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). |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for LIQUID PRED (LIQUID PRED).
| Breastfeeding | Prednisolone excreted in breast milk; M/P ratio 0.1-0.3. Low risk with maternal doses <20 mg/day. Monitor infant for adrenal suppression. |
| 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). |
■ FDA Black Box Warning
None (no FDA boxed warning).
| Common Effects | No common side effects seen |
| Serious Effects |
["Systemic fungal infections","Hypersensitivity to prednisolone or any component","Administration of live or live-attenuated vaccines (relative)"]
| 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)"] |
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| Fertility Effects | No direct impairment, but ovulation disorders may occur with high doses. Low doses (<10 mg/day) unlikely to affect fertility. |