Prednisone  

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Prednisone
Systematic (IUPAC) name
(8S,9S,10R,13S,14S,17R)- 17-hydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-7,8,9,10,12,13,14,15,16,17- decahydro-3H-cyclopenta[a]phenanthrene-3,11(6H)-dione
Identifiers
CAS number	53-03-2
ATC code	A07EA03 H02AB07
PubChem	5865
DrugBank	APRD00340
ChemSpider	5656
Chemical data
Formula	C21H26O5
Mol. mass	358.428 g/mol
SMILES	eMolecules & PubChem
Pharmacokinetic data
Bioavailability	70%
Metabolism	prednisolone (liver)
Half life	1 hour
Excretion	Renal
Therapeutic considerations
Pregnancy cat.	C
Legal status	Rx Only (US)
Routes	Oral, Nasal, Rectal, Injection, IV
Y(what is this?)  (verify)

Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant, and affects virtually all of the immune system. It is used to treat certain inflammatory diseases and (at higher doses) cancers, but has significant adverse effects. It is usually taken orally but can be delivered by intramuscular injection or intravenous injection. It has a mainly glucocorticoid effect. Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug and also a steroid.

Uses

Prednisone can, therefore, be used in autoimmune diseases, inflammatory diseases (such as severe asthma, severe allergies, angioedema episodes, severe urushiol-induced contact dermatitis, systemic lupus erythematosus, ulcerative colitis, rheumatoid arthritis, Still's disease, Bell's palsy, Crohn's disease, pemphigus and sarcoidosis), uveitis, various kidney diseases including nephrotic syndrome, mononucleosis Epstein-Barr virus, and to prevent and treat rejection in organ transplantation. Prednisone has also been used in the treatment of migraine headaches and cluster headaches and for severe aphthous ulcer ("Cankersore") outbreaks. It can also be used to treat autoimmune pancreatitis.

Prednisone is used as an antitumor drug. Prednisone is very important in the treatment of acute lymphoblastic leukemia, Non-Hodgkin lymphomas, Hodgkin's lymphoma, multiple myeloma, and other tumors in combination with other anticancer drugs.

Furthermore, the pharmaceutical industry uses prednisone tablets for the calibration of dissolution testing equipment according to the United States Pharmacopeia (USP).

Intravenous application may be employed for cerebral inflammation, as in the periodic attacks caused by multiple sclerosis.

Prednisone is also used for the treatment of the Herxheimer reaction which is common during the treatment of syphilis, and to delay the onset of symptoms of Duchenne muscular dystrophy. The mechanism for the delay of symptoms is unknown.

Because it suppresses the adrenals, it is also sometimes used in the treatment of congenital adrenal hyperplasia.

History

The first commercially feasible synthesis of prednisone was carried out in 1955 in the laboratories of Schering Corporation, which later became Schering-Plough Corporation, by Arthur Nobile and coworkers.^[1] They discovered that cortisone could be microbiologically oxidized to prednisone by the bacterium Corynebacterium simplex. The same process was used to prepare prednisolone from hydrocortisone.^[2] Their discovery was protected by US Patents 2,837,464 (1958); 2,897,216 (1959); and 3,134,718 (1964).

The enhanced adrenocorticoid activity of these compounds over cortisone and hydrocortisone was demonstrated in mice.^[3]

Prednisone and prednisolone were introduced by Schering in the mid-1960s under the brand names Meticorten and Meticortelone respectively.

These prescription medicines are now available from a number of manufacturers as generic drugs.

