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 oh 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 fabrics. 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 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 mineralization bone tissue 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, prednisolone prevents the release of inflammatory mediators from mast cells, reduces capillary permeability, and stabilizes cell membranes. In addition, prednisolone interferes with the synthesis of prostaglandins from arachidonic acid, cytokines (interleukins, a special protein - tumor necrosis factor).

Prednisolone also has an immunosuppressive effect. It prevents communication various types lymphocytes and their migration, reduces the intensity of the formation of antibodies, 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.
At shock states prednisolone increases arterial pressure, reduces the permeability of the walls of blood vessels, has a membrane-protective effect, activates those involved in metabolic processes liver enzymes.

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 may be present in the blood 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 the middle and high degree gravity. 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 dangerous complication like cerebral edema. This state 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, poisoning.

Also, the drug is used in severe bronchial asthma, systemic diseases connective tissue (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, neuritis optic nerve. And the use of medication similar diseases helps not only to relieve swelling and inflammation, but often to avoid loss of vision.

Prednisolone is also prescribed for congenital hyperplasia adrenal glands, berylliosis, Lefler's syndrome, multiple sclerosis, thyrotoxicosis, acute hepatitis, hepatic coma, serious illnesses kidneys.

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 prescribed and with some varieties oncological diseases eg 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 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 without the drug in such a case can not be dispensed with, then it should be used as part of complex therapy, which should also include measures aimed at the destruction of pathogens, for example, taking antibiotics.

Prednisolone is often 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, when long-term use the drug may experience adrenal dysfunction, which becomes noticeable after the end of the reception. Over time, this usually goes away.

Tablets have the most wide range testimony. 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 use eye drops are:

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

Release form

The pharmaceutical industry releases prednisolone in various forms, each of which is intended for use in certain diseases and situations in which the patient found himself. For example, tablets are most suitable for the treatment of chronic inflammatory or allergic processes. For treatment 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.

Solution for intravenous injections has a dosage of 30 and 15 mg per 1 ml. In the composition of the solution, you can also find some Excipients:

• 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 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. It's about the state life threatening. 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 remedy is prescribed for some cardiovascular diseases, it should not 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 of hydrochloric acid in the stomach, which predetermines its prohibition when peptic ulcer this organ and the 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,
• nonspecific 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 a minimum effective dose and minimal short 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 ointment for treatment 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 a survey of cardio-vascular system, stomach, urinary organs, eyes, blood tests (amount of glucose and electrolytes), radiography chest. 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, adversely affect the development of the fetus. especially strongly this effect manifests itself 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 in breast milk penetrates very small dose drug (approximately 1% of the concentration in the blood), however, this is enough to render Negative influence on the body of the newborn. Therefore, in such cases, mothers are encouraged to stop breastfeeding.

Side effects

The drug acts on various biochemical and physiological processes in organism. And this means that it affects various systems organisms and organ groups.

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

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

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

• 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 psyche and nervous system the following violations 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:

• promotion intraocular pressure up to damage to the optic nerve;
• bacterial, viral or fungal infections eye;
• 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 when long-term use drops for the eyes, 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, in order to ensure the minimum number of negative manifestations during therapy, the patient should adhere to a diet. The diet should include a minimum of fat, salt and carbohydrates, a large number 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 adverse reactions increases.

Overdose when taking tablets or parenteral administration is manifested in increased side effects. Recommended symptomatic therapy and gradual drug withdrawal. 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

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 exceeding the standard one, up to 100 mg / day, may also 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 quit taking after a long course of treatment, since in this case a withdrawal syndrome and deterioration of well-being may occur, as well as an exacerbation of the symptoms of the disease for which 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, the most recent receptions are canceled. 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 repeats after 3-4 hours. The daily dose is 300-1200 mg.

In acute hepatic 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 apply intramuscular injection 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, it is allowed preventive use ointment, 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.

At sharing Prednisolone and anticholinergics, tricyclic antidepressants and nitrates may increase intraocular pressure.

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, contribute to increased therapeutic effect 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.

Prednisolone refers to drugs that are used in any medical industry. Sometimes it is this medicine that can save the life of a child or an adult. However, its uncontrolled and independent use can lead to serious consequences.

