PREDO

Prednisolone is a glucocorticoid similar to cortisol used for its anti-inflammatory, immunosuppressive, anti-neoplastic, and vasoconstrictive effects.

Prednisolone was granted

FDA approval on 21 June 1955.

Prednisolone is indicated to treat endocrine, rheumatic, and hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, and gastrointestinal diseases; allergic and edematous states; and other conditions like tuberculous meningitis.

Corticosteroids bind to the glucocorticoid receptor, inhibiting pro-inflammatory signals, and promoting anti-inflammatory signals.

Prednisolone has a short duration of action as the half life is 2.1-3.5 hours.

Corticosteroids have a wide therapeutic window as patients make require doses that are multiples of what the body naturally produces.

Patients taking corticosteroids should be counselled regarding the risk of hypothalamic-pituitary-adrenal axis suppression and increased susceptibility to infections.

Oral prednisolone reaches a

C max of 113-1343ng/mL with a T max of 1.0-2.6 hours.

Oral prednisolone is approximately 70% bioavailable.

A 0.15 mg/kg dose of prednisolone has a volume of distribution of 29.3 L, while a 0.30 mg/kg dose has a volume of distribution of 44.2 L.

Prednisolone can be reversibly metabolized to prednisone which is then metabolized to 17α,21-dihydroxy-pregnan-1,4,6-trien-3,11,30-trione (M-XVII), 20α-dihydro-prednisone (M-V), 6βhydroxy-prednisone (M-XII), 6α-hydroxy-prednisone (M-XIII), or 20β-dihydro-prednisone (M-Intravenous). 3 20β-dihydro-prednisone is metabolized to 17α,20ξ,21-trihydroxy-5ξ-pregn-1-en-3,11-dione(M-XVIII).

Prednisolone is metabolized to Δ6-prednisolone (M-XI), 20α-dihydro-prednisolone (M-III), 20β-dihydro-prednisolone (M-II), 6αhydroxy-prednisolone (M-VII), or 6βhydroxy-prednisolone(M-VI). 3 6αhydroxy-prednisolone is metabolized to 6α,11β,17α,20β,21-pentahydroxypregnan-1,4-diene-3-one (M-X). 3 6βhydroxy-prednisolone is metabolized to 6β,11β,17α,20β,21-pentahydroxypregnan-1,4-diene-3-one (M-VIII), 6β,11β,17α,20α,21-pentahydroxypregnan-1,4-diene-3-one (M-IX), and 6β,11β,17α,21-tetrahydroxy-5ξ-pregn-1-en-3,20-dione (M-XIV).

MVIII is metabolized to 6β,11β,17α,20β,21-pentahydroxy-5ξ-pregn-1-en-3-one (M-XV) and then to MXIV, while MIX is metabolized to 6β,11β,17α,20α,21-pentahydroxy-5ξ-pregn-1-en-3-one (M-XVI) and then to MXIV.

These metabolites and their glucuronide conjugates are excreted predominantly in the urine.

Hover over products below to view reaction partners Prednisolone Δ6-prednisolone (M-XI) 20α-dihydro-prednisolone (M-III) 20β-dihydro-prednisolone (M-II) 6αhydroxy-prednisolone (M-VII) 6α,11β,17α,20β,21-pentahydroxypregnan-1,4-diene-3-one (M-X) 6βhydroxy-prednisolone(M-VI) 6β,11β,17α,20α,21-pentahydroxypregnan-1,4-diene-3-one (M-IX) 6β,11β,17α,20α,21-pentahydroxy-5ξ-pregn-1-en-3-one (M-XVI) 6β,11β,17α,21-tetrahydroxy-5ξ-pregn-1-en-3,20-dione (M-XIV) 6β,11β,17α,21-tetrahydroxy-5ξ-pregn-1-en-3,20-dione (M-XIV) 6β,11β,17α,20β,21-pentahydroxypregnan-1,4-diene-3-one (M-VIII) 6β,11β,17α,20β,21-pentahydroxy-5ξ-pregn-1-en-3-one (M-XV) 6β,11β,17α,21-tetrahydroxy-5ξ-pregn-1-en-3,20-dione (M-XIV) Prednisone 6βhydroxy-prednisone (M-XII) 6α-hydroxy-prednisone (M-XIII) 20β-dihydro-prednisone (M-Intravenous) 17α,20ξ,21-trihydroxy-5ξ-pregn-1-en-3,11-dione(M-XVIII) 20α-dihydro-prednisone (M-V) 17α,21-dihydroxy-pregnan-1,4,6-trien-3,11,30-trione (M-XVII).

