Before understanding the side effects of prednisolone, let’s know the mechanism of action of prednisolone and the role of corticosteroids.
Corticosteroids are hormones produced in the cortex of adrenal glands. They are glucocorticoids, mineralocorticoids, and a small number of androgens.
These are used to lower inflammation in the body.
The drug that we are discussing today, prednisolone is a corticosteroid medication.
Pharmacokinetics
Most of the glucocorticoids are well absorbed orally. Hydrocortisone undergoes high first-pass metabolism. Glucocorticoids are metabolized in the liver by oxidation and conjugation. The kidneys excrete it.
Preparation
Glucocorticoids are given by many routes orally, parentally, topically, by inhalation, and by nasal spray. They can also be injected intra articularly.
Mechanism of Action:
Corticosteroids enter the cells by simple diffusion, bind to specific receptors in the cytoplasm, and activate them.
The drug-receptor complex is transported into the nucleus, where it binds to specific sites on DNA and induces the synthesis of particular mRNA. By this, they regulate the synthesis of new proteins that bring about hormone effects.
With a potent glucocorticoid with mild mineralocorticoid activity, Prednisolone is the most commonly used glucocorticoid.
Being four times more potent than hydrocortisone, it’s also a more selective glucocorticoid. However, fluid retention can occur with high doses. It has an intermediate duration of action. It causes less pituitary-adrenal suppression with a single morning dose.
Prednisolone reduces inflammation, allergic reactions, autoimmune diseases, and malignancies.
Uses of Prednisolone
- Prednisolone works with the body’s immune system response to reduce inflammation. It is an active immunosuppressant and is hence used in organ transplants.
- It is used in autoimmune hepatitis, hemolytic anemia.
- Used for allergic rhinitis.
- Used for blood disorders like thrombocytopenic purpura in adults.
- Treatment of allergic reactions such as asthma, contact dermatitis, atopic dermatitis.
- Used in severe skin diseases like erythema multiforme, steven johnson syndrome.
- Prednisolone is used in certain eye conditions and eye pain caused due to inflammation or injury. It helps with redness and itching
- It is used in allergic bronchopulmonary aspergillosis.
- Uveitis and optic neuritis should be treated with a steroid eye drop. Long-term use of steroid administration can increase IOP, which should be monitored. In ocular infections, steroids are contraindicated.
- Severe allergic reactions to hay fever, serum sickness, edema, rheumatoid arthritis -intraarticular joints are preferred.
- Used for osteoarthritis – a minimum of 3 months should be given before injecting two steroid injections into the joint.
- Acute gout with NSAID has not been successful, and prednisolone is used as an adjuvant.
- It is used in bronchial asthma and collagen diseases like polyarteritis nodosa, lupus erythematosus, polymyositis.
- Gastrointestinal disease and mild inflammatory bowel disease.
- Used for Sarcoidosis
- It is also used to treat mouth blisters or mouth ulcers.
Contraindications
Consult your doctor immediately if you experience any discomfort. Detailed medical history should be taken before administering the high doses or low doses.
Please do not administer prednisolone if you have any of the below medical conditions:
- Tuberculosis
- Thyroid problems
- Stomach ulcer
- Ulcerative colitis
- Severe depression, mental illness, and psychosis
- Liver diseases
- Herpes simplex infection
- High blood pressure
- Osteoporosis
- Myasthenia gravis
- Multiple sclerosis
Others: Diabetes mellitus, as it increases glucose levels in diabetic patients. So patients with diabetes are advised to regularly check sugar levels with their doctor and take the diabetes medication on time.
People with viral ocular infections, epilepsy, CCF, glaucoma, renal failure, and kidney disease should avoid the medication too.
What are Some of the Preventive Measures to be Taken Before Taking Prednisolone?
Accurate drug information is essential before the consumption of steroids along with other measures such as:
- Avoid alcohol
- Do not take any live vaccines [like smallpox, measles]
- Avoid sitting or hanging out with people down with infections as the body’s immunity will already be less.
- Do not combine prednisolone and avoid drug interactions with carbamazepine, ephedrine, barbiturates, phenytoin, other medications, and other drugs like rifampicin, clarithromycin, cyclosporin, estrogens, ketoconazole as it may decrease the effectiveness of prednisolone and increase the side effects of prednisolone.
- Please do not use it when you have any fungal infections in your body.
Side Effects of Prednisolone
Side effects of prednisolone call for a medical emergency. It is necessary to seek and provide medical advice if you experience any and seek emergency treatment.
Let’s discuss some adverse effects:
It can be dose-dependent, duration of therapy, and relative potency of additional mineralocorticoids effects. Single doses are harmless, while short courses are well tolerated. Prolonged use is associated with toxicity. Notice symptoms immediately.
- Cushing habitus – round face, narrow mouth, supraclavicular hump, truncal obesity, muscle wasting are diagnostic features.
- Hyperglycemia, high blood sugar.
- Susceptibility to infections due to immunosuppression.
- Fragile skin, purple striae, easy bruising, telangiectasia, hirsutism.
- Withdrawal symptoms can be seen, and myopathy can occur.
- Opportunistic infections like candida can flare-up.
- Slow wound healing.
- Peptic ulcerations may sometimes occur on prolonged therapy, especially when other ulcerogenic drugs are used.
- Mental disturbances, alterations in behavior can occur with high doses of steroids. It may result in insomnia, anxiety, euphoria, nervousness, mood swings, and depression.
- Raised intracranial pressure, convulsions, menstrual periods disorders.
- Mineralocorticoid effects like weight gain, hypokalemia.
