraindications:

pregnancy and lactation (you must stop breastfeeding for the period of treatment);
skin tumors;
bacterial and fungal infections skin;
skin reaction to vaccination;
herpes zoster and other diseases viral etiology;
chicken pox;
tuberculosis and syphilitic processes in the area of application of the drug;
individual intolerance.

Drug interactions

Prednisolone enhances the effect of anticoagulants and increases the risk of bleeding when taking salicylates. At simultaneous administration Diuretics may cause disturbances in electrolyte metabolism. The drug also reduces the effect of hypoglycemic drugs.

Attention!
Prednisolone is a hormonal drug and its uncontrolled use is prohibited. You should also not change the dosage of prednisolone, increase the course of treatment, or stop taking medications on your own.

All these actions may entail severe consequences, exacerbation of chronic diseases. Information about the drug is presented in a simplified form and is not a recommendation for use. Before starting treatment, you should consult your doctor.