What is a normal dose of prednisone. Prednisone, oral tablet
For older people: As you age, your kidneys, liver, and heart may not work as well. Prednisone is processed in your liver and removed from your body through your kidneys.
It makes these organs work extra hard. For children: Children might not grow as tall if they take prednisone for several months. This dosage information is for prednisone oral tablet. All possible dosages and forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:.
Dosage for children is usually based on weight. Your doctor will determine the best dosage for your child. Older adults may process drugs more slowly. A normal adult dose may cause levels of the drug to be higher than normal. If you are aged 65 years and older, you may need a lower dose or a different dosing schedule. For immediate-release tablets only: If you have a sudden return or worsening of your MS symptoms, you may need to take mg once per day for one week.
This dosage may then be reduced to 80 mg once per day every other day for one month. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:.
But if your symptoms are severe, call or go to the nearest emergency room right away. What to do if you miss a dose: If you forget to take a dose, take it as soon as you remember. How to tell if the drug is working: You should experience less pain and swelling. There are also other signs that show that prednisone is effective, depending on the condition being treated. Talk with your doctor if you have questions about whether this medication is working.
Your doctor may do tests to check your health and make sure the drug is working and is safe for you. These tests may include:. Steroids such as prednisone change the amount of water and salts in your body.
In large doses, prednisone can cause your body to retain salt or lose potassium. Your doctor may recommend changes to your diet to manage this side effect. There are other drugs available to treat your condition. Some may be better suited for you than others. High doses of corticosteroids administered to lactating women for long periods could potentially produce problems in the breastfed infant including growth and development and interfere with endogenous corticosteroid production. At higher daily prednisone doses, avoidance of breast-feeding during times of peak milk concentrations can help limit infant exposure; however, such adjustments are rarely necessary.
Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Use systemic corticosteroids such as prednisone with caution in the geriatric patient; the risks and benefits of therapy should be considered for any individual patient, particularly with chronic use. According to the Beers Criteria, systemic corticosteroids are considered potentially inappropriate medications PIMs for use in geriatric patients with delirium or at high risk for delirium and should be avoided in these patient populations due to the possibility of new-onset delirium or exacerbation of the current condition.
The Beers expert panel notes that oral and parenteral corticosteroids may be required for conditions such as exacerbation of chronic obstructive pulmonary disease COPD but should be prescribed in the lowest effective dose and for the shortest possible duration.
According to the OBRA guidelines, the need for continued use of a glucocorticoid, with the exception of topical or inhaled formulations, should be documented, along with monitoring for and management of adverse consequences.
Intermediate or longer-term use may cause hyperglycemia, psychosis, edema, insomnia, hypertension, osteoporosis, mood lability, or depression. Abatacept: Moderate Concomitant use of immunosuppressives, as well as long-term corticosteroids, may potentially increase the risk of serious infection in abatacept treated patients.
Advise patients taking abatacept to seek immediate medical advice if they develop signs and symptoms suggestive of infection. Acetaminophen; Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Concomitant use increases the risk of GI bleeding. In patients receiving concomitant corticosteroids and chronic use of salicylates, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance.
Acetaminophen; Aspirin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Aspirin; Diphenhydramine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Monitor patients for increased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Acetaminophen; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetaminophen; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Acetazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with acetazolamide.
Hypokalemia may be especially severe with prolonged use of corticotropin, ACTH. Acetohexamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Corticosteroids may increase blood glucose concentrations. Risk factors for impaired glucose tolerance due to corticosteroids include the corticosteroid dose and duration of treatment.
Corticosteroids stimulate hepatic glucose production and inhibit peripheral glucose uptake into muscle and fatty tissues, producing insulin resistance. Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Albiglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Alemtuzumab: Moderate Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression.
Monitor patients carefully for signs and symptoms of infection. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Alogliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents.
The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment. Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. Ambenonium Chloride: Moderate Concomitant use of anticholinesterase agents, such as ambenonium chloride, and corticosteroids may produce severe weakness in patients with myasthenia gravis.
If possible, anticholinesterase agents used to treat myasthenia should be withdrawn at least 24 hours before initiating corticosteroid therapy.
Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures.
If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients. Amiloride; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. Aminosalicylate sodium, Aminosalicylic acid: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.
Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Aprepitant, Fosaprepitant: Moderate Use caution if prednisone and aprepitant, fosaprepitant are used concurrently and monitor for an increase in prednisone-related adverse effects for several days after administration of a multi-day aprepitant regimen.
The active metabolite of prednisone, prednisolone, is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.
Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Arsenic Trioxide: Moderate Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide.
Articaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. Asparaginase Erwinia chrysanthemi: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy.
Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. Aspirin, ASA: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Monitor for decreased response to prednisone during concurrent use. Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Caffeine; Orphenadrine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Carisoprodol: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Carisoprodol; Codeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Dipyridamole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Omeprazole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Oxycodone: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Pravastatin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Atazanavir: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use. Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Atenolol; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Atracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers. Clinical improvement or recovery after stopping therapy may require weeks to years. Azilsartan; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Benazepril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bendroflumethiazide; Nadolol: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Bismuth Subsalicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Brompheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Bupivacaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. Bupropion; Naltrexone: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone.
Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary. Prednisone is a P-glycoprotein P-gp substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown.
Caffeine; Sodium Benzoate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia. Canagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Candesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Captopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution. Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure. Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection. Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpropamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorthalidone; Clonidine: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone.
Choline Salicylate; Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Cisatracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects. Dapagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment. Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids.
Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Desmopressin: Major Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Dextromethorphan; Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 DPP-4 inhibitor use; a DPP-4 dose adjustment may be necessary. Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications.
Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. Dulaglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids. For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea. Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C.
When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Empagliflozin; Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Empagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. The strength of tablets range from 1mg to 25mg. There are 2 strengths of liquid with either 1mg or 10mg in every 1ml. In children, the dose may be lower than for an adult with the same problem because it is calculated based on their height and weight. Once your health problem or condition starts to get better, it's likely that your dose will go down.
Your doctor may reduce your dose before you stop treatment completely. This is to reduce the risk of withdrawal symptoms. Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, with breakfast.
For example, if your dose is 40mg daily, your doctor may tell you to take 8 tablets 8 x 5mg all at the same time. Take prednisolone with breakfast so it does not upset your stomach. Taking prednisolone in the morning also means it's less likely to affect your sleep. The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor.
You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.
If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness. This medicine may cause you to get more infections than usual.
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Prednisone (Oral Route) Proper Use - Mayo Clinic - Latest news
The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. The usual dose varies between 5mg and 60mg daily but occasionally higher doses may be prescribed.
The strength of tablets range from 1mg to 25mg. There are 2 strengths of liquid with either 1mg or 10mg in every 1ml. In children, the dose may be lower than for an adult with the same problem because it is calculated based on their height and weight. Once your health problem or condition starts to get better, it's likely that your dose will go down. Your doctor may reduce your dose before you stop treatment completely. This is to reduce the risk of withdrawal symptoms.
Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, with breakfast. For example, if your dose is 40mg daily, your doctor may tell you to take 8 tablets 8 x 5mg all at the same time.