This medicine is synthetic hormone, glucocorticoid. It is widely prescribed by rheumatologists, allergists, dermatologists and immunologists. Also, hormonal drugs are used in therapy and pediatrics, surgery and traumatology.

However, the most important practical value has the use of this drug in emergency care, resuscitation. This is due to the peculiarity of its action and the effects produced.

The drug is available in the form of tablets and solution for injection. Tablet forms are commonly used in the treatment chronic diseases, while injections are necessary for life-threatening conditions.

In any medical institution, this hormone must be present in the form of a solution in ampoules to provide emergency care with anaphylaxis and shock. And any health worker should be able to use it correctly - to know how much medicine can be administered and in what situations to use it.

Mechanism of action

Working mechanism this medicine quite complex, as it affects various processes occurring in the body. So, this hormone performs the following actions:

1. It inhibits inflammation, its proliferative phase, by inhibiting the activity of fibroblasts and collagen synthesis.
2. Accelerates the breakdown of protein in muscle tissue.
3. Stimulates protein synthesis in the liver.
4. Slows down development lymphoid tissue which leads to suppression of the immune system.
5. Affects mast cells responsible for the onset of allergic reactions. Prednisolone inhibits their degranulation.
6. Increases the sensitivity of blood vessels to the action of vasoconstrictor substances that are formed in the body or enter it from the outside.

effects

Participation in various metabolic processes provides those medicinal effects which are successfully used in pediatric, therapeutic and resuscitation practice.

So, the most significant are:

• Antishock.
• Antiallergic.
• Anti-inflammatory.
• Antitoxic.

However, negative effects of this drug are also significant. Sometimes, because of them, you have to change the treatment regimen or replace prednisolone with another medicine.

During treatment, the hormone can produce the following negative effects:

1. Immunosuppressive.
2. Gastropathic and ulcerogenic (formation of ulcers) by stimulating the secretion of hydrochloric acid.
3. Causes osteoporosis.
4. Gives rise to endocrine pathology- Itsenko-Cushing's syndrome.

Indications

This medicine is widely used in rheumatology for the treatment of autoimmune diseases. It suppresses the inflammatory process, has a decongestant effect. With such a disease, patients can take prednisolone tablets for life.

It is very important to use the drug in the treatment emergency conditions. These may be the following pathologies:

• Quincke's edema.
• Anaphylactic shock.
• Asthma attack, status asthmaticus.
• Acute stenosing laryngotracheitis in children.
• Sudden drop in blood sugar.
• Acute adrenal insufficiency.

In pediatrics, prednisolone is also actively used, but its use in children requires caution due to the high risk of developing side effects hormone.

Hormones in pediatrics

IN childhood there are a number of diseases and conditions in which prednisolone injections are indispensable. For example, an insect bite - a wasp or a bee - can cause a severe allergic reaction in a baby, up to anaphylactic shock. In such a situation, only the rapid administration of prednisolone along with epinephrine can help.

If a child suffers from bronchial asthma, a prolonged attack seriously threatens his health and even life. And although it is not recommended to prick a baby in most cases, inhaled corticosteroids in this situation most often do not help. If done in time the right shot, prednisolone quickly stops the attack.

As a rule, the parents of such patients know what to expect from bronchial asthma and are able to alleviate the condition of a sick child. In acute stenosing laryngotracheitis, a completely different clinical picture is observed.

The attack usually develops suddenly, against the background of a banal viral infection. The baby appears barking cough, the voice becomes hoarse. If help is not provided in time, an asthma attack develops.

The called ambulance team in such a situation gives the child an injection of prednisolone, after which his condition quickly improves. Often, parents ask the doctor if they can use prednisolone on their own if the attack suddenly recurs.

Self-administration of prednisone

Few doctors are able to offer parents: “Inject prednisone during an attack on your own!” After all, the risk of complications when using hormonal drugs is quite high, especially if the injection is performed by a non-professional.

Yet sometimes parents have to master the role of a health worker. It happens when the baby has a tendency to develop acute stenosing laryngotracheitis against the background of any SARS. Unfortunately, in the conditions of city traffic jams, the ambulance does not always have time to arrive within 10-15 minutes.

Also, emergency medical skills can be useful for those parents who live far from the city and medical institution.

However, you should be aware that it is strictly forbidden to administer prednisolone or another hormonal drug to a child using dosages taken on the Internet. Even an instruction in such a situation cannot be a guide to action.

