Prednisolone

CLINICAL USE

Corticosteroid:Immunosuppression Anti-inflammatory

DOSE IN NORMAL RENAL FUNCTION

Oral: variableIM: 25–100 mg once or twice weekly (as prednisolone acetate)

PHARMACOKINETICS

Molecular weight :360.4

%Protein binding :70–95 saturable

%Excreted unchanged in urine : 11–30

Volume of distribution (L/kg) :1.3–1.7

half-life – normal/ESRD (hrs) :2–4/Increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Not dialysed. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antibacterials: metabolism accelerated by rifamycins; metabolism possibly inhibited by erythromycin

Anticoagulants: efficacy of coumarins may be altered

Anti-epileptics: metabolism accelerated by carbamazepine, barbiturates, phenytoin and primidone

Antifungals: increased risk of hypokalaemia with amphotericin – avoid concomitant use; metabolism possibly inhibited by itraconazole and ketoconazole

Antivirals: concentration possibly increased by ritonavir

Ciclosporin: rare reports of convulsions in patients on ciclosporin and high-dose corticosteroids; increased levels of prednisolone; increased ciclosporin levels reported with prednisoloneCytotoxics: increased risk of haematological toxicity with methotrexate

Diuretics: enhanced hypokalaemic effects of acetazolamide, loop diuretics and thiazide diureticsVaccines: high dose corticosteroids can impair immune response to vaccines – avoid concomitant use with live vaccines

ADMINISTRATION

Reconstition

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Route

Oral, IM, rectal

Rate of Administration

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Comments

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OTHER INFORMATION

Evidence of unpredictable bioavailability from enteric coated tablets – avoid if possible.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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