Take prednisolone with breakfast so it does not upset your stomach. Taking prednisolone in the morning also means it's less likely to affect your sleep. If your prednisolone tablets are labelled as "enteric coated" or "gastro resistant", you can take these with or without food but make sure to swallow them whole. Do not take indigestion medicines 2 hours before or after taking enteric coated or gastro resistant tablets.
Sometimes, your doctor may advise you to take prednisolone on alternate days only. You may need to take it for longer, even for many years or the rest of your life. If you miss a dose of prednisolone, take it as soon as you remember. If you do not remember until the following day, skip the missed dose and take the next one at the usual time. If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
Decreased insulin production may occur in the pancreas due to a direct effect on pancreatic beta cells. Albiglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Alemtuzumab: Moderate Concomitant use of alemtuzumab with immunosuppressant doses of corticosteroids may increase the risk of immunosuppression.
Monitor patients carefully for signs and symptoms of infection. Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and thiazide diuretics cause increased renal potassium loss. Aliskiren; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Alogliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Alpha-glucosidase Inhibitors: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Systemic and inhaled corticosteroids are known to increase blood glucose and worsen glycemic control in patients taking antidiabetic agents. The main risk factors for impaired glucose tolerance due to corticosteroids are the dose of steroid and duration of treatment.
Altretamine: Minor Concurrent use of altretamine with other agents which cause bone marrow or immune suppression such as corticosteroids may result in additive effects. Ambenonium Chloride: Moderate Concomitant use of anticholinesterase agents, such as ambenonium chloride, and corticosteroids may produce severe weakness in patients with myasthenia gravis.
If possible, anticholinesterase agents used to treat myasthenia should be withdrawn at least 24 hours before initiating corticosteroid therapy. Amifampridine: Moderate Carefully consider the need for concomitant treatment with systemic corticosteroids and amifampridine, as coadministration may increase the risk of seizures.
If coadministration occurs, closely monitor patients for seizure activity. Seizures have been observed in patients without a history of seizures taking amifampridine at recommended doses. Systemic corticosteroids may increase the risk of seizures in some patients. Amiloride; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Aminolevulinic Acid: Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. Aminosalicylate sodium, Aminosalicylic acid: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Amphotericin B cholesteryl sulfate complex ABCD : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Serum potassium levels should be monitored in patients receiving these drugs concomitantly. Amphotericin B lipid complex ABLC : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.
Amphotericin B liposomal LAmB : Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B.
Amphotericin B: Moderate The potassium-wasting effects of corticosteroid therapy can be exacerbated by concomitant administration of other potassium-depleting drugs including amphotericin B. Aprepitant, Fosaprepitant: Moderate Use caution if prednisone and aprepitant, fosaprepitant are used concurrently and monitor for an increase in prednisone-related adverse effects for several days after administration of a multi-day aprepitant regimen.
The active metabolite of prednisone, prednisolone, is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.
Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Arsenic Trioxide: Moderate Caution is advisable during concurrent use of arsenic trioxide and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with arsenic trioxide.
Articaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Corticosteroids may potentiate the hypokalemic effects of epinephrine. Asparaginase Erwinia chrysanthemi: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia.
L-Asparaginase transiently inhibits insulin production contributing to hyperglycemia seen during concurrent corticosteroid therapy. Insulin therapy may be required in some cases. Administration of L-asparaginase after rather than before corticosteroids reportedly has produced fewer hypersensitivity reactions. Aspirin, ASA: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Monitor for decreased response to prednisone during concurrent use. Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Caffeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Caffeine; Orphenadrine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Carisoprodol: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Carisoprodol; Codeine: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Dipyridamole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Aspirin, ASA; Omeprazole: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Oxycodone: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Aspirin, ASA; Pravastatin: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Atazanavir: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Corticosteroids, such as beclomethasone and prednisolone, whose concentrations are less affected by strong CYP3A4 inhibitors, should be considered, especially for long-term use.
Atazanavir; Cobicistat: Moderate Coadministration of prednisone with atazanavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Atenolol; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Atracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. An acute myopathy has been observed with the use of high doses of corticosteroids in patients receiving concomitant long-term therapy with neuromuscular blockers.
Clinical improvement or recovery after stopping therapy may require weeks to years. Azilsartan; Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Benazepril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Bendroflumethiazide; Nadolol: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bismuth Subsalicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Brompheniramine; Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Brompheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Brompheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Bupivacaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Bupropion is associated with a dose-related seizure risk; concomitant use of other medications that lower the seizure threshold, such as systemic corticosteroids, increases the seizure risk. Bupropion; Naltrexone: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use.
Butabarbital: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine: Moderate Coadministration may result in decreased exposure to prednisone. Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Coadministration may result in decreased exposure to prednisone.
Cabozantinib: Minor Monitor for an increase in prednisone-related adverse reactions if coadministration with cabozantinib is necessary; a dose adjustment of prednisone may be necessary. Prednisone is a P-glycoprotein P-gp substrate. Cabozantinib is a P-gp inhibitor and has the potential to increase plasma concentrations of P-gp substrates; however, the clinical relevance of this finding is unknown.
Caffeine; Sodium Benzoate: Moderate Corticosteroids may cause protein breakdown, which could lead to elevated blood ammonia concentrations, especially in patients with an impaired ability to form urea. Corticosteroids should be used with caution in patients receiving treatment for hyperammonemia.
Canagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Captopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Carbamazepine: Moderate Hepatic microsomal enzyme inducers, including carbamazepine, can increase the metabolism of prednisone. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbetapentane; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carbetapentane; Phenylephrine; Pyrilamine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Carbinoxamine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Carvedilol: Minor Increased concentrations of prednisone may occur if it is coadministered with carvedilol; exercise caution.
Carvedilol is a P-glycoprotein P-gp inhibitor and prednisone is a P-gp substrate. Ceritinib: Minor Monitor for steroid-related adverse reactions if coadministration of ceritinib with prednisone is necessary, due to increased prednisone exposure. Certolizumab pegol: Moderate The safety and efficacy of certolizumab in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with certolizumab may be at a greater risk of developing an infection. Many of the serious infections occurred in patients on immunosuppressive therapy who received certolizumab. Chlophedianol; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Chlorpheniramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Chlorpropamide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Chlorthalidone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Chlorthalidone; Clonidine: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Cholestyramine: Moderate Cholestyramine may increase the clearance of corticosteroids, such as prednisone. Choline Salicylate; Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Cisatracurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Codeine; Phenylephrine; Promethazine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Daclatasvir: Moderate Systemic exposure of prednisone, a P-glycoprotein P-gp substrate, may be increased when administered concurrently with daclatasvir, a P-gp inhibitor. Taking these drugs together could increase or prolong the therapeutic effects of prednisone; monitor patients for potential adverse effects. Dapagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Darunavir: Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Darunavir; Cobicistat: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Moderate Coadministration of prednisone with darunavir may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Consider use of an alternative corticosteroid whose concentrations are less affected by strong CYP3A4 inhibitors, such as beclomethasone and prednisolone, especially during long-term treatment. Deferasirox: Moderate Because gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including corticosteroids.
Denosumab: Moderate The safety and efficacy of denosumab use in patients with immunosuppression have not been evaluated.
Patients receiving immunosuppressives along with denosumab may be at a greater risk of developing an infection. Desmopressin: Major Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer.