If really health care sometimes it is not available, and the child is prone to asthma attacks, parents should discuss with the doctor the possibility of self-administration of prednisolone in an acute situation. And only if the specialist gives the go-ahead and explains the tactics of action, you can purchase the drug for home first aid kit. It must also be remembered that such medicine should be kept out of reach of children.

Complications of hormone therapy

Self-administration of prednisolone is fraught with various complications. The most common among them is:

1. The use of medication in the absence of indications.
2. Violation of the solution injection technique (wrong choice of place, subcutaneous injection instead of intramuscular).
3. Incorrectly calculated dose of the drug. With self-administration of the drug, there can be both an overdose and the intake of an insufficient amount of the hormone into the body.

However, even with a correctly performed injection and a calculated dose, in a medical institution, treatment with prednisolone can lead to the following consequences:

• Adrenal dysfunction.
• development of steroid diabetes.
• endocrine disorders.
• development of osteoporosis.

Introduction hormonal medication against the backdrop of a viral bacterial infection can worsen the course of the disease due to immunosuppression. This is true for long-term treatment with glucocorticoids.

Hormone therapy is characterized by a withdrawal syndrome. With a sharp cessation of treatment, the patient may experience the following symptoms:

• Fever.
• Pain in bones and muscles.
• Nausea and vomiting.
• Diarrhea.
• Lethargy.

This is a serious violation that should be stopped immediately. That is why therapy with glucocorticosteroids should not be stopped suddenly. Such complications are especially dangerous in childhood.

Prevention of complications

Since the likelihood of complications in the treatment of glucocorticoids is quite high, the doctor should carry out their prevention.

When using prednisolone as a means emergency assistance, this is not necessary. In such a situation, the drug is administered once, less often twice, in medium doses. Severe consequences(in the absence of an overdose) do not have time to develop, as well as addiction - and therefore there is no withdrawal syndrome.

However, with prolonged hormonal treatment prevention is very important. First of all, a thorough examination of the patient is necessary - especially if it is a child.

In diseases of the gastrointestinal tract, endocrine pathology, it is necessary to carry out drug correction. If the disease cannot be brought into remission, the regimen of glucocorticoid therapy is changed. Doses should be selected in such a way as to ensure the effectiveness of treatment and prevent characteristic complications.

It is also necessary to regularly monitor blood counts, blood glucose and calcium levels, periodically conduct x-rays of the musculoskeletal system.

Why can there be complications in the treatment of prednisolone? In most cases, this happens due to under-examination of the patient or an incorrect treatment regimen.

Prednisolone is a medicine that in many situations is indispensable. However, self-medication is unacceptable to them.

Prednisolone is an anti-inflammatory, anti-allergic, anti-toxic and anti-shock drug. And in order to know exactly what Prednisolone should be taken from, you should read our article. This drug is a synthetic analogue of the hormones cortisone and hydrocortisone, which are secreted by the adrenal cortex. When taken orally, it is more effective than cortisone by 4-5 times and about 3 times than hydrocortisone. Prednisolone slightly increases potassium excretion and practically does not cause sodium and water retention in the human body. When taking Prednisolone tablets orally, its maximum accumulation in plasma is noted after 1.5 hours. The drug is well absorbed from the gastrointestinal tract. Biotransformed through oxidation mostly in the liver. The drug is excreted from the body in the form of metabolites with urine and feces. Prednisolone affects protein, water-electrolyte, carbohydrate and fat metabolism in the human body.

What does prednisone help with?

• inflammation of the cornea of ​​\u200b\u200bthe eye with intact mucosa; blepharitis (inflammation of the edges of the eyelids);
• allergic and chronic conjunctivitis (inflammation of the mucous membrane of the eye);
• sympathetic ophthalmia (inflammation of the membrane of the eye due to injury to the other eye);
• after eye surgery;
• multiple sclerosis;
• bronchial asthma;
• hepatitis; chronic and acute allergies ( atopic dermatitis, urticaria, food and drug allergy, Quincke's edema, toxicoderma, hay fever);
• rheumatic fever;
• rheumatic carditis;
• chronic and acute illnesses joints (polyarthritis, osteoarthritis, bursitis, synovitis, rheumatoid arthritis, psoriatic and gouty arthritis, humeroscapular periarthritis, Still's syndrome in adults);
• inflammatory diseases of the gastrointestinal tract (local enteritis, ulcerative colitis);
• infectious mononucleosis (an infectious disease in which the palatine lymph nodes, liver increase and heat body);
• connective tissue diseases (dermatomyositis, scleroderma, lupus erythematosus, periarteritis nodosa);
• autoimmune diseases;
• acute pancreatitis ( nonspecific inflammation pancreas);
• hemolytic anemia;
• glomerulonephritis (kidney disease).

