Prednisolone

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Prednisolone
File:Prednisolone-2D-skeletal.svg
File:Prednisolone-3D-balls.png
Systematic (IUPAC) name
(11β)-11,17,21-Trihydroxypregna-1,4-diene-3,20-dione
Clinical data
AHFS/Drugs.com monograph
MedlinePlus a682794
Licence data US FDA:link
Pregnancy
category
  • AU: A
  • US: C (Risk not ruled out)
Legal status
Pharmacokinetic data
Biological half-life 2-3 hours
Excretion urine
Identifiers
CAS Number 50-24-8 YesY
ATC code A07EA01 (WHO) C05AA04, D07AA03, H02AB06, R01AD02, S01BA04, S02BA03, S03BA02
PubChem CID: 5755
IUPHAR/BPS 2866
DrugBank DB00860 YesY
ChemSpider 5552 YesY
UNII 9PHQ9Y1OLM YesY
KEGG D00472 YesY
ChEBI CHEBI:8378 YesY
ChEMBL CHEMBL131 YesY
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
Chemical data
Formula C21H28O5
Molecular mass 360.444 g/mol
  (verify)

Prednisolone is a synthetic glucocorticoid, a derivative of cortisol, used to treat a variety of inflammatory and autoimmune conditions and some cancers. It is the active metabolite of the drug prednisone[1] and is used especially in patients with liver failure, as these individuals are unable to metabolize prednisone into active prednisolone; it is primarily metabolized via the liver enzyme, 11-β-hydroxydehydrogenase.[2] Adverse effects are not generally seen with short term therapy, but weight gain, impaired immune response, and behavioral disturbances commonly occur with longer durations of treatment.[2]

It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.[3]

Medical uses

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[4] such as asthma,[5] uveitis, pyoderma gangrenosum, rheumatoid arthritis, ulcerative colitis, pericarditis, temporal arteritis and Crohn's disease, Bell's palsy, multiple sclerosis,[6] cluster headaches, vasculitis, acute lymphoblastic leukemia and autoimmune hepatitis,[7] systemic lupus erythematosus, Kawasaki disease,[8] dermatomyositis,[9] and sarcoidosis.[10]

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.[11][12]

Prednisolone can also be used for allergic reactions ranging from seasonal allergies to drug allergic reactions.[13]

Prednisolone can also be used as an immunosuppressive drug for organ transplants[9][14] and in cases of primary adrenal insufficiency (Addison's disease).[15][16]

Corticosteroids inhibit the inflammatory response to a variety of inciting agents and, it is presumed, delay or slow healing.[17] They inhibit the edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation with inflammation.[18]

Adverse effects

There are several adverse reaction from the use of prednisolone:

  • Increase appetite, weight gain, nausea, and malaise
  • Increase 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 increase 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, increase 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 and loss, osteoporosis, long bone fractures, tendon rupture and back fractures.
  • Neurological effects include involuntary movements (convulsions), headaches, and vertigo
  • Behavioral disturbances [19]

Nasal septum perforation and bowel perforation are also notable adverse effects that restrict steroids' use in some pathologic conditions.[20][21]

Withdrawal from prednisolone after long term or high dose use can lead to adrenal insufficiency. [19]

Pregnancy and breastfeeding

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.[19]

Mechanism of action

As a synthetic glucocorticoid (GC), its lipophilic structure 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.[22]

Society and culture

Dosage forms

In the United States

  • Prednisolone sodium posphate oral solution (Pediapred)[19]
  • Prednisolone acetate oral suspension (Flo-Pred)[23]
  • Prednisolone oral tablets (Millipred)[13]
  • Prednisolone sodium phosphate oral dissolving tablets (Orapred)[24]

Athletics

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.[25] 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.[25]

See also

References

  1. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  2. 2.0 2.1 Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  3. "19th WHO Model List of Essential Medicines (April 2015)" (PDF). WHO. April 2015. Retrieved May 10, 2015.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  4. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  5. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  6. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  7. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  8. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  9. 9.0 9.1 Product Information: ORAPRED ODT(TM) orally disintegrating tablets, prednisolone sodium phosphate orally disintegrating tablets. Cima Labs Inc, Alpharetta, GA, 2006.
  10. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  11. "Pred Forte Package Insert" (PDF).<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  12. Product Information: OMNIPRED(TM) ophthalmic suspension, prednisolone acetate ophthalmic suspension. Alcon Laboratories Inc, Fort Worth, TX, 2005
  13. 13.0 13.1 "Millipred tablets package insert".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  14. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  15. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  16. AMA Department of Drugs: AMA Drug Evaluations, 6th. American Medical Association, Chicago, IL, 1986.
  17. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  18. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  19. 19.0 19.1 19.2 19.3 "PEDIAPRED" (PDF).<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  20. "Bowel Perforation in Steroid-Treated Patients"
  21. "Intranasal steroids and septum perforation--an overlooked complication?"
  22. Stahn, Cindy (17 May 2007). "Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists" (PDF). Molecular and Cellular Endocrinology.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  23. "Flo-Pred Package Insert" (PDF).<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  24. "Package Insert for Orapred ODT" (PDF).<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  25. 25.0 25.1 "The 2011 Prohibited List".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

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