Dextromethorphan; Bupropion: Moderate Monitor for seizure activity during concomitant bupropion and corticosteroid use. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dipeptidyl Peptidase-4 Inhibitors: Moderate Monitor blood glucose during concomitant corticosteroid and dipeptidyl peptidase-4 DPP-4 inhibitor use; a DPP-4 dose adjustment may be necessary.
Diphenhydramine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone. Dofetilide: Major Corticosteroids can cause increases in blood pressure, sodium and water retention, and hypokalemia, predisposing patients to interactions with certain other medications.
Corticosteroid-induced hypokalemia could also enhance the proarrhythmic effects of dofetilide. Doxacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. The concomitant administration of dronedarone with CYP3A4 and P-gp substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution.
Droperidol: Moderate Caution is advised when using droperidol in combination with corticosteroids which may lead to electrolyte abnormalities, especially hypokalemia or hypomagnesemia, as such abnormalities may increase the risk for QT prolongation or cardiac arrhythmias. Dulaglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Echinacea: Moderate Echinacea possesses immunostimulatory activity and may theoretically reduce the response to immunosuppressant drugs like corticosteroids.
For some patients who are using corticosteroids for serious illness, such as cancer or organ transplant, this potential interaction may result in the preferable avoidance of Echinacea.
Although documentation is lacking, coadministration of echinacea with immunosuppressants is not recommended by some resources. Econazole: Minor In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C.
When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Coadministration of prednisone with cobicistat may cause elevated prednisone serum concentrations, potentially resulting in Cushing's syndrome and adrenal suppression.
Empagliflozin; Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Empagliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Enalapril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Enzalutamide: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with enzalutamide; a dosage increase may be necessary.
Concurrent use may decrease the exposure of prednisone. Ephedrine: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids.
Decreased blood concentrations and lessened physiologic activity may necessitate an increase in corticosteroid dosage.
Ephedrine; Guaifenesin: Moderate Ephedrine may enhance the metabolic clearance of corticosteroids. Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Erlotinib: Moderate Monitor for symptoms of gastrointestinal GI perforation e. Permanently discontinue erlotinib in patients who develop GI perforation. The pooled incidence of GI perforation clinical trials of erlotinib ranged from 0. Ertugliflozin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Estrogens: Moderate Monitor for corticosteroid-related adverse events if corticosteroids are used with estrogens.
Concurrent use may increase the exposure of corticosteroids. Estrogens may decrease the hepatic clearance of corticosteroids thereby increasing their effect.
Caution is warranted if these drugs are coadministered. Exenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Fluoxymesterone: Moderate Coadministration of corticosteroids and fluoxymesterone may increase the risk of edema, especially in patients with underlying cardiac or hepatic disease. Corticosteroids with greater mineralocorticoid activity, such as fludrocortisone, may be more likely to cause edema.
Administer these drugs in combination with caution. Fosamprenavir: Moderate Concomitant use of prednisone and fosamprenavir may result in altered prednisone plasma concentrations. Amprenavir, the active metabolite of fosamprenavir, is an inducer of P-gp and a potent inhibitor and moderate inducer of CYP3A4. Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Fosphenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with fosphenytoin; a dosage increase may be necessary. Gallium Ga 68 Dotatate: Moderate Repeated administration of high corticosteroid doses prior to gallium Ga 68 dotatate may result in false negative imaging.
Corticosteroids can down-regulate somatostatin subtype 2 receptors: thereby, interfering with binding of gallium Ga 68 dotatate to malignant cells that overexpress these receptors. Glecaprevir; Pibrentasvir: Moderate Caution is advised with the coadministration of glecaprevir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects.
Prednisone is a substrate of P-glycoprotein P-gp ; glecaprevir is a P-gp inhibitor. Moderate Caution is advised with the coadministration of pibrentasvir and prednisone as coadministration may increase serum concentrations of prednisone and increase the risk of adverse effects. Prednisone is a substrate of P-glycoprotein P-gp ; pibrentasvir is a P-gp inhibitor. Glimepiride: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Glimepiride; Rosiglitazone: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glipizide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glipizide; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glyburide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Glyburide; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Glycerol Phenylbutyrate: Moderate Corticosteroids may induce elevated blood ammonia concentrations. Corticosteroids should be used with caution in patients receiving glycerol phenylbutyrate. Monitor ammonia concentrations closely. Golimumab: Moderate The safety and efficacy of golimumab in patients with immunosuppression have not been evaluated. Patients receiving immunosuppressives along with golimumab may be at a greater risk of developing an infection.
Guaifenesin; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Haloperidol: Moderate Caution is advisable during concurrent use of haloperidol and corticosteroids as electrolyte imbalance caused by corticosteroids may increase the risk of QT prolongation with haloperidol. Hemin: Moderate Hemin works by inhibiting aminolevulinic acid synthetase. Corticosteroids increase the activity of this enzyme should not be used with hemin.
Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Hydrochlorothiazide, HCTZ; Methyldopa: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Hydrochlorothiazide, HCTZ; Moexipril: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Ibritumomab Tiuxetan: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
While therapy is designed to take advantage of this effect, patients may be predisposed to over-immunosuppression resulting in an increased risk for the development of severe infections.
If coadministration is necessary, close clinical monitoring is advised and therapy should be accompanied by appropriate antimicrobial therapies as indicated. Incretin Mimetics: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Indapamide: Moderate Additive hypokalemia may occur when indapamide is coadministered with other drugs with a significant risk of hypokalemia such as systemic corticosteroids.
Coadminister with caution and careful monitoring. Inebilizumab: Moderate Concomitant usage of inebilizumab with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering therapies that cause immunosuppression with inebilizumab.
Infliximab: Moderate Many serious infections during infliximab therapy have occurred in patients who received concurrent immunosuppressives that, in addition to their underlying Crohn's disease or rheumatoid arthritis, predisposed patients to infections.
The impact of concurrent infliximab therapy and immunosuppression on the development of malignancies is unknown. In clinical trials, the use of concomitant immunosuppressant agents appeared to reduce the frequency of antibodies to infliximab and appeared to reduce infusion reactions.
Insulin Degludec; Liraglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Insulin Glargine; Lixisenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Insulins: Moderate Monitor blood glucose during concomitant corticosteroid and insulin use; an insulin dose adjustment may be necessary.
Irbesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Isavuconazonium: Moderate Concomitant use of isavuconazonium with prednisone may result in increased serum concentrations of prednisone. Prednisolone, the active metabolite of prednisone, is a substrate of the hepatic isoenzyme CYP3A4; additionally prednisone is a substrate of the drug transporter P-glycoprotein P-gp. Caution and close monitoring for adverse effects, such as corticosteroid-related side effects, are advised if these drugs are used together.
Isoniazid, INH; Rifampin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifampin; a dosage increase may be necessary. Isoproterenol: Moderate The risk of cardiac toxicity with isoproterenol in asthma patients appears to be increased with the coadministration of corticosteroids. Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0. Isotretinoin: Minor Both isotretinoin and corticosteroids can cause osteoporosis during chronic use.
Patients receiving systemic corticosteroids should receive isotretinoin therapy with caution. Itraconazole: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone.