Prednisolone tablets from what else can you take:

• shock during surgical interventions;
• prevention of rejection in tissue and organ transplantation.

Mode of application:

The dose of the drug for each person is set individually. To correctly prescribe the dose of Prednisolone, you need to take into account the daily secretory rhythm of glucocorticoids. Tablets are taken orally with a small amount of liquid. Usually, a large dose is prescribed in the morning, an average dose in the afternoon, and a small dose in the evening. As a rule, the introductory dose of the drug is 20-30 mg over 24 hours (4-6 tablets). Gradually, the transition to a maintenance dose is carried out, which is 5-10 mg (1-2 tablets). For certain diseases (some rheumatic diseases, nephrosis) daily introductory dose may be 15-100 mg. To complete the treatment with Prednisolone, the daily dose is gradually reduced. For children, the initial dose of the drug is prescribed at the rate of 1-2 mg / kg of body weight and distributed into 4-6 doses per day. The maintenance dose of the drug is 300-600 mcg / kg of the child's body weight. When treating with Prednisolone, blood pressure should be checked, urine tests should be done and blood sugar levels should be determined.

Contraindications:

• individual susceptibility to the components of the drug;
• post-vaccination period; diabetes;
• acute endocarditis;
• pregnancy;
• duodenal ulcer and stomach;
• gastritis; acute peptic ulcer;
• persistent rise in blood pressure;
• active form of tuberculosis;
• syphilis;
• nephritis (inflammation of the kidneys);
• acute psychosis;
• polio;
• recent myocardial infarction;
• chronic heart failure.

Side effects:

The occurrence of adverse reactions depends on the duration of treatment with Prednisolone and the magnitude of the dose taken. Possible development of such side effects:

• mental disorders;
• increase in blood sugar levels;
• violation of the menstrual cycle;
• obesity;
• decreased resistance to infections;
• hirsutism (excess hair growth in women);
• convulsions;
• dizziness;
• osteoporosis;
• growth retardation in children;
• depression;
• insomnia;
• hallucinations;
• decrease in muscle mass.

We hope that this article has helped you understand what Prednisolone is for, and how to calculate its dose.

Prednisolone in ampoules, the instructions for use of which indicate that it is a synthetic hormonal drug, reports the possibility of use in case of serious allergy attacks. It has a strong anti-allergic and anti-inflammatory effect and is therefore widely used in medicine. The introduction of Prednisolone allows you to remove inflammatory processes and also neutralize allergic manifestations.

In appearance, the solution for injection is almost completely clear liquid may develop a yellowish/greenish tint.

Prednisolone can be administered to the human body only intravenously or intramuscularly.

The anti-inflammatory effect is achieved as follows: the drug releases inflammatory mediators, and also reduces capillary permeability. It also stabilizes the membranes of cells and its components, which increases their resistance to damage. active action the drug is distributed through all stages during inflammation.

Prednisone injections affect immune system, suppressing it in case of manifested allergic reactions, thereby reducing negative effect from them. Also, the drug reduces the sensitivity of cells to the allergen, reduces the generation of allergy mediators. As a result, the drug has a full-fledged anti-allergic effect on a person.

Most of the injected solution binds intravenously to blood proteins, and with the help of the liver and / or kidneys is easily and quickly excreted. After two to three hours, most of the drug will already be excreted from the body along with urine and / or bile.

Indications for the use of Prednisolone in ampoules

What are they used for this drug? Prednisolone injections are usually used intravenously precisely in cases of emergency situations requiring immediate action. These situations are:

• acute and severe variants of allergic manifestations, anaphylactic shock or anafil. reaction;
• various states of shock, such as: burn and surgical, trauma. or cardiogenic shock;
• cerebral edema;
• severe acute variants of bronchial asthma;
• acute adrenal insufficiency;
• systemic cases of connective tissue disease;
• acute hepatitis;
• thyrotoxic crisis.

