Prednisone

Additional information

Pharmacokinetics and dosing

Prednisone is both a pro-drug to prednisolone and an inactive metabolite of prednisolone. Therefore, the pharmacokinetics of prednisone could be attributed to prednisolone. Prednisolone pharmacokinetics was investigated in healthy white and black men and women (16 men, 16 women) receiving a single oral dose 0.27 mg/kg of prednisone (precursor to prednisolone). Clearance of free prednisolone normalized for bodyweight was higher in men than in women, regardless of race [4]. Contrary to this, another smaller study (4 men, 4 women) observed a higher total and free clearance in women after receiving prednisolone 0.075-1.5 mg/kg [5].

The pharmacokinetics of total and unbound prednisone and prednisolone was studied in adult diabetic and non-diabetic kidney transplant recipients (30 men, 8 women). Men had a higher affinity constant than women for prednisolone bound to corticosteroid binding globulin. However, due to the small number of women in this study, it is not possible to conclude if sex the influence prednisone pharmacokinetics [6].

Effects

The impact of glucocorticoid-induced growth impairment has been investigated in several studies. Growth and pubertal development in children with congenital adrenal hyperplasia (CAH) on treatment with hydrocortisone acetate, cortisone acetate, or prednisone has been investigated (8 boys, 10 girls). Growth was evaluated according to Tanner’s standards. Boys had earlier onset of puberty, but not girls, and the authors speculate that this might be due to induction through hypothalamic stimulation by androgens [7].Growth in children with cystic fibrosis was studied in a randomized, double-blind trial (126 boys, 98 girls; ages 6-14). Children were randomized to low-dose prednisone or placebo. After 18 years of age, prednisone-treated boys had lower mean height and weight than placebo-treated boys, while prednisone-treated girls reached similar heights and weights as placebo-treated girls [8].

Adverse effects

A large meta-analysis of corticosteroid-induced osteoporosis in adults showed that oral corticosteroid treatment with doses above 5 mg/day (of prednisolone or equivalent) reduced bone mineral density and increased the risk of fracture during treatment, irrespective of age, sex, or underlying disease (66 studies with 2891 patients with BMD measures, 71.5% women and 23 studies with 558 with fractures in corticosteroid users, and 244 235 corticosteroid users with fractures in the General Practice Research Database) [1]. However, a study not included in the meta-analysis, retrospectively analyzed the population attributable risk of fracture in a cohort using oral corticosteroids (8192 men, 12034 women). Compared to the general population, corticosteroids users had a higher risk of fracture (RR 1.90), and women had a higher risk than men (RR 2.13) [2]. Another meta-analysis of glucocorticoid therapy in children (in total 287 patients with BMD measure, and 37 819 with fractures) showed corticosteroid use to be associated with reduced spine bone mineral density and no sex difference in the risk for fracture were seen [3].No effect of low-dose prednisone on BMD was seen in RA patients overall (16 men, 164 women). However, a post hoc analysis of the study, including the 109 women who were postmenopausal, showed that a dose of 5 mg/day or less reduced hip BMD [9].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).