Prednisolone

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Not to be confused with Prednisone.
Prednisolone
Prednisolone-2D-skeletal.svg
Prednisolone-3D-balls.png
Clinical data
Trade names many
AHFS/Drugs.com Monograph
MedlinePlus a682794
License data
Pregnancy
category
  • AU: A
  • US: C (Risk not ruled out)
ATC code
Legal status
Legal status
Pharmacokinetic data
Biological half-life 2-3 hours
Excretion urine
Identifiers
Synonyms 11,17-Dihydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-6,7,8,9,10,11,12,13,14,15,16,17-dodecahydrocyclopenta[a] phenanthren-3-one
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard 100.000.020
Chemical and physical data
Formula C21H28O5
Molar mass 360.444 g/mol
3D model (Jmol)
  (verify)

Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers.[1][2] Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthritis, dermatitis, eye inflammation, asthma, and multiple sclerosis.[2] It is used by mouth, injection into a vein, as a skin cream, and as eye drops.[3]

Side effects with short term use include nausea and feeling tired.[1] More severe side effects include pyschiatric problems, which may occur in about 5% of people.[4] Common side effects with long term use include bone loss, weakness, yeast infections, and easy bruising.[2] While short term use in the later part of pregnancy is safe, use long term or early in early pregnancy is occasionally associated with harm to the baby.[5] It is a glucocorticoid made from hydrocortisone (cortisol).[6]

Prednisolone was discovered and approved for medical use in 1955.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] It is available as a generic medication.[2] The wholesale cost in the developing world is about 0.01 to 0.02 USD per day.[8]

Medical uses[edit]

Prednisolone is a corticosteroid drug with predominant glucocorticoid and low mineralocorticoid activity, making it useful for the treatment of a wide range of inflammatory and autoimmune conditions[9] such as asthma,[10] uveitis, pyoderma gangrenosum, rheumatoid arthritis, ulcerative colitis, pericarditis, temporal arteritis and Crohn's disease, Bell's palsy, multiple sclerosis,[11] cluster headaches, vasculitis, acute lymphoblastic leukemia and autoimmune hepatitis,[12] systemic lupus erythematosus, Kawasaki disease,[13] dermatomyositis,[14] and sarcoidosis.[15]

Prednisolone acetate ophthalmic suspension (eye drops) is an adrenocortical steroid product, prepared as a sterile ophthalmic suspension and used to reduce swelling, redness, itching, and allergic reactions affecting the eye.[16][17]

Prednisolone can also be used for allergic reactions ranging from seasonal allergies to drug allergic reactions.[18]

Prednisolone can also be used as an immunosuppressive drug for organ transplants.[14][19]

Prednisolone in lower doses can be used in cases of primary adrenal insufficiency (Addison's disease).[20][21]

Corticosteroids inhibit the inflammatory response to a variety of inciting agents and, it is presumed, delay or slow healing.[22] They inhibit the edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation with inflammation.[23]

Adverse effects[edit]

There are several adverse reactions from the use of prednisolone:

  • Increased appetite, weight gain, nausea and malaise
  • Increased risk of infection
  • Cardiovascular events in children
  • Dermatological effects including reddening of face, bruising/skin discoloration, impaired wound healing, thinning of skin, skin rash, fluid build up and abnormal hair growth
  • Hyperglycemia; patients with diabetes may need increased insulin or diabetic therapies
  • Menstrual abnormalities
  • Less response to hormones, especially during stressful instances such as surgery or illness
  • Change in electrolytes: rise in blood pressure, increased sodium and low potassium, leading to alkalosis
  • GI system effects: swelling of stomach lining, reversible increase in liver enzymes and risk of stomach ulcers
  • Muscular and skeletal abnormalities, such as muscle weakness/muscle loss, osteoporosis, long bone fractures, tendon rupture and back fractures
  • Neurological effects, including involuntary movements (convulsions), headaches and vertigo
  • Behavioral disturbances [24]

Nasal septum perforation and bowel perforation are also notable adverse effects that restrict steroid use in some pathologic conditions.[25][26]

Withdrawal from prednisolone after long-term or high-dose use can lead to adrenal insufficiency.[24]

Pregnancy and breastfeeding[edit]

Although there are no major human studies of prednisolone use in pregnant women, studies in several animals show that it may cause birth defects including increase cleft palate. Prednisolone should be used in pregnant women when benefits outweigh the risks and children born from mothers using prednisolone during pregnancy should be monitored for impaired adrenal function.