Contraindications to the use of the drug

When the drug is administered to the vital dangerous situations the only contraindication will be considered only individual hypersensitivity patient to the components of the drug.

The dosage of the medicine, as well as the duration of the use of the drug, is prescribed exclusively by the doctor and, of course, individually. The dose, as well as the treatment of the patient, depends on his condition, the severity of the disease being treated.

The drug can be injected into the body intramuscularly or intravenously, by jet. When administering the drug intravenously, you must first enter the drug in a stream.

Dosage of Prednisolone in ampoules in the instructions for use in various situations:

1. Adrenal insufficiency - treatment from three to sixteen days, daily dose one hundred to two hundred milligrams.
2. Bronchial asthma. The duration of treatment is also from three to sixteen days, the amount of the drug is determined by the severity of the disease, 75 - 675 milligrams. In very severe cases of asthma, the dose may be increased up to 1400 milligrams, which will need to be gradually reduced over the course of treatment.
3. Asthmatic status - a daily dose of 500 to 1200 milligrams. Gradually, the dose is reduced to 300, and a transition is made to small, maintenance doses.
4. Thyroid crisis. For one injection, no more than 100 milligrams are administered, daily rate- from two hundred to three hundred. In case of urgent need, the amount of medication administered per day can be up to 1000 milligrams. The course of treatment is determined within six days.
5. Shock not treated by standard methods. Then, at the very start of therapy, the drug is administered to the patient only in a jet, and then a dropper. Maximum dose per day is from 300 to 1200 milligrams, one-time introduction provides for no more than 150 (in severe situations, it can be increased to 400 mg).

In other cases, the dosage of Prednisolone and the duration of the course of treatment can only be prescribed by the attending physician.

If the course of treatment is long, then in no case should it be abruptly stopped! Daily dosage it is necessary to reduce gradually, reaching a minimum, and only after this administration of the drug can be stopped.

Side effects of prednisone injections

When using the drug, manifestations of such side effects were noted:

1. IN endocrine system I can develop diabetes mellitus (steroid), an increase in blood sugar, a decrease in the functionality of the adrenal glands, inhibition of puberty in children.
2. In the stomach and / or intestines: gastric ulcer and duodenal ulcer (steroid), hiccups, nausea and / or vomiting, bleeding in the stomach and / or intestines, erosive esophagitis, digestive complications.
3. The cardiovascular system. Arrhythmia, development or increase in heart failure, hypokalemia are possible, thrombosis and hypercoagulation are also possible.
4. CNS. A certain disorientation, a feeling of euphoria is possible, or vice versa - depression, short hallucinations, paranoia. From physical negative sensations, headache, convulsions, dizziness and insomnia are possible.

In case of an overdose, side effects may increase, and in this case, it is urgent to reduce the dose of the administered drug.

Prednisolone injections for safety reasons should be given to a person separately from other drugs, since side effects may occur if drugs are incompatible.

Special instructions, precautions when using Prednisolone

During the period of treatment (and especially with more or less prolonged treatment) with the drug, it is highly desirable to undergo observations with an ophthalmologist. You also need to control blood pressure and blood glucose levels, and checking the current water and electrolyte balance will not hurt.

In order to reduce the possibility of side effects, the current level of Potassium in the patient's organs should be increased. Additionally, antacids can be prescribed to a person. The food consumed at the time of use of the drug should be low-fat, with a minimum content of table salt and reduced carbohydrates. Food, respectively, should be rich in proteins and, of course, vitamins.

In patients with a disease such as cirrhosis of the liver and / or hypothyroidism, the drug should be used with caution - the effect of Prednisolone in such cases is enhanced.

If there are any mental disorders, the drug is able to further strengthen them, therefore, in such cases, doctors reduce the dose of the administered drug or perform treatment under the highest control.

It is also necessary to exercise caution in the case of myocardial infarction - the drug can provoke the spread of necrosis, and in turn, rupture of the heart muscle.

When emerging stressful situations kind of like surgical intervention or infectious diseases(during the period of maintenance treatment), the body's need for corticosteroids increases, so in such cases it is necessary to further adjust the dosage of prednisolone.