Monitor patients for corticosteroid-related side effects if both prednisone and itraconazole are taken. Ketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole.
Concurrent use may increase the exposure of prednisone. In a study, ketoconazole inhibited 6 beta-hydroxylase and increased the exposure of biologically active unbound prednisolone after oral prednisone administration.
L-Asparaginase Escherichia coli: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. Ledipasvir; Sofosbuvir: Moderate Caution and close monitoring of prednisone-associated adverse reactions is advised with concomitant administration of ledipasvir.
Prednisone is a substrate of the drug transporter P-glycoprotein P-gp ; ledipasvir is a P-gp inhibitor. Taking these drugs together may increase prednisone plasma concentrations. Letermovir: Moderate A clinically relevant increase in the plasma concentration of prednisolone the active metabolite of prednisone may occur if given with letermovir. In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified.
Prednisolone is a CYP3A4 substrate. Levoketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole.
Lidocaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Liraglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary. Lisinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Live Vaccines: Contraindicated Live vaccines should generally not be administered to an immunosuppressed patient. Live vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment. The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses.
If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule.
Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Patients on corticosteroid treatment for 2 weeks or more may be vaccinated after steroid therapy has been discontinued for at least 3 months in accordance with general recommendations for the use of live vaccines.
The CDC has stated that discontinuation of steroids for 1 month prior to live vaccine administration may be sufficient. Live vaccines should not be given to individuals who are considered to be immunocompromised until more information is available. Lixisenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Lonafarnib: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with lonafarnib. Lonapegsomatropin: Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted.
Loop diuretics: Moderate Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Both corticosteroids and loop diuretics cause increased renal potassium loss.
Lopinavir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Losartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Lumacaftor; Ivacaftor: Moderate Lumacaftor; ivacaftor may reduce the efficacy of prednisone and prednisolone by decreasing systemic exposure of the corticosteroid. If used together, a higher systemic corticosteroid dose may be required to obtain the desired therapeutic effect. Lumateperone: Minor The manufacturer of lumateperone recommends that concurrent use of prednisone be avoided and lists prednisone as a CYP3A4 inducer.
Lumateperone is a CYP3A4 substrate. However, prednisone is not an established CYP3A4 inducer, and the potential outcome of using this combination is unknown. Be alert for a potential reduction in lumateperone efficacy.
Macimorelin: Major Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids. Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin. Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Mannitol: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Mecasermin rinfabate: Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF Similar counteractive effects are expected in humans.
If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored.
Mecasermin, Recombinant, rh-IGF Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF Meglitinides: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Repaglinide: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Metformin; Rosiglitazone: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Saxagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Sitagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Methazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide.
Methenamine; Sodium Acid Phosphate: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
Methenamine; Sodium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Methyclothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Metolazone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Metoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Metyrapone: Contraindicated Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone. Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Micafungin: Moderate Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin.
Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects. In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin mg and oral prednisolone 20 mg. This reaction was transient, and the subject did not develop significant anemia.
Mifepristone: Major Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses e.
For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions. This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness. Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring.
Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism.
Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events.
Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone 85 hours. Mitotane: Moderate Use caution if mitotane and prednisone are used concomitantly, and monitor for decreased efficacy of prednisone and a possible change in dosage requirements. Mitotane is a strong CYP3A4 inducer and prednisone is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of prednisone.
Mivacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Natalizumab: Major Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab.
Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy.
Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone.
In multiple sclerosis MS clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently.
Nateglinide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Neostigmine: Moderate Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy.
Neuromuscular blockers: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Nevirapine: Major The use of prednisone to prevent nevirapine-associated rash is not recommended. In a clinical trial, concomitant use of prednisone was associated with an increase in incidence and severity of rash during the first 6 weeks of nevirapine therapy.
Nirmatrelvir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Nonsteroidal antiinflammatory drugs: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug NSAID use.
The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. Ocrelizumab: Moderate Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression.
Ofatumumab: Moderate Concomitant use of ofatumumab with corticosteroids may increase the risk of immunosuppression. Ofatumumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids. Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Olmesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression. Plasma concentrations and efficacy of prednisolone may be reduced if these drugs are administered concurrently. Oxymetholone: Moderate Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema.
Ozanimod: Moderate Concomitant use of ozanimod with prednisone may increase the risk of immunosuppression. In clinical studies for ulcerative colitis, the use of systemic corticosteroids did not appear to influence safety or efficacy of ozanimod. Pancuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Coadministration of pazopanib and prednisone, a CYP3A4 substrate, may cause an increase in systemic concentrations of prednisone. Use caution when administering these drugs concomitantly. In addition, concomitant administration may predispose the patient to over-immunosuppression resulting in an increased risk for the development of severe infections. Pegaspargase: Moderate Monitor for an increase in glucocorticoid-related adverse reactions such as hyperglycemia and osteonecrosis during concomitant use of pegaspargase and glucocorticoids.
Peginterferon Alfa-2a: Moderate Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives. Penicillamine: Major Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity.
Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone. Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Phenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with phenytoin; a dosage increase may be necessary. Photosensitizing agents topical : Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment. Physostigmine: Moderate Concomitant use of anticholinesterase agents.
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Prednisone: Side effects, dosage, uses, and more.
Glyburide: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone. Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Neostigmine: Moderate Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase inhibitors at least 24 hours before initiating corticosteroid therapy.
How and when to take prednisolone tablets and liquid. It's important to take prednisolone as your doctor has advised. Dosage and strength The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. Changes to your dose Your dose may go up or down. Your dose may go up if your symptoms get worse. How to take it Unless your doctor or pharmacist gives you different instructions, it's best to take prednisolone as a single dose once a day, with breakfast.
How long to take it for This depends on your health problem or condition. You may only need a short course of prednisolone for up to 1 week.
If you forget to take it If you miss a dose of prednisolone, take it as soon as you remember. Do not take a double dose to make up for a forgotten one.
Itraconazole: Moderate Prednisone is metabolized by the liver to the active metabolite prednisolone. Monitor patients for corticosteroid-related side effects if both prednisone and itraconazole are taken. Ketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole. Concurrent use may increase the exposure of prednisone. In a study, ketoconazole inhibited 6 beta-hydroxylase and increased the exposure of biologically active unbound prednisolone after oral prednisone administration.
L-Asparaginase Escherichia coli: Moderate Concomitant use of L-asparaginase with corticosteroids can result in additive hyperglycemia. Ledipasvir; Sofosbuvir: Moderate Caution and close monitoring of prednisone-associated adverse reactions is advised with concomitant administration of ledipasvir.
Prednisone is a substrate of the drug transporter P-glycoprotein P-gp ; ledipasvir is a P-gp inhibitor. Taking these drugs together may increase prednisone plasma concentrations. Letermovir: Moderate A clinically relevant increase in the plasma concentration of prednisolone the active metabolite of prednisone may occur if given with letermovir.
In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified. Prednisolone is a CYP3A4 substrate. Levoketoconazole: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with ketoconazole.
Lidocaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary. Linagliptin; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Liraglutide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Lisinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Live Vaccines: Contraindicated Live vaccines should generally not be administered to an immunosuppressed patient. Live vaccines may induce the illness they are intended to prevent and are generally contraindicated for use during immunosuppressive treatment.