Prednisolone has a plasma half life of 2.1-3.5 hours.

This half life is shorter in children and longer in those with liver disease.

A 0.15 mg/kg dose of prednisolone has a clearance of 0.09 L/kg/h, while a 0.30 mg/kg dose has a clearance of 0.12 L/kg/h.

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The intraperitoneal

LD in rats is 2 g/kg and 65 mg/kg in mice.

The subcutaneous

LD in rats is 147 mg/kg and >3500 mg/kg in mice.

The oral

LD in mice is 1680 mg/kg.

In humans, the oral TDLO in men is 9 mg/kg/2W and in women is 14 mg/kg/13D.

Patients experiencing an overdose of prednisolone may present with gastrointestinal disturbances, insomnia, and restlessness.

Overdose of oral prednisolone may be treated by gastric lavage or inducing vomiting if the overdose was recent, as well as supportive and symptomatic therapy.

Chronic overdosage may be treated by dose reduction or treating patients on alternate days.

An overdose by the ophthalmic route is not expected to cause problems.

Prolonged use of corticosteroids may result in posterior subcapsular cataract formation and may increase intraocular pressure in susceptible individuals, resulting in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision.

Prolonged use may also suppress the host immune response and thus increase the hazard of secondary ocular infections.

If this product is used for 10 days or longer, intraocular pressure should be routinely monitored even though it may be difficult in children and uncooperative patients.

Steroids should be used with caution in the presence of glaucoma.

Intraocular pressure should be checked frequently.

Various ocular diseases and long-term use of topical corticosteroids have been known to cause corneal and scleral thinning.

Use of topical corticosteroids in the presence of thin corneal or scleral tissue may lead to perforation.

Acute purulent infections of the eye may be masked or activity enhanced by the presence of corticosteroid medication.

The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).

Employment of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution; frequent slit lamp microscopy is recommended.

FORTE ® suspension contains sodium bisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.

The overall prevalence of sulfite sensitivity in the general population is unknown and probably low.

Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people.

® suspension is contraindicated in acute untreated purulent ocular infections, in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures.

FORTE ® suspension is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.

Shake well before using.

Instill one to two drops into the conjunctival sac two to four times daily.

During the initial to 48 hours, the dosing frequency may be increased if necessary.

Care should be taken not to discontinue therapy prematurely.

If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

® (prednisolone acetate ophthalmic suspension, USP) 1% is supplied sterile in opaque white LDPE plastic bottles with droppers with pink high impact polystyrene (HIPS) caps as follows: 1 mL in 5 mL bottle.

• NDC 11980-180-01 5 mL in 10 mL bottle.

• NDC 11980-180-05 10 mL in 15 mL bottle.

• NDC 11980-180-10 15 mL in 15 mL bottle.

• NDC 11980-180-15 Storage: Store at up to 25°C (77°F).

Protect from freezing.

Store in an upright position.

Revised: 02 / 2024 Distributed by: AbbVie, Inc.

Chicago, IL 60064 © 2024 AbbVie.

All rights reserved.

Pred Forte and its design are trademarks of Allergan, Inc., an AbbVie company. v2.0USPI180 Shape Description automatically generated.

Prednisolone has been shown to be teratogenic in mice when given in doses 1-10 times the human dose.

Dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both eyes of pregnant mice five times per day on days 10 through of gestation.

A significant increase in the incidence of cleft palate was observed in the fetuses of the treated mice.

There are no adequate well-controlled studies in pregnant women.

Prednisolone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk.

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects.

Because of the potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

The safety and effectiveness in pediatric patients have been established.

Use in pediatric patients is supported by evidence from adequate and well-controlled studies of prednisolone acetate ophthalmic suspension in adults with additional data in pediatric patients.

No overall differences in safety or effectiveness have been observed between elderly and younger patients.

It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk.

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects.

Because of the potential for serious adverse reactions in nursing infants from prednisolone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

The safety and effectiveness in pediatric patients have been established.

Use in pediatric patients is supported by evidence from adequate and well-controlled studies of prednisolone acetate ophthalmic suspension in adults with additional data in pediatric patients.

No overall differences in safety or effectiveness have been observed between elderly and younger patients.