When taking the drug, it is strictly not recommended to make an abrupt stop (especially with prolonged preliminary administration). large doses), as this can start the development of a withdrawal syndrome (which is accompanied by weakness, muscle pain, nausea and anorexia). Less likely, but perhaps even an increase in the disease, for the treatment of which Prednisolone was intended.

Since Prednisolone suppresses the immune system, thus acting against allergies, it is not necessary to vaccinate during treatment, since the immune system cannot be guaranteed to interact correctly and fully with the vaccine being administered. In this regard, if a patient has tuberculosis, intercurrent infections, bactericidal antibiotics should be additionally used.

When long-term treatment a drug like Prednisolone is applied to a child, then in such a case, you need to carefully monitor the process of its development and, of course, growth. If the child has been in contact with patients with measles or chickenpox during treatment, it is recommended to prescribe additional immunoglobulins to avoid infection.

If the patient is sick diabetes, then during treatment it is necessary to additionally control the amount of glucose in the body. And with strong deviations from the required norm, additional therapy should be urgently carried out.

In patients with latent (not manifesting) infectious diseases kidneys and / or urinary canals, taking Prednisolone can provoke leukocyturia, which should be taken care of when prescribing the drug and additional diagnostics should be carried out.

Catad_pgroup Systemic corticosteroids

Prednisolone Nycomed - official instruction by application

INSTRUCTIONS
By medical use drug

(PREDNISOLONY NYCOMED)

Registration number

Tradename: Prednisolone Nycomed

International non-proprietary name:

Prednisolone

Chemical Name:(6 alpha, 11 beta)-11,17,21-Trihydroxypregna-1,4-diene-3,20-dione

Dosage form
Pills; solution for intravenous and intramuscular administration.

Compound

1 tablet contains:
active substance- prednisolone 5 mg,
Excipients: magnesium stearate, talc, corn starch, lactose monohydrate.

1 ml of solution contains:
active substance- prednisolone 25 mg,
Excipients: glycerol formal, butanol, sodium chloride, water for injection.

Description
Pills white color, round, flat on both sides, with bevelled edges, x notch for graduation on one side and engraving "PD" above the notch and "5.0" below the notch.
Solution- transparent colorless.

Pharmacotherapeutic group:

Glucocorticosteroid.

ATC code: H02AB06.

Pharmacological properties
Pharmacodynamics.
Prednisolone Nycomed is a synthetic glucocorticosteroid drug, a dehydrated analogue of hydrocortisone. It has anti-inflammatory, anti-allergic, immunosuppressive effects, increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.
Interacts with specific cytoplasmic receptors (glucocorticosteroid (GCS) receptors 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.)
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), 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 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 metabolism: retains sodium and water in the body, stimulates the excretion of potassium (mineralocorticoid activity), reduces the absorption of calcium from the gastrointestinal tract, reduces the mineralization of bone tissue.
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. It acts on all stages of the inflammatory process: it inhibits the synthesis of prostaglandins at the level of arachidonic acid (lipocortin inhibits phospholipase A2, inhibits 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, etc.); increases the resistance of the cell membrane to the action of various damaging factors.
The immunosuppressive effect is due to the involution of lymphoid tissue, inhibition of the proliferation of lymphocytes (especially T-lymphocytes), suppression of B-cell migration and the interaction of T- and B-lymphocytes, inhibition of the release of cytokines (interleukin-1, 2; interferon gamma) from lymphocytes and macrophages and decreased antibody production.
The antiallergic effect develops as a result of a decrease in the synthesis and secretion of allergy mediators, inhibition of the release of histamine from sensitized mast cells and basophils, etc. biologically active substances, reducing 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 formation, changes in the body's immune response.
In obstructive diseases of the respiratory tract, 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 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 ACTH and secondarily - the synthesis of endogenous corticosteroids.
It 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. Maximum concentration in the blood is achieved within 1-1.5 hours after oral intake. Up to 90% of the drug binds to plasma proteins: transcortin (cortisol-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.
It is excreted in bile and urine by glomerular filtration and is reabsorbed by tubules by 80-90%. 20% of the dose is excreted by the kidneys unchanged.
The plasma elimination half-life after oral administration is 2-4 hours. intravenous administration 2-3.5 hours.