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Precautions

Prednisolone is contraindicated in people with systemic fungal infections and known hypersensitivity to its components. Steroids should be used with caution in nonspecific ulcerative colitis, pyogenic infection, diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, renal insufficiency, hypertension, osteoporosis, and myasthenia gravis.

 

Abruptly stopping Prednisolone can cause symptoms of corticosteroid insufficiency if this were to happen it would be accompanied by nausea, vomiting and shock. Withdrawal should be conducted gradually.

 

Prednisolone and other corticosteroids can mask signs of infection and can seriously impair the way the body’s natural immune system works. Patients on corticosteroids are more susceptible to viral infections and can develop more serious infections to common viruses like chickenpox and measles. These viruses can produce serious and even fatal illnesses in patients on high doses of Prednisolone. During treatment on Prednisolone live virus vaccines and immunizations, should be avoided. Some infectious organisms, such as tuberculosis and malaria, can lie dormant in a patient for years and may potentially be reactivated by Prednisolone. Patients with dormant TB may require anti-TB medications while undergoing prolonged corticosteroid treatment. Corticosteroids may mask some signs of infection, and new infections may appear during their use. Infections with any pathogen including viral, bacterial, fungal, protozoan or helminthic infections, in any location of the body. 

 

Prolonged use of Prednisolone may also stop the adrenal glands from producing corticosteroids naturally, use caution.

 

Therefore, if you are to withdrawal from Prednisolone, it should be commenced by gradual tapering. Gradually tapering off Prednisolone not only minimizes the symptoms of corticosteroid insufficiency, but also reduces the possibility of an abrupt flare up.

 

Corticosteroids may mask some signs of infection, and new infections may appear during their use. Infections with any pathogen including viral, bacterial, fungal, protozoan or helminthic infections, in any location of the body, may be associated with the use of corticosteroids alone or in combination. These infections may be mild, but can be severe and at times fatal. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. There may be decreased resistance and inability to localize infection when corticosteroids are used. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses. 

 

If chicken pox develops, treatment with antiviral agents may be considered. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Prednisolone can also interfere with the tuberculin skin test giving false results.

 

Prednisolone impairs calcium absorption, new bone formation, and prolonged treatment with prednisolone and other corticosteroids can develop osteoporosis and an increased risk of bone fractures. Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning. In some patients, medications used to treat osteoporosis might need to be prescribed. In rare individuals, destruction of large joints while undergoing treatment with Prednisolone or other corticosteroids occured. These patients experience severe pain in the involved joints, and can require replacement of joints. The reason behind such destruction is not clear.

 

Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be re-instituted. Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should, be administered concurrently.

 

Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids. Convulsions have been reported with concurrent use of methylprednisolone and cyclosporin. Use caution if using concurrently.

 

There are no adequate studies in pregnant women of Prednisolone. Do not take this medication if you are pregnant or thinking about becoming pregnant without first consulting a doctor.

 

Drug Interactions

Rifampin decreases blood levels of Prednisolone by increasing its breakdown in the liver. The dose of Prednisolone may need to be increased in order to avoid therapeutic failure. Corticosteroids have variable effects of Warfarin (Coumadin) therapy. Coagulation levels should be monitored more closely when anticoagulants are combined with corticosteroids. Estrogens may increase the levels of Prednisolone by decreasing its breakdown. When estrogens are used with Prednisolone, side effects of Prednisolone should be monitored.

 

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