Prednisolone

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Definition
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Weakly effective, non-halogenated, synthetic glucocorticoid.

Half-life
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2,2 (0,5 h).

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Indication
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First choice for syst. Glucocorticoid therapy; external application for eczema, psoriasis.

Limited indication
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Strict indication during pregnancy: Prednisolone 0.3 mg/kg bw, side effects are not expected with a therapy duration < 4 weeks. In case of high dose or long duration of therapy the fetal growth should be evaluated by ultrasound. Adrenal insufficiencies should be taken into account. A 3.4-fold increased risk of oral cleft is reported in the literature. In summary, according to the current state of knowledge, the use of prednisolone is supported in various maternal diseases, and information about the risks should be provided in advance.

Dosage and method of use
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Topical: Ointments/Creams/Compound: Apply 0.25/0.5% thinly 1-3 times/day to the affected skin areas. The optimum stability is pH 6-7; when prednisolone is incorporated into the "Hydrophilic Base Emulsion", crystal clusters develop in a very short time. In water-rich vehicle systems, the molecule forms a hydrate envelope around itself. The resulting prednisolone hydrate is less water-soluble than pure prednisolone. In this respect a supersaturated solution is formed. The prednisolone precipitates. In this respect it is recommended to exchange prednisolone for its ester prednisolone acetate. This has already been taken into account in the NRF regulation "Hydrophilic Prednisolone Acetate Cream NRF 11.35.

Systemic: Dosage according to indication. In eczematous diseases, dosages between 50 and 100 mg/day are generally sufficient; higher dosages are necessary in the case of blistering immune dermatoses (initial: 100-200 mg/day). In these cases, a combination therapy with an immunosuppressive agent (e.g. azathioprine, ciclosporin A or cyclophosphamide) is usually carried out (see also the respective diagnoses). In case of resistance to therapy, a glucocorticoid pulse therapy can be applied: prednisone equivalent 1 g as short infusion on 3 consecutive days. Then reduce the dose gradually (750-500-250 mg/day).

Undesirable effects
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Systemic: Cushing's syndrome in long-term use, perioral or periocular dermatitis, steroid acne. Herpes simplex or other infections, wound healing disorders.

For use on the eye: eye irritation, burning, perforation of the cornea or sclera, posterior subcapsular cataract, mydriasis, ptosis.

Interactions
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When applied to the eye: Idoxuridine eye drops increase the wound healing disorders, trifluridine eye drops increase the impairment of the reaction capacity.

Contraindication
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When used on the eye: hypersensitivity to the active ingredient, glaucoma, ocular tuberculosis, herpes corneae superficialis, corneal defect, bacterial eye infections.

Recipe(s)
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Prednisolone acetate cream, hydrophilic 0.25/0.5% (NRF 11.35.)
for the treatment of mucosal inflammations (e.g. pemphigus diseases) a solution containing nystatin/lidocaine and prednisolone can be prescribed (Rp. Nystatin 100KUI/Lidocaine 0.1/Prednisolone 0.1/ aqua purificata ad 100.0/ S: use a mild, well-tolerated solution containing cortisone 1-2 times daily).