The immune response of the immunocompromised patient to vaccines may be decreased, even despite alternate vaccination schedules or more frequent booster doses.
If immunization is necessary, choose an alternative to live vaccination, or, consider a delay or change in the immunization schedule. Practitioners should refer to the most recent CDC guidelines regarding vaccination of patients who are receiving drugs that adversely affect the immune system. Patients on corticosteroid treatment for 2 weeks or more may be vaccinated after steroid therapy has been discontinued for at least 3 months in accordance with general recommendations for the use of live vaccines.
The CDC has stated that discontinuation of steroids for 1 month prior to live vaccine administration may be sufficient. Live vaccines should not be given to individuals who are considered to be immunocompromised until more information is available. Lixisenatide: Moderate Monitor blood glucose during concomitant corticosteroid and incretin mimetic use; an incretin mimetic dose adjustment may be necessary.
Lonafarnib: Moderate Monitor for corticosteroid-related adverse events if prednisone is used with lonafarnib. Lonapegsomatropin: Moderate Corticosteroids can retard bone growth and therefore, can inhibit the growth-promoting effects of somatropin. If corticosteroid therapy is required, the corticosteroid dose should be carefully adjusted. Loop diuretics: Moderate Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Both corticosteroids and loop diuretics cause increased renal potassium loss. Lopinavir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Losartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Lumacaftor; Ivacaftor: Moderate Lumacaftor; ivacaftor may reduce the efficacy of prednisone and prednisolone by decreasing systemic exposure of the corticosteroid.
If used together, a higher systemic corticosteroid dose may be required to obtain the desired therapeutic effect. Lumateperone: Minor The manufacturer of lumateperone recommends that concurrent use of prednisone be avoided and lists prednisone as a CYP3A4 inducer. Lumateperone is a CYP3A4 substrate.
However, prednisone is not an established CYP3A4 inducer, and the potential outcome of using this combination is unknown. Be alert for a potential reduction in lumateperone efficacy. Macimorelin: Major Avoid use of macimorelin with drugs that directly affect pituitary growth hormone secretion, such as corticosteroids. Healthcare providers are advised to discontinue corticosteroid therapy and observe a sufficient washout period before administering macimorelin.
Use of these medications together may impact the accuracy of the macimorelin growth hormone test. Magnesium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Mannitol: Moderate Corticosteroids may accentuate the electrolyte loss associated with diuretic therapy resulting in hypokalemia. Also, corticotropin may cause calcium loss and sodium and fluid retention. Mannitol itself can cause hypernatremia. Close monitoring of electrolytes should occur in patients receiving these drugs concomitantly. Mecasermin rinfabate: Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF In animal studies, corticosteroids impair the growth-stimulating effects of growth hormone GH through interference with the physiological stimulation of epiphyseal chondrocyte proliferation exerted by GH and IGF Dexamethasone administration on long bone tissue in vitro resulted in a decrease of local synthesis of IGF Similar counteractive effects are expected in humans.
If systemic or inhaled glucocorticoid therapy is required, the steroid dose should be carefully adjusted and growth rate monitored.
Mecasermin, Recombinant, rh-IGF Moderate Additional monitoring may be required when coadministering systemic or inhaled corticosteroids and mecasermin, recombinant, rh-IGF Meglitinides: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Repaglinide: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Metformin; Rosiglitazone: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Metformin; Saxagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary.
Metformin; Sitagliptin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Methazolamide: Moderate Corticosteroids may increase the risk of hypokalemia if used concurrently with methazolamide. Methenamine; Sodium Acid Phosphate: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Methenamine; Sodium Salicylate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Methyclothiazide: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Metolazone: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Metoprolol; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Metyrapone: Contraindicated Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone.
Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Micafungin: Moderate Leukopenia, neutropenia, anemia, and thrombocytopenia have been associated with micafungin. Patients who are taking immunosuppressives such as the corticosteroids with micafungin concomitantly may have additive risks for infection or other side effects.
In a pharmacokinetic trial, micafungin had no effect on the pharmacokinetics of prednisolone. Acute intravascular hemolysis and hemoglobinuria was seen in a healthy volunteer during infusion of micafungin mg and oral prednisolone 20 mg. This reaction was transient, and the subject did not develop significant anemia. Mifepristone: Major Mifepristone for termination of pregnancy is contraindicated in patients on long-term corticosteroid therapy and mifepristone for Cushing's disease or other chronic conditions is contraindicated in patients who require concomitant treatment with systemic corticosteroids for life-saving purposes, such as serious medical conditions or illnesses e.
For other situations where corticosteroids are used for treating non-life threatening conditions, mifepristone may lead to reduced corticosteroid efficacy and exacerbation or deterioration of such conditions. This is because mifepristone exhibits antiglucocorticoid activity that may antagonize corticosteroid therapy and the stabilization of the underlying corticosteroid-treated illness.
Mifepristone may also cause adrenal insufficiency, so patients receiving corticosteroids for non life-threatening illness require close monitoring. Because serum cortisol levels remain elevated and may even increase during treatment with mifepristone, serum cortisol levels do not provide an accurate assessment of hypoadrenalism.
Patients should be closely monitored for signs and symptoms of adrenal insufficiency, If adrenal insufficiency occurs, stop mifepristone treatment and administer systemic glucocorticoids without delay; high doses may be needed to treat these events. Factors considered in deciding on the duration of glucocorticoid treatment should include the long half-life of mifepristone 85 hours.
Mitotane: Moderate Use caution if mitotane and prednisone are used concomitantly, and monitor for decreased efficacy of prednisone and a possible change in dosage requirements.
Mitotane is a strong CYP3A4 inducer and prednisone is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of prednisone. Mivacurium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Natalizumab: Major Ordinarily, patients receiving chronic immunosuppressant therapy should not be treated with natalizumab.
Treatment recommendations for combined corticosteroid therapy are dependent on the underlying indication for natalizumab therapy. Corticosteroids should be tapered in those patients with Crohn's disease who are on chronic corticosteroids when they start natalizumab therapy, as soon as a therapeutic benefit has occurred. If the patient cannot discontinue systemic corticosteroids within 6 months, discontinue natalizumab. The concomitant use of natalizumab and corticosteroids may further increase the risk of serious infections, including progressive multifocal leukoencephalopathy, over the risk observed with use of natalizumab alone.
In multiple sclerosis MS clinical trials, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in natalizumab-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. Short courses of steroid use during natalizumab, such as when they are needed for MS relapse treatment, appear to be acceptable for use concurrently. Nateglinide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Neostigmine: Moderate Concomitant use of anticholinesterase agents, such as neostigmine, and systemic corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating systemic corticosteroid therapy. Neuromuscular blockers: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Nevirapine: Major The use of prednisone to prevent nevirapine-associated rash is not recommended. In a clinical trial, concomitant use of prednisone was associated with an increase in incidence and severity of rash during the first 6 weeks of nevirapine therapy. Nirmatrelvir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Nonsteroidal antiinflammatory drugs: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and nonsteroidal antiinflammatory drug NSAID use. The Beers criteria recommends that this drug combination be avoided in older adults; if coadministration cannot be avoided, provide gastrointestinal protection. Ocrelizumab: Moderate Ocrelizumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids.