Dependency

Adrenal suppression will occur if prednisone is taken for longer than 7 days. This will cause the body to lose the ability to synthesize natural corticosteroids, resulting in dependence on prednisone. For this reason, prednisone should not be abruptly stopped if taken for more than seven days, and instead, the dosage should be gradually reduced. This weaning process may be over a few days if the course of prednisone was short, but may take weeks or months if the patient had been on long-term treatment. Abrupt withdrawal may lead to an Addisonian crisis. For those on chronic therapy, alternate-day dosing may preserve adrenal function, thereby reducing side-effects.^[4]

Glucocorticoids act to feedback inhibit both the hypothalamus (decreasing Corticotropin-releasing hormone [CRH]) and corticotrophs in the anterior pituitary gland (decreasing the amount of Adrenocorticotropic hormone [ACTH]). For this reason exogenous glucocorticoid analogues down-regulate the body's ability to naturally produce glucocorticoids. This mechanism leads to dependence in a short time and can be very dangerous if medications are withdrawn too quickly. The body must have time to begin synthesis of CRH and ACTH and for the adrenal glands to begin functioning normally again.

Side-effects

Short-term side-effects, as with all glucocorticoids, include high blood glucose levels, especially in patients that already have diabetes mellitus or are on other medications that increase blood glucose (such as tacrolimus), and mineralocorticoid effects such as fluid retention (it is worth noting, however, that the mineralocorticoid effects of prednisone are very minor; this is why it is not used in the management of adrenal insufficiency unless a more potent mineralocorticoid is administered concomitantly).

Additional short-term side-effects include insomnia, euphoria, and, rarely, mania (particularly in those suffering from Bipolar I and II).

Long-term side-effects include Cushing's syndrome, truncal weight gain, osteoporosis, glaucoma, type II diabetes mellitus, and depression upon withdrawal.

Major

Micrograph of fatty liver, as may be seen due to long-term prednisone use. Trichrome stain.

• increased blood sugar for diabetics
• weight gain
• facial swelling
• depression, mania, psychosis or other psychiatric symptoms
• unusual fatigue or weakness
• mental confusion / indecisiveness
• blurred vision
• abdominal pain
• peptic ulcer
• infections
• painful hips or shoulders
• Steroid-induced osteoporosis
• Long term migraines
• insomnia
• severe joint pain
• cataracts
• anxiety
• black stool
• stomach pain or bloating
• severe swelling
• mouth sores or dry mouth
• avascular necrosis
• hepatic steatosis

Minor

• stretch marks
• nervousness
• acne
• rash
• increased appetite
• hyperactivity
• frequent urination
• diarrhea
• removes intestinal flora
• leg pain
• sensitive teeth

References

National Inventors Hall of Fame induction of Arthur Nobile [1]

External links

• Kelly, Janis (July 2000). "Prednisone-related growth impairment persists in children with CF". Respiratory Reviews 5 (7). http://www.respiratoryreviews.com/jul00/rr_jul00_prednisone.html. 

Recent Prednisone Forums  View All  

Gout Is Prednisone ok for Gout treatment Friday, 10/2/2009 7:57:53 PM  1 Reply

What Time Should I Take My Medicine what time should i take my medicine wen it says take 1 pill 3 times a day and i already took one pill at 4:30 Tuesday, 9/29/2009 1:38:54 PM  Post a Reply

Presidone i take it for itching,i have a high count of red blood cells. Monday, 8/31/2009 1:45:31 PM  1 Reply

Optic Nerve Inflamation My doctor has prescribed prednisone 10mg 4 times a day I just started taking it a few days ago my optic nerve is inflammed causing my vision in my right eye to be blurred and foggy.i seen a nuero opthsmologist at university of michigan medical center and he dida ton of tests he knew what was wrong but could not find what was causing i guess what i want to know is has anyone had this condition and has prednisone worked? Sunday, 8/16/2009 7:37:14 PM  Post a Reply

Predisone Causes Pain In Chest I have had stinits placed in the arteries and when I take predisone it makes my chest hurt. Tuesday, 7/28/2009 7:34:38 PM  Post a Reply

