LIQUID PRED
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LIQUID PRED (LIQUID PRED).
Prednisolone is a corticosteroid that binds to the glucocorticoid receptor, leading to modulation of gene expression and suppression of inflammatory mediators (cytokines, prostaglandins, leukotrienes).
| Metabolism | Primarily hepatic via CYP3A4; also undergoes 11β-hydroxysteroid dehydrogenase interconversion. |
| Excretion | Primarily renal: prednisolone is excreted as glucuronide and sulfate conjugates; less than 1% unchanged. Biliary/fecal excretion accounts for <5%. |
| Half-life | 2.1–3.5 hours (terminal elimination half-life; shorter half-life in children; prolonged in hepatic impairment). |
| Protein binding | 70–90% bound to corticosteroid-binding globulin (CBG, transcortin) and albumin; saturable at high doses. |
| Volume of Distribution | 0.4–1.0 L/kg (large Vd indicates extensive tissue distribution, including penetration into CNS). |
| Bioavailability | Oral: 70–90% (well absorbed; food delays but does not reduce absorption). |
| Onset of Action | Oral: 1–2 hours (peak effect on gluconeogenesis and immunosuppression). |
| Duration of Action | Oral: 12–36 hours (duration of adrenal suppression; anti-inflammatory effect persists beyond plasma half-life due to intracellular glucocorticoid receptor binding). |
| Molecular Weight | 360.45 |
5-60 mg/day orally in divided doses; typical starting dose 5-10 mg every 6-12 hours.
| Dosage form | SYRUP |
| Renal impairment | No dose adjustment required; prednisolone is eliminated primarily via hepatic metabolism, with less than 15% excreted unchanged in urine. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: avoid or use with caution, consider alternative. |
| Pediatric use | 0.1-2 mg/kg/day orally in divided doses every 6-12 hours; maximum 60 mg/day. |
| Geriatric use | Start at lower end of dosing range (e.g., 5-10 mg/day) and titrate cautiously due to increased risk of osteoporosis, hyperglycemia, and immunosuppression. |
| 1st trimester | Prednisolone is generally avoided in the first trimester unless essential, as early exposure is associated with a small increased risk of oral clefts (odds ratio ~3). Use lowest effective dose for shortest duration. |
| 2nd trimester | Use with caution; monitor for maternal complications like gestational diabetes and hypertension. Fetal growth and adrenal function should be assessed if prolonged use. |
| 3rd trimester | Use with caution; prolonged use may suppress fetal adrenal function. Neonatal adrenal insufficiency may occur; monitor infant for hypoglycemia and stress-responsiveness. |
Clinical note
Comprehensive clinical and safety monograph for LIQUID PRED (LIQUID PRED).
| Placental transfer | Prednisolone is partially inactivated by placental 11β-hydroxysteroid dehydrogenase type 2, but significant amounts cross to the fetal circulation. Cord blood levels are about 10-15% of maternal levels. |
| Breastfeeding |
■ FDA Black Box Warning
None (no FDA boxed warning).
| Common Effects | No common side effects seen |
| Serious Effects |
Systemic fungal infectionsHypersensitivity to prednisolone or any component
| Precautions | Immunosuppression and increased risk of infections, Adrenal suppression with prolonged use, Osteoporosis, Gastrointestinal perforation, Cushing's syndrome, Growth suppression in children, Ocular effects (cataracts, glaucoma), Psychiatric disturbances, Cardiovascular effects (hypertension, fluid retention) |
| Food/Dietary | Avoid grapefruit and grapefruit juice as they may increase prednisolone levels. Limit sodium intake to reduce fluid retention. Avoid alcohol as it may increase gastric irritation. High potassium foods (e.g., bananas, oranges) are generally safe but monitor potassium levels if also on diuretics. |
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| Prednisolone is excreted into breast milk in low concentrations (<10% of maternal dose). At doses up to 40 mg/day, levels in milk are minimal and unlikely to affect the infant. For doses >40 mg/day, discard milk for 4 hours after dose or pump and discard. Monitor infant for growth and adrenal suppression. |
| Lactation Rating | L2 (Safely Compatible; limited data suggest low risk in moderate doses) |
| Teratogenic Risk | First trimester: Cleft palate risk increased (odds ratio 3.0-6.0). Second/third trimester: Intrauterine growth restriction, adrenal suppression. Use only if benefit outweighs risk. |
| Fetal Monitoring | Maternal: Blood pressure, blood glucose, weight, signs of infection. Fetal: Ultrasound for growth restriction, fetal adrenal suppression (e.g., nonstress test). |
| Fertility Effects | No direct impairment, but ovulation disorders may occur with high doses. Low doses (<10 mg/day) unlikely to affect fertility. |
| Clinical Pearls | Prednisolone is the active metabolite of prednisone; no hepatic conversion required, useful in liver impairment. Taper dose to avoid adrenal crisis; never abruptly discontinue after >3 weeks of therapy. Monitor for hyperglycemia, especially in diabetics. Consider PPI prophylaxis in patients also on NSAIDs or with history of GI bleed. Use lowest effective dose for shortest duration. |
| Patient Advice | Take with food or milk to reduce stomach upset. · Do not stop taking this medication suddenly without consulting your doctor; dose must be tapered gradually. · Avoid live vaccines (e.g., MMR, nasal flu) while on this medication. · Report signs of infection (fever, sore throat, fatigue) promptly as prednisolone can mask symptoms. · Carry a medical alert card or wear a bracelet indicating you are taking corticosteroids. · Monitor for weight gain, swelling, mood changes, or vision problems. |