Concomitant use of ocrelizumab with any of these therapies may increase the risk of immunosuppression. Ofatumumab: Moderate Concomitant use of ofatumumab with corticosteroids may increase the risk of immunosuppression. Ofatumumab has not been studied in combination with other immunosuppressive or immune modulating therapies used for the treatment of multiple sclerosis, including immunosuppressant doses of corticosteroids.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Olmesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Ombitasvir; Paritaprevir; Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Plasma concentrations and efficacy of prednisolone may be reduced if these drugs are administered concurrently. Oxymetholone: Moderate Concomitant use of oxymetholone with corticosteroids or corticotropin, ACTH may cause increased edema.
Ozanimod: Moderate Concomitant use of ozanimod with prednisone may increase the risk of immunosuppression. In clinical studies for ulcerative colitis, the use of systemic corticosteroids did not appear to influence safety or efficacy of ozanimod. Pancuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Coadministration of pazopanib and prednisone, a CYP3A4 substrate, may cause an increase in systemic concentrations of prednisone. Use caution when administering these drugs concomitantly. In addition, concomitant administration may predispose the patient to over-immunosuppression resulting in an increased risk for the development of severe infections.
Pegaspargase: Moderate Monitor for an increase in glucocorticoid-related adverse reactions such as hyperglycemia and osteonecrosis during concomitant use of pegaspargase and glucocorticoids.
Peginterferon Alfa-2a: Moderate Additive myelosuppressive effects may be seen when alpha interferons are given concurrently with other myelosuppressive agents, such as antineoplastic agents or immunosuppressives.
Penicillamine: Major Agents such as immunosuppressives have adverse reactions similar to those of penicillamine. Concomitant use of penicillamine with these agents is contraindicated because of the increased risk of developing severe hematologic and renal toxicity.
Phenobarbital: Moderate Coadministration may result in decreased exposure to prednisone. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: Moderate Coadministration may result in decreased exposure to prednisone. Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Phenytoin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with phenytoin; a dosage increase may be necessary. Photosensitizing agents topical : Minor Corticosteroids administered prior to or concomitantly with photosensitizing agents used in photodynamic therapy may decrease the efficacy of the treatment.
Physostigmine: Moderate Concomitant use of anticholinesterase agents. If possible, withdraw anticholinesterase inhibitors at least 24 hours before initiating corticosteroid therapy. Pimozide: Moderate According to the manufacturer of pimozide, the drug should not be coadministered with drugs known to cause electrolyte imbalances, such as high-dose, systemic corticosteroid therapy.
Pimozide is associated with a well-established risk of QT prolongation and torsade de pointes TdP , and electrolyte imbalances e. Pimozide is contraindicated in patients with known hypokalemia or hypomagnesemia. Topical corticosteroids are less likely to interact. Pioglitazone; Glimepiride: Moderate Monitor blood glucose during concomitant corticosteroid and sulfonylurea use; a sulfonylurea dose adjustment may be necessary.
Pioglitazone; Metformin: Moderate Monitor blood glucose during concomitant corticosteroid and metformin use; a metformin dose adjustment may be necessary. Ponesimod: Moderate Monitor for signs and symptoms of infection. Additive immune suppression may result from concomitant use of ponesimod and high-dose corticosteroid therapy which may extend the duration or severity of immune suppression. Posaconazole: Moderate Posaconazole and prednisone should be coadministered with caution due to an increased potential for adverse events.
Posaconazole is a potent inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of prednisone. Further, both prednisone and posaconazole are substrates of the drug efflux protein, P-glycoprotein, which when administered together may increase the absorption or decrease the clearance of the other drug. This complex interaction may cause alterations in the plasma concentrations of both posaconazole and prednisone, ultimately resulting in an increased risk of adverse events.
Potassium Phosphate; Sodium Phosphate: Moderate Use sodium phosphate cautiously with corticosteroids, especially mineralocorticoids or corticotropin, ACTH, as concurrent use can cause hypernatremia. Potassium-sparing diuretics: Minor The manufacturer of spironolactone lists corticosteroids as a potential drug that interacts with spironolactone.
Intensified electrolyte depletion, particularly hypokalemia, may occur. However, potassium-sparing diuretics such as spironolactone do not induce hypokalemia. In fact, hypokalemia is one of the indications for potassium-sparing diuretic therapy.
Therefore, drugs that induce potassium loss, such as corticosteroids, could counter the hyperkalemic effects of potassium-sparing diuretics. Pramlintide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Prilocaine; Epinephrine: Moderate Monitor potassium concentrations during concomitant corticosteroid and epinephrine use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Primidone: Moderate Coadministration may result in decreased exposure to prednisone. Promethazine; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be increased in patient receiving corticosteroids, such as hydrocortisone.
Propranolol: Moderate Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia. Concurrent use may increase risk of hypoglycemia because of loss of the counter-regulatory cortisol response. Propranolol; Hydrochlorothiazide, HCTZ: Moderate Monitor blood sugar during concomitant corticosteroid and propranolol use due to risk for hypoglycemia.
Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Propylthiouracil, PTU: Moderate The metabolism of corticosteroids is increased in hyperthyroidism and decreased in hypothyroidism.
Dosage adjustments may be necessary when initiating, changing or discontinuing thyroid hormones or antithyroid agents. Purine analogs: Minor Concurrent use of purine analogs with other agents which cause bone marrow or immune suppression such as other antineoplastic agents or immunosuppressives may result in additive effects. Pyridostigmine: Moderate Concomitant use of anticholinesterase agents.
If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy. Quinapril; Hydrochlorothiazide, HCTZ: Moderate Monitor potassium concentrations during concomitant corticosteroid and thiazide diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary.
Quinolones: Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids.
Discontinue quinolone therapy at the first sign of tendon inflammation or tendon pain, as these are symptoms that may precede rupture of the tendon. Rapacuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy.
Repaglinide: Moderate Monitor patients receiving antidiabetic agents closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Rifampin: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifampin; a dosage increase may be necessary.
Rifapentine: Moderate Monitor for decreased corticosteroid efficacy if prednisone is used with rifapentine; a dosage increase may be necessary. Rilonacept: Moderate Patients receiving immunosuppressives along with rilonacept may be at a greater risk of developing an infection. Ritonavir: Moderate Coadministration of prednisone with ritonavir a strong CYP3A4 inhibitor may cause prednisone serum concentrations to increase, potentially resulting in Cushing's syndrome and adrenal suppression.
Rituximab: Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy. Rituximab; Hyaluronidase: Moderate Rituximab and corticosteroids are commonly used together; however, monitor the patient for immunosuppression and signs and symptoms of infection during combined chronic therapy.
Rocuronium: Moderate Limit the period of use of neuromuscular blockers and corticosteroids and only use when the specific advantages of the drugs outweigh the risks for acute myopathy. Salicylates: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use. Salsalate: Moderate Monitor for gastrointestinal toxicity during concurrent corticosteroid and salicylate use.
Saquinavir: Major Saquinavir may inhibit CYP3A4 metabolism of prednisone, resulting in increased plasma prednisone concentrations and reduced serum cortisol concentrations. There have been reports of clinically significant drug interactions in patients receiving ritonavir with other corticosteroids, resulting in systemic corticosteroid effects including Cushing syndrome and adrenal suppression.