Prednisolone is found in breast milk of mothers taking prednisolone.[24]

Pharmacology[edit]

As a glucocorticoid, the lipophilic structure of prednisolone allows for easy passage through the cell membrane where it then binds to its respective glucocorticoid receptor (GCR) located in the cytoplasm. Upon binding, formation of the GC/GCR complex causes dissociation of chaperone proteins from the glucocorticoid receptor enabling the GC/GCR complex to translocate inside the nucleus. This process occurs within 20 minutes of binding. Once inside the nucleus, the homodimer GC/GCR complex binds to specific DNA binding-sites known as glucocorticoid response elements (GREs) resulting in gene expression or inhibition. Complex binding to positive GREs leads to synthesis of anti-inflammatory proteins while binding to negative GREs block the transcription of inflammatory genes.[27]

Chemistry[edit]

Prednisolone is a synthetic pregnane corticosteroid and derivative of cortisol (hydrocortisone) and is also known as δ1-cortisol, δ1-hydrocortisone, 1,2-dehydrocortisol, or 1,2-dehydrohydrocortisone, as well as 11β,17α,21-trihydroxypregna-1,4-diene-3,20-dione.[28][29]

Society and culture[edit]

Dosage forms[edit]

In the United States:

Athletics[edit]

As a glucocorticosteroid, unauthorized or ad-hoc use of prednisolone during competition via oral, intravenous, intramuscular or rectal routes is banned under WADA anti-doping rules.[32] The drug may be used in competition with a TUE (Therapeutic Use Exemption), in compliance with WADA regulations. Local or topical use of prednisolone during competition as well as any use out of competition is not regulated.[32]

Veterinary uses[edit]

Prednisolone is used in the treatment of inflammatory and allergic conditions in cats and dogs.

See also[edit]

References[edit]

