Article: Prednisone

Prednisone
Systematic (IUPAC) name
17-hydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl- 7,8,9,10,12,13,14,15,16,17-decahydro-6H- cyclopenta[a]phenanthrene-3,11-dione
Identifiers
CAS number	53-03-2
ATC code	A07EA03 H02AB07
PubChem	5865
DrugBank	APRD00340
Chemical data
Formula	C21H26O5
Mol. weight	358.428 g/mol
Pharmacokinetic data
Bioavailability	70%
Metabolism	prednisolone (liver)
Half life	1 hour
Excretion	Renal
Therapeutic considerations
Pregnancy cat.	A
Legal status	Prescription only
Routes	Oral, Nasal, Rectal, Injection, IV

Prednisone is a synthetic corticosteroid drug which is usually taken orally and can be used for a large number of different conditions. It has a mainly glucocorticoid effect. Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug and a steroid.

Uses

Prednisone is particularly effective as an immunosuppressant and affects virtually all of the immune system. It can therefore be used in autoimmune diseases, inflammatory diseases (such as asthma, severe poison ivy, and Crohn's disease), various kidney diseases including nephrotic syndrome, and to prevent and treat rejection in organ transplantation.

History

Prednisone was invented in the early 1950s when Arthur Nobile (1920 - 2004) at Schering demonstrated that the side effects of cortisone such as water retention, high blood pressure and muscle weakness could be removed by oxidisation of the drug through exposure to microbes. The drug was introduced by Schering in the mid-1960s.

Dependency

Adrenal suppression occurs if prednisone is taken for longer than seven days, a condition which means the body is unable to synthesise natural corticosteroids and becomes dependent on the prednisone taken by the patient. For this reason, prednisone should not be stopped abruptly if taken for longer than seven days, but needs to be reduced slowly; this reduction may be over a few days if the course of prednisolone was short, but may take weeks or months if the patient has been on long-term treatment. Abrupt withdrawal will lead to an Addisonian crisis, which may be life-threatening.

Side effects

Short-term side effects, as with all glucocorticoids, include high blood glucose levels, especially in patients who already have diabetes mellitus or are on other medications that increase blood glucose (such as tacrolimus), and mineralocorticoid effects such as fluid retention. Additional short-term side effects include insomnia and rarely mania. Long-term side effects include Cushing's syndrome, weight gain, osteoporosis, glaucoma, type II diabetes mellitus, and depression upon withdrawal.

Minor

• weight gain
• facial swelling
• nervousness
• acne
• rash
• increased appetite
• insomnia
• hyper-activity

Major

• depression, mania, or other psychiatric symptoms
• unusual fatigue or weakness
• blurred vision
• abdominal pain
• peptic ulcer
• infections
• painful hips or shoulders
• osteoporosis