To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid. Measure the concentrated liquid with the special oral dropper that comes with the package.
If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug. Prednisone works by weakening your immune system. If these effects are mild, they may go away within a few days or a couple of weeks.
Call your doctor right away if you have serious side effects. Serious side effects and their symptoms can include the following:. Disclaimer: Our goal is to provide you with the most relevant and current information.
However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history. Prednisone oral tablet can interact with other medications, vitamins , or herbs you may be taking.
An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help avoid interactions, your doctor should manage all of your medications carefully. Taking mifepristone with prednisone may prevent prednisone from working correctly. Taking bupropion with prednisone may cause seizures.
Taking prednisone weakens your immune system. If you receive a live vaccine while taking prednisone, your immune system might not be able to handle it properly. This may lead to an infection. Taking prednisone with drugs that treat diabetes may result in an increase in your blood glucose levels and problems controlling your diabetes. Examples of these drugs include:. Taking warfarin with prednisone may reduce the blood-thinning effect of warfarin. If you take these drugs together, your doctor may monitor your treatment with warfarin closely.
However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. Prednisone oral tablet can cause a serious allergic reaction in some people. This reaction can cause a skin rash, which can include:. Taking it again could be fatal cause death. For people with infections: Taking prednisone weakens your immune system and can worsen an infection you already have.
It also increases your risk of getting a new infection. For people living with heart or kidney disease: Prednisone may make you retain salt and water, which can raise your blood pressure. For people living with diabetes: Prednisone can increase your blood sugar level.
Send the page " " to a friend, relative, colleague or yourself. We do not record any personal information entered above. Commonly-prescribed oral corticosteroid with little mineralocorticoid activity; metabolized to prednisolone; prednisone is roughly 4 times as potent as hydrocortisone as a glucocorticoid Used in many conditions in adult and pediatric patients, including asthma, COPD, SLE, rheumatoid and psoriatic arthritis, prevention of transplant rejection, and many allergic, dermatologic, and inflammatory states If long-term therapy required, the lowest possible effective dose should be used.
For acute conditions, parenteral steroid therapy is recommended initially. NOTE: Hydrocortisone and cortisone are the preferred agents; prednisone has little to no mineralocorticoid properties. NOTE: Hydrocortisone is the preferred glucocorticoid in infants.
Titrate to response. The usual range is 5 mg to 30 mg PO once daily. Renal transplant guidelines recommend a calcineurin inhibitor CNI such as tacrolimus and an antiproliferative agent such as mycophenolate plus or minus corticosteroids for initial prophylaxis. In patients at low immunologic risk who receive induction therapy, corticosteroid discontinuation during first week after transplantation is suggested.
Some evidence exists that steroids may be safely stopped in most patients after 3 to 12 months on combination therapy with a CNI and mycophenolate. Data suggest that the risk of steroid withdrawal depends on the use of concomitant immunosuppressives, immunological risk, ethnicity, and time after transplantation.
Once the prednisone taper is completed without a flare, the cyclosporine dose is tapered to alternate day dosing such that the patient is taking prednisone one day and cyclosporine the next day. Once patients reach their maximal response, therapy is continued for another 3 months and then tapered. Multiple dosage regimens have been studied. Dosage requirements are variable though and should be individualized based on the response of the patient and tolerance to treatment.
The American College of Gastroenterology states that corticosteroids are not effective for maintenance of medically-induced remission in Crohn's disease and should not be used for long-term treatment. Corticosteroids for Crohn's disease are more effective for small-bowel involvement than for colonic involvement.
Because of the potential complications of steroid use in this disease, steroids should be used selectively and in the lowest dose possible. Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.
Total course of treatment may range from 3 to 10 days. Dosing in the afternoon at PM may be helpful for patients prone to nocturnal symptoms, with no increase in adrenal suppression. Consider add-on low dose oral corticosteroids CS 7. Add CS only after exclusion of other contributory factors and consideration of other add-on treatments. In pediatric patients, the use of oral corticosteroids is usually limited to a few weeks until asthma control is improved and the patient can be stabilized on other, preferred treatments.
Increase by 5 mg every 2 to 3 days as needed. For chronic use, may change to every other day therapy. Usual dosage ranges from 5 to 30 mg PO once daily. Use the lowest effective dose usually less than 7. American College of Rheumatology guidelines recommend 0. Taper the dose after a few weeks to the lowest effective dose that maintains control. Insufficient data exist to recommend a specific steroid taper because nephritis and extrarenal manifestations vary from patient to patient.
Some patients may require long-term therapy. If needed, the long-term maintenance dose is 0. In patients with severe skin reactions, higher initial doses e.
Adjust until a satisfactory response is noted; taper as clinically indicated. High-dose corticosteroids are controversial; administration has been associated with decreased survival. Depending on the indication, the initial dose may be gradually tapered after 1 to 2 weeks and discontinued by 4 to 6 weeks, as guided by symptoms.
Oral corticosteroids are usually reserved for cases not responding to standard topical treatments. Use lowest effective dose. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.
Corticosteroid use in ARDS is controversial. The initial dosage may vary from 5 to 60 mg PO per day. Guidelines use a dose of 0. Taper to 0. Guidelines suggest use of prednisone with cyclophosphamide or azathioprine, and a minimum of 6 months duration. Objective responses may not be noted until at least 3 months of therapy.
Exact duration of treatment and need for long-term maintenance should be individualized to clinical response and tolerance of therapy. Chronic doses of prednisone 15 mg to 20 mg PO once daily may be adequate as maintenance therapy.
Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Weight-based dosing: 0. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, as guided by symptoms. Chemotherapy cycle is repeated every 57 days. Depending on indication, gradually taper the initial dose after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Guidelines recommend as adjunct therapy for meningitis.
Routine use outside of CNS involvement is not recommended; however, select patients may benefit. The National Institutes of Health NIH COVID treatment guidelines recommend prednisone as an alternative corticosteroid for hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation ECMO.
The NIH recommends 40 mg PO once daily or in 2 divided doses for up to 10 days or until hospital discharge whichever comes first. The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting prednisone.
Treatment cycles may be repeated when the granulocyte and platelet counts returned to normal. Response may be gradual over several months.
The optimal dosage of melphalan and prednisone plus thalidomide has not been clearly established and dosages have varied in randomized controlled trials. In one study, previously untreated patients between 65 and 75 years of age received melphalan 0. Thalidomide was stopped after day 4 of the last cycle. In another study, patients aged 75 years and older received melphalan 0. In cycles 1 through 4, bortezomib 1.
In cycles 5 to 9, bortezomib 1. Dosage not established. The progression-free survival time was not significantly improved with carfilzomib, melphalan, and prednisone compared with bortezomib, melphalan, and prednisone in a randomized, phase 3 trial the CLARION trial ; additionally, serious and fatal adverse reactions occurred more often in the carfilzomib-containing arm.
There is not sufficient evidence to support the use of this drug combination for this indication. If side effects e. NOTE: The definitive treatment for median-nerve entrapment is surgery. Corticosteroids are temporary measures; patients who have intermittent pain and paresthesias without any fixed motor sensory deficits may respond to conservative therapy.
