PEDIAPRED
Clinical safety rating: caution
Comprehensive clinical and safety monograph for PEDIAPRED (PEDIAPRED).
Prednisolone is a glucocorticoid receptor agonist that binds to the intracellular glucocorticoid receptor, leading to modulation of gene expression. It suppresses inflammation by inhibiting phospholipase A2, reducing prostaglandin and leukotriene synthesis, and decreasing cytokine production (e.g., IL-1, IL-6, TNF-alpha). It also suppresses immune responses by reducing lymphocyte proliferation and activity.
| Metabolism | Primarily hepatic metabolism via 11β-hydroxysteroid dehydrogenase and other pathways; metabolites are inactive or less active. Prednisolone is the active form of prednisone and undergoes further biotransformation. |
| Excretion | Renal: ~80% as metabolites (mainly glucuronides and sulfates) and <5% unchanged; fecal: ~15%. |
| Half-life | 2.5–3.5 hours (terminal) in children; clinical context: requires multiple daily doses for sustained effect. |
| Protein binding | 70–90%, primarily to corticosteroid-binding globulin (transcortin) and albumin. |
| Volume of Distribution | 0.5–1.0 L/kg; indicates wide distribution into tissues, including penetration into CNS. |
| Bioavailability | Oral: 50–70% (first-pass metabolism); IM: ~80%. |
| Onset of Action | Oral: 1–2 hours; IM: 30 minutes–1 hour. |
| Duration of Action | 12–36 hours (depends on dose and condition); clinical note: single dose may suppress adrenal function for up to 48 hours. |
| Molecular Weight | 360.44 |
Oral: 5-60 mg/day as a single dose or divided doses; adjust based on condition and response.
| Dosage form | SOLUTION |
| Renal impairment | No specific dose adjustment required for renal impairment; use with caution in severe impairment. |
| Liver impairment | Child-Pugh A: No adjustment; Child-Pugh B: Reduce dose by 50%; Child-Pugh C: Avoid use or reduce dose by 75%. |
| Pediatric use | Oral: 0.05-2 mg/kg/day divided every 6-12 hours; maximum 60 mg/day; dosing based on severity of condition. |
| Geriatric use | Start at lowest effective dose (e.g., 5 mg/day) and titrate slowly due to increased risk of osteoporosis, hyperglycemia, and muscle wasting. |
| 1st trimester | Prednisolone crosses placenta; use only if benefit outweighs risk. First trimester use may increase risk of oral clefts (studies suggest small increase, absolute risk low). |
| 2nd trimester | Use if clearly needed; monitor for maternal glucose intolerance and fetal growth restriction. |
| 3rd trimester | Prolonged use may cause neonatal adrenal suppression; use lowest effective dose. |
Clinical note
Comprehensive clinical and safety monograph for PEDIAPRED (PEDIAPRED).
| Placental transfer | Prednisolone crosses the placenta; however, it is partially metabolized by placental 11-beta-hydroxysteroid dehydrogenase type 2 to inactive prednisone, reducing fetal exposure compared to other corticosteroids. Transfer is dose-dependent. |
| Breastfeeding | Prednisolone is excreted into breast milk in low amounts (less than 10% of maternal dose). At maternal doses up to 40 mg daily, infant exposure is minimal and generally considered compatible with breastfeeding. Monitor infant for potential growth suppression or adrenal suppression. |
■ FDA Black Box Warning
None.
| Serious Effects |
Systemic fungal infectionsKnown hypersensitivity to prednisolone or any component of the formulationAdministration of live virus vaccines (e.g., smallpox vaccine) due to risk of generalized infection
| Precautions | Increased risk of infections due to immunosuppression; may mask signs of infection., Adrenal suppression with prolonged use; abrupt withdrawal may cause adrenal insufficiency., Osteoporosis with long-term use; monitor bone density., Gastrointestinal perforation, especially in patients with GI ulcers or diverticulitis., Exacerbation of diabetes mellitus; monitor blood glucose., Hypertension, fluid retention, and electrolyte disturbances., Cushing's syndrome with chronic high-dose therapy., Psychiatric disturbances including euphoria, insomnia, mood swings, and psychosis., Increased intraocular pressure, glaucoma, and cataracts with prolonged use., Growth suppression in children; monitor growth., Kaposi sarcoma reported in patients receiving corticosteroid therapy., Live vaccines contraindicated; may decrease immune response to vaccines. |
| Food/Dietary |
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| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | Prednisolone (active metabolite of prednisone) crosses the placenta but is largely inactivated by 11β-HSD2. First trimester: Increased risk of oral clefts (odds ratio ~1.5-3.0) with high-dose exposure. Second/third trimesters: Associated with fetal adrenal suppression, intrauterine growth restriction, and preterm delivery. Chronic high-dose exposure increases risk of maternal hypertension, gestational diabetes, and infections. Overall risk-benefit must be assessed. |
| Fetal Monitoring | Monitor maternal blood pressure, blood glucose (especially if high dose or prolonged therapy), and signs of infection. Assess fetal growth via ultrasound if prolonged therapy. In neonates exposed to high doses near term, monitor for signs of adrenal insufficiency. |
| Fertility Effects | No direct impairment of fertility reported in humans. High-dose chronic use may cause menstrual irregularities or ovulatory dysfunction due to suppression of hypothalamic-pituitary-adrenal axis. |
| Avoid grapefruit and grapefruit juice as they may increase prednisolone levels. Limit high-sodium foods to reduce fluid retention; increase potassium-rich foods (e.g., bananas) if on prolonged therapy. |
| Clinical Pearls | PEDIAPRED (prednisolone sodium phosphate) is a corticosteroid; use the lowest effective dose for the shortest duration to minimize adrenal suppression. In acute asthma exacerbations, short courses (3-5 days) are effective; no taper needed if <7 days. Monitor for hyperglycemia, especially in diabetic children. Do not use in systemic fungal infections or live virus vaccinations. Abrupt discontinuation after prolonged use may cause adrenal crisis. |
| Patient Advice | Take exactly as prescribed; do not stop abruptly without consulting your doctor. · Take with food or milk to reduce stomach upset. · Avoid close contact with people who have infections (e.g., chickenpox, measles) and report any exposure immediately. · Do not receive live vaccines while taking this medication. · Notify your doctor if you experience unusual weight gain, swelling, vision changes, or persistent sore throat. · Carry a steroid warning card if on long-term therapy. |