Prednisone My husband died in our living room and I called 911. He was revived after they broke 3 ribs and had a major surgery and was hospitalized for weeks. When I panic I get short of breath. After Bill (husband) was taken to the hospital I had a panic attack and couldn't breathe. I called 911 and ended up in the hospital myself. At no time did anyone ask me about my history, what happened or anything. They just began giving me Prednisone. I had no idea what it was and took it. The take-down dose when I left the hospital was 20 mgms. three times a day for a certain period, then 10 mgms for another period and now I am down to 5 mgms per day and have been taking it for over a year. The hospital refuses to tell me what the dosage was when I was hospitalized but because of the 60 mgm daily take-down dose I know it must have been a great deal. All my life I have had shortness of breath when I panic but no one ever asked me. No history of any kind was ever taken...I was just given the Prednisone. On top of that, when I was released from the hospital the doctor who had been treating me refused to see me any longer and told me to find another doctor. At that point in time I did not realize the damage that had been done and I wrote him a letter telling him I did not blame him. In retrospect, I now realize that he knew he had overdosed me with Prednisone and he was afraid to do anything else so he simply refused to see me any longer. I can only imagine that the hospital dosage must have been huge and by the time I had reduced the dosage to 5 mgms daily the damage was done. A side effect of this medication is that I have lost my short term memory. The loss was immediate after taking the medication. I have to write everything down and post notes near wherever I happen to be working or sitting so that I don't forget to do anything, i.e., put the bread in to bake when it is raised enough. I have always been a very smart and alert person and I am now a woman who can no longer remember anything for more than a minute or two...and then the memory is gone. There are those who think this was caused by my age (I was 73 then) but I can assure you I was not then, and am not now, the least bit senile. This medication caused an almost overnight loss of short term memory to the point where it frightens me. I will be 75 in August and no longer drive simply because I think that old people cause accidents because their driving skills deteriorate with age. In addition to this, I now have a problem with my hands shaking. Most of the time the shaking is so bad I cannot write. My penmanship is a disaster. I have been given a tranquilizer for the shaking and it works to a point but I can no longer do many of the things I was able to do prior to the administration of the Prednisone. I do not look upon these problems as being those of aging because the onset was too sudden...and it immediately followed the high dosage of the Prednisone I was given in the hospital. To be perfectly truthful, whatever the dosage was when I was hospitalized, it enabled me to walk around, breath easily, and not tire. However, after a very short period of this feeling of wellbeing the other symptoms began to appear in rapid order. I have never been told what the dosage was while I was hospitalized and nothing appeared on the billing giving any indication. I would love to be able to take a subtitute for this drug but I am told there is not one. I do not like taking it but have found that I can no longer function without it. Changes in the weather have an effect on my breathing also. During the rainy season I have a much harder time than in the summer as long as the humidity is not too high. The more moisture there is in the air, the harder it is for me to breathe. I have been told that now that I am taking this medication I cannot stop and must continue with it as long as I live. I have to take vitamins to decrease the osteoporosis which I now have getting worse. Worst of all, I think, is that this medication causes depression and I find I have to fight that constantly. Surely there must be something I could take that would not destroy my life as Prednisone has done. Thursday, 7/2/2009 11:06:32 PM  1 Reply

Polymyalgia & Prednisone IF I TAKE LOW DOSE PREDNISONE FOR PMR, HOW CAN I AVOID MOONFACE AND WEIGHT GAIN? Tuesday, 6/23/2009 9:57:22 PM  1 Reply

Prednisone my mom is on predinosone and is having severe anxiety and insomnia. She is a totally different person. The docs have lowered her dose and tell us she will improve 4-6 weeks after it is lowered. Anyone else go through this and did it get better after that time? I need advice Tuesday, 6/23/2009 9:47:56 PM  2 Replies

Prednisone I felt dizzy,dr said i have excess fluid behind right ear. i was given prednisone. next morning, i cant walk, no balance. have to hold on to something to walk. talked to dr, she say this is normal. is it? Wednesday, 12/3/2008 7:53:59 AM  1 Reply

Prednisone Is there a non-script replacement for Prednisone. This may sound really dumb, but we have a dog with big time alergies and the only thing that will help him is Prednisone. Problem is that the Vet wants to run $200 - $300 worth of blood test every month before they will renew the script. Needless to say, we really can't afford this. The dog is 14 years old and nothing else helps with the alergies. Wednesday, 11/19/2008 7:19:33 AM  1 Reply