Initially, 20 mg to 30 mg PO once daily has been recommended. Some experts give a combination of prednisone and azathioprine. For maintenance, prednisone 5 mg to 15 mg PO once daily has been recommended. Doses for the various manifestations of SLE vary widely. Maintenance doses are usually 10 to 20 mg PO once daily or 20 to 40 mg PO every other day. Initially, large doses e. Individualize dose and titrate to response. After symptoms controlled, decrease dose slowly every 5 to 7 days.
Maintenance doses for chronic conditions are usually 10 to 20 mg PO once daily or 20 mg to 40 mg PO every other day. The treatment combination demonstrated superior results over colchicine alone in the treatment of primary amyloidosis.
A multicenter, randomized, controlled trial confirmed that this shorter duration of low dose prednisone is equivalent to using 40 mg of prednisone for a longer duration i. Data from studies indicate that systemic glucocorticoids shorten recovery time; improve lung function FEV-1improve oxygenation, and reduce the risk of early relapse, treatment failure, and the length of hospitalization.
Taper dose over at least 6 weeks. There is variation in the literature with regard to dosage regimens. Prednisone 0. Use of IV methylprednisolone for a few days may precede oral corticosteroid use. While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value.
Higher quality data are needed to establish the benefits vs. Experts generally agree that patients who have neurologic deficits should receive a corticosteroid; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation. Topically applied corticosteroids are as effective as systemic corticosteroids for anterior ocular inflammation.
Common regimens from high-quality clinical trials include a prednisone or prednisolone dose of 60 mg PO per day for 5 days, followed by a 5-day taper or 25 mg PO twice daily for 10 daysin combination with appropriate antiviral treatment. A prednisone dose of mg PO administered in descending doses over 10 days has also been used with efficacy. The American Academy of Neurology notes that for new-onset Bell's palsy, steroids are effective in increasing the probability of complete facial functional recovery according to data derived from class I high quality studies.
The optimal dose of prednisone for infantile spasms has not been determined. Based on the evidence currently available, the American Academy of Neurology and the Child Neurology Society's practice parameters for the treatment of infantile spasms state that there is insufficient evidence that oral corticosteroids are effective in the treatment of infantile spasms. There are limited data available for the treatment of refractory seizure types in pediatric patients.
The standard prednisone dosage for adults is mg per day. Use our prednisone dosage chart to find the recommended and maximum dosage of prednisone. Oral: 1 mg/kg (maximum dose: 60 to 80 mg/day) once daily or 2 mg/kg (maximum dose: mg) every other day; duration of therapy depends on.
The standard prednisone dosage for adults is mg per day. Use our prednisone dosage chart to find the recommended and maximum dosage of prednisone. The starting dose of prednisone may be between 5 mg to 60 mg per day. A dose above 40 mg per day may be considered a high dose. The dose of prednisolone you'll take depends on your health problem and whether you are taking it as a short course or for longer. The usual dose varies.
Systemic corticosteroids may increase the risk of seizures in some patients. How long to take it for This depends on your health problem or condition. Take this medicine exactly as directed by your doctor. Advertising and sponsorship policy Advertising and sponsorship opportunities.
Prednisone is a prescription steroid drug. It comes as an immediate-release tablet, a delayed-release tablet, and a liquid solution. You take all of these forms by mouth. Prednisone delayed-release tablet is available as a generic drug and as the brand-name drug Rayos.
The immediate-release tablet is only available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug. Prednisone works by weakening your immune system. If these effects are mild, they may go away within a few days or a couple of weeks.
Call your doctor right away if you have serious side effects. Serious side effects and their symptoms can include the following:. Disclaimer: Our goal is to provide you with the most relevant and current information.
However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.
Prednisone oral tablet can interact with other medications, vitamins , or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. To help avoid interactions, your doctor should manage all of your medications carefully. Taking mifepristone with prednisone may prevent prednisone from working correctly. Taking bupropion with prednisone may cause seizures.
Taking prednisone weakens your immune system. If you receive a live vaccine while taking prednisone, your immune system might not be able to handle it properly. This may lead to an infection. Taking prednisone with drugs that treat diabetes may result in an increase in your blood glucose levels and problems controlling your diabetes.
Examples of these drugs include:. Taking warfarin with prednisone may reduce the blood-thinning effect of warfarin. If you take these drugs together, your doctor may monitor your treatment with warfarin closely.
However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. Prednisone oral tablet can cause a serious allergic reaction in some people.
This reaction can cause a skin rash, which can include:. Taking it again could be fatal cause death. For people with infections: Taking prednisone weakens your immune system and can worsen an infection you already have. It also increases your risk of getting a new infection. For people living with heart or kidney disease: Prednisone may make you retain salt and water, which can raise your blood pressure.
For people living with diabetes: Prednisone can increase your blood sugar level. You might need to monitor your blood sugar level more closely.
If it goes up too much, your dosage of diabetes medication might need to be changed. For people living with eye problems: Long-term prednisone use can increase your risk of getting eye infections, cataracts, or glaucoma. Let your doctor know if you experience any vision changes or eye pain. For people living with stomach problems: Prednisone can cause damage to your stomach. Let your doctor know if you experience bad stomach pain that does not go away or you get dark or bloody stools.
For people living with mood disorders: Prednisone may cause changes in your mood or behavior. Let your doctor know if you have changes in your mood, feel depressed, or have trouble sleeping. Research in animals has shown adverse effects on the fetus when the mother takes prednisone. Studies show a risk of adverse effects to the pregnancy when the mother takes the drug.
Prednisone can be passed through breast milk. For older people: As you age, your kidneys, liver, and heart may not work as well. Prednisone is processed in your liver and removed from your body through your kidneys. It makes these organs work extra hard. For children: Children might not grow as tall if they take prednisone for several months. This dosage information is for prednisone oral tablet. All possible dosages and forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:.
Dosage for children is usually based on weight. Your doctor will determine the best dosage for your child. Older adults may process drugs more slowly. A normal adult dose may cause levels of the drug to be higher than normal. If you are aged 65 years and older, you may need a lower dose or a different dosing schedule. For immediate-release tablets only: If you have a sudden return or worsening of your MS symptoms, you may need to take mg once per day for one week.
This dosage may then be reduced to 80 mg once per day every other day for one month. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. For this drug to work well, a certain amount needs to be in your body at all times.
If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:. But if your symptoms are severe, call or go to the nearest emergency room right away.
What to do if you miss a dose: If you forget to take a dose, take it as soon as you remember. How to tell if the drug is working: You should experience less pain and swelling. There are also other signs that show that prednisone is effective, depending on the condition being treated. Talk with your doctor if you have questions about whether this medication is working.
Your doctor may do tests to check your health and make sure the drug is working and is safe for you. These tests may include:. Steroids such as prednisone change the amount of water and salts in your body. In large doses, prednisone can cause your body to retain salt or lose potassium. Your doctor may recommend changes to your diet to manage this side effect. There are other drugs available to treat your condition.
Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you. Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional.
You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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Prednisone, oral tablet. Medically reviewed by Alan Carter, Pharm. Important warnings.