- HPA AXIS SUPPRESSION – adrenal cortex atrophies due to a feedback mechanism. And adrenal gland problems may occur. If the dose is suddenly stopped, acute adrenal insufficiency can occur. To minimize the HPA axis suppression, the lowest effective dose of glucocorticoids should be used for a short period. A single morning dose should be given, and the dosing schedule should be followed.
- Shortness of breath and trouble breathing.
- Headaches and dizziness.
- Decreased vision.
- Facial hair growth in females.
- Loss of appetite.
- Back pain and skin rash, consult dermatologist in case of severe allergic reaction and get the skin tests done.
- Emergency medical care should be taken in case of painful and difficult urination and heartburn.
- Sore throat and vomiting, sweating.
Mostly mild side effects of prednisolone are witnessed, and these side effects usually last for about a week to 10 days. For mild side effects of prednisolone, you might not even need to visit your doctor.
However for the serious side effects of prednisolone such as rise in blood sugar levels, change in vision, allergic reactions, swelling of ankles or feet, it is vital to call your doctor and seek medical advice.
Pregnancy, Breastfeeding, and Prednisolone Use:
Retarded slow growth of children, teratogenicity, adrenal cortex suppression, reduced placental, and birth weight in the unborn baby is seen with the use of corticosteroids during pregnancy.
Increased risk of respiratory distress syndrome and increased risk of cleft palate cases have been observed too. So, do not consume any amount of dosage without your doctor’s approval if you are pregnant or are breastfeeding.
Cataracts are rare in infants born to mothers consuming long-term corticosteroid therapy.
Hypoadrenalism and fetal risk are high. Tell your doctor if you experience anything unusual while on medication. All the necessary medical tests should be done. Approach your child’s doctor if you experience anything unusual.
Fetal abnormalities: Cleft palate, risk of abortion is high, stillbirth or neonatal death is not increased, intrauterine growth and retardation can occur after prolonged therapy, neurological and behavioural disturbance in offsprings is seen.
Prednisolone is safer than DEXA and betamethasone, as it is metabolized by the placenta, reducing fetal exposure.
Do not use corticosteroids for a long time as it may cause gestational diabetes in women and pre-eclampsia.
Directions of Usage:
Take the medication with food to prevent stomach irritation and stomach upset. Call your doctor or follow the instructions as prescribed.
With an increase of specific lab tests and pharmacological research, prednisolone can be prescribed under many brand names, and methylprednisolone is a derivative of prednisolone slightly more potent and more effective comparatively. It can be used in retention edema in ulcerative colitis, rheumatoid arthritis, renal transplant, and pemphigus.
Oral liquid prednisolone tablets are available easily. The dosing schedule should be followed with the prescription of your doctor. You can take prednisolone as a single dose or alternate doses.
Please do not stop the medications without instructions in case of a missed dose. Please take it as soon as you recall or skip the medicine for the day. Do not consume double the amount. Take the next dose on the following day.
RAYOS is a delayed-release medication. The delayed-release tablet whole is a prednisone-coated tablet that is in the inactive form. It releases and shows its effect after 4 hours which prolongs the duration of effectiveness.
Sometimes the patient experiences withdrawal symptoms such as nausea and vomiting or muscle pain. In case of emergency and withdrawal, lower your dose gradually.
Overdosage of prednisolone can rarely harm the patient but do not take the medications for a long time as it can cause impotence and loss in sexual interest and muscle pain, weakness, and bone pain. Other medicines which cause drug interactions should be avoided.
It is advised that prednisolone should be consumed in the morning as that is the ideal time for cortisol secretion.
Always store prednisolone at room temperature and keep it away from light.
Methylprednisolone: A Derivative of Prednisolone:
Which One is the Best: Prednisone or Methylprednisone?
Let’s compare.
Prednisolone has 4 glucocorticoid activity and 0.8 mineralocorticoid activity with 5mg of equivalent dose, whereas methylprednisolone has 5 glucocorticoid activity and 0.5 methyl prednisolone activity with 4mg of equivalent dose. It is similar to prednisolone and is used as a retention enema and for high-dose pulse therapy.
Slightly more potent than prednisolone and more selective than prednisolone, Methylprednisolone acetate has been used as a retention enema.
What are Some Precautions That Need to be Taken Before Consuming Prednisolone:
- Allergic reactions and viral infections
- If you are allergic to prednisolone, let the doctor know.
- Oral disintegrating tablets should be taken in the morning
- Routine eye check-ups should be done
- Bone density and osteoporosis needs to be checked when consuming high dosage prednisolone
- Check for hives and rashes
- If you consume high caffeine or coffee grounds, avoid taking it along with prednisolone as it may cause insomnia, which is one of the side effects of prednisolone.
Note: Shake the oral suspensions before measuring the dose. It is advised to keep the disintegrating tablet in its blister pack until you are ready to use it.
If you are going in for surgery, tell your doctor before using prednisolone, as you might have to stop taking medicine for a short time.
Avoid taking over-the-counter medicines along with prednisolone, other vitamins, and herbal or ayurvedic products. Single doses are always recommended over split doses. If you wear contact lenses, make sure that prednisolone ophthalmic solution is unsafe and compatible with contact lenses.
If you want to undergo any dental procedure, let your dentist know that you are under prednisolone medication.
Summary
Do not consume or take the medications on your own in case of severe risk symptoms. Call your physician and let them know. Do not consume without a prescription. In case of emergency, always contact your doctor.
Please do not stop the medicines suddenly in pregnancy and breastfeeding or any surgery or dental visit. Always make them aware of the usage of prednisolone.
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