  1. ^ a b WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 53–54. ISBN 9789241547659. Retrieved 8 December 2016. 
  2. ^ a b c d "Prednisolone". The American Society of Health-System Pharmacists. Retrieved 8 December 2016. 
  3. ^ "Search results - (eMC)". www.medicines.org.uk. Retrieved 13 December 2016. 
  4. ^ "Pevanti 10mg Tablets - Summary of Product Characteristics (SPC) - (eMC)". www.medicines.org.uk. 1 December 2014. Retrieved 13 December 2016. 
  5. ^ "Prednisolone Use During Pregnancy | Drugs.com". www.drugs.com. Retrieved 13 December 2016. 
  6. ^ a b Kim, Kyu-Won; Roh, Jae Kyung; Wee, Hee-Jun; Kim, Chan (2016). Cancer Drug Discovery: Science and History. Springer. p. 169. ISBN 9789402408447. 
  7. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
  8. ^ "Prednisolone". International Drug Price Indicator Guide. Retrieved 8 December 2016. 
  9. ^ Czock D, Keller F, Rasche FM, Häussler U (2005). "Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids". Clin Pharmacokinet. 44 (1): 61–98. doi:10.2165/00003088-200544010-00003. PMID 15634032. 
  10. ^ Fiel SB, Vincken W (Jun 2006). "Systemic corticosteroid therapy for acute asthma exacerbations". J Asthma. 43 (5): 321–31. doi:10.1080/02770900600567163. PMID 16801135. 
  11. ^ Thrower BW (Jan 2009). "Relapse management in multiple sclerosis". Neurologist. 15 (1): 1–5. doi:10.1097/NRL.0b013e31817acf1a. PMID 19131851. 
  12. ^ Lambrou GI, Vlahopoulos S, Papathanasiou C, Papanikolaou M, Karpusas M, Zoumakis E, Tzortzatou-Stathopoulou F (2009). "Prednisolone exerts late mitogenic and biphasic effects on resistant acute lymphoblastic leukemia cells: Relation to early gene expression". Leuk Res. 33 (12): 1684–95. doi:10.1016/j.leukres.2009.04.018. PMID 19450877. 
  13. ^ Miura M, Tamame T, Naganuma T, Chinen S, Matsuoka M, Ohki H (2011). "Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy". Paediatrics & Child Health. 16 (8): 479–84. PMC 3202387Freely accessible. PMID 23024586. 
  14. ^ a b Product Information: ORAPRED ODT(TM) orally disintegrating tablets, prednisolone sodium phosphate orally disintegrating tablets. Cima Labs Inc, Alpharetta, GA, 2006.
  15. ^ Gera, Kamal; Gupta, Nitesh; Ahuja, Anuradha; Shah, Ashok (2014-04-30). "Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure". BMJ Case Reports. 2014: bcr2013202247. doi:10.1136/bcr-2013-202247. ISSN 1757-790X. PMC 4024548Freely accessible. PMID 24789154. 
  16. ^ "Pred Forte Package Insert" (PDF). 
  17. ^ Product Information: OMNIPRED(TM) ophthalmic suspension, prednisolone acetate ophthalmic suspension. Alcon Laboratories Inc, Fort Worth, TX, 2005
  18. ^ a b "Millipred tablets package insert" (PDF). 
  19. ^ Vethe, Nils; Midtvedt, Karsten; Åsberg, Anders; Amundsen, Rune; Bergan, Stein. "Legemiddelinteraksjoner og immunsuppresjon hos organtransplanterte". Tidsskrift for Den norske legeforening. 131 (20): 2000–2003. doi:10.4045/tidsskr.11.0138. 
  20. ^ Husebye, E. S.; Allolio, B.; Arlt, W.; Badenhoop, K.; Bensing, S.; Betterle, C.; Falorni, A.; Gan, E. H.; Hulting, A.-L. (2014-02-01). "Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency". Journal of Internal Medicine. 275 (2): 104–115. doi:10.1111/joim.12162. ISSN 1365-2796. 
  21. ^ AMA Department of Drugs: AMA Drug Evaluations, 6th. American Medical Association, Chicago, IL, 1986.
  22. ^ Schwiebert, L. M.; Beck, L. A.; Stellato, C.; Bickel, C. A.; Bochner, B. S.; Schleimer, R. P.; Schwiebert, L. A. (1996-01-01). "Glucocorticosteroid inhibition of cytokine production: relevance to antiallergic actions". The Journal of Allergy and Clinical Immunology. 97 (1 Pt 2): 143–152. doi:10.1016/s0091-6749(96)80214-4. ISSN 0091-6749. PMID 8568145. 
  23. ^ Lee, Sang Hag (2015). "Mechanisms of Glucocorticoid Action in Chronic Rhinosinusitis". Allergy, Asthma & Immunology Research. 7 (6): 534–7. doi:10.4168/aair.2015.7.6.534. PMC 4605925Freely accessible. PMID 26333699. 
  24. ^ a b c d "PEDIAPRED" (PDF). 
  25. ^ ReMine SG, McIlrath DC. "Bowel perforation in steroid-treated patients". Ann Surg. 192: 581–6. doi:10.1097/00000658-198010000-00016. PMC 1347010Freely accessible. PMID 7425698. 
  26. ^ Cervin A, Andersson M. "Intranasal steroids and septum perforation--an overlooked complication? A description of the course of events and a discussion of the causes". Rhinology. 36: 128–32. PMID 9830677. 
  27. ^ Stahn, Cindy (17 May 2007). "Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists" (PDF). Molecular and Cellular Endocrinology. 275: 71–78. doi:10.1016/j.mce.2007.05.019. 
  28. ^ J. Elks (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. pp. 1011–1012. ISBN 978-1-4757-2085-3. 
  29. ^ Index Nominum 2000: International Drug Directory. Taylor & Francis. January 2000. pp. 869–. ISBN 978-3-88763-075-1. 
  30. ^ "Flo-Pred Package Insert" (PDF). 
  31. ^ "Package Insert for Orapred ODT" (PDF). 
  32. ^ a b "The 2011 Prohibited List".