Deltasone: Potent Systemic Corticosteroid for Inflammation Control
Deltasone
DELTASONE is used to reduce inflammation and reduce the symptoms in a variety of conditions like ulcerative colitis and asthma.
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Synonyms | |||
Deltasone (prednisone) is a cornerstone systemic corticosteroid medication, a synthetic analog of hormones naturally produced by the adrenal cortex. It is a potent anti-inflammatory and immunosuppressive agent, prescribed to manage a wide spectrum of conditions where modulating the body’s immune response and reducing inflammation is clinically paramount. Its efficacy is rooted in its ability to inhibit multiple inflammatory mediators and suppress immune cell function, providing rapid and significant symptomatic relief. This product card provides a detailed, expert-level overview for healthcare professionals and informed patients, covering its pharmacological profile, therapeutic applications, and essential safety information.
Features
- Active Ingredient: Prednisone.
- Drug Class: Synthetic glucocorticoid (corticosteroid).
- Available Forms: Oral tablets (1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg).
- Mechanism of Action: Crosses cell membranes, binds to intracellular glucocorticoid receptors, and complexes migrate to the cell nucleus to modify gene transcription. This action leads to the inhibition of leukocyte infiltration, interference in the function of mediators of inflammatory response, and suppression of humoral immune responses.
- Pharmacokinetics: Readily absorbed from the gastrointestinal tract. Prednisone is a prodrug that is metabolized in the liver by 11-beta-hydroxysteroid dehydrogenase to its active form, prednisolone. Peak plasma concentrations of prednisolone occur within 1 to 2 hours. Plasma half-life is 2 to 3 hours, though its biological half-life (physiological effect) is 18-36 hours. Metabolized in the liver and excreted by the kidneys.
Benefits
- Rapid and Potent Anti-inflammatory Action: Effectively and quickly reduces inflammation by decreasing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability, leading to a significant reduction in edema, redness, heat, and pain.
- Effective Immunosuppression: Suppresses the immune system by reducing lymphocyte proliferation and antibody production, making it invaluable for managing autoimmune disorders and preventing organ transplant rejection.
- Symptom Control in Allergic Reactions: Provides powerful relief from severe allergic conditions that are unresponsive to conventional treatments, including severe contact dermatitis and anaphylactic shock (as an adjunct to epinephrine).
- Management of Neoplastic Diseases: Used as part of combination chemotherapy regimens for certain leukemias and lymphomas due to its lympholytic and anti-inflammatory effects.
- Replacement Therapy: Provides essential glucocorticoid activity in cases of adrenal insufficiency (e.g., Addison’s disease), ensuring normal metabolic function and stress response.
- Broad Therapeutic Utility: Its multi-faceted mechanism allows it to be a first-line or adjunctive therapy for a vast array of endocrine, rheumatic, collagen, dermatologic, ophthalmic, respiratory, hematologic, and gastrointestinal conditions.
Common use
Deltasone is indicated for a wide range of conditions where anti-inflammatory or immunosuppressive effects are desired. Its use is always based on a risk-benefit assessment by a qualified physician.
- Endocrine Disorders: Primary or secondary adrenal insufficiency (used with a mineralocorticoid), congenital adrenal hyperplasia, hypercalcemia of malignancy, thyroiditis.
- Rheumatic Disorders: As adjunctive therapy for short-term administration in acute flares of: rheumatoid arthritis (including juvenile rheumatoid arthritis), psoriatic arthritis, ankylosing spondylitis, acute and subacute bursitis, epicondylitis, acute nonspecific tenosynovitis, polymyalgia rheumatica, systemic lupus erythematosus, acute gouty arthritis.
- Collagen Diseases: During an exacerbation or as maintenance therapy in selected cases of systemic dermatomyositis (polymyositis), systemic lupus erythematosus, acute rheumatic carditis.
- Dermatologic Diseases: Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis.
- Allergic States: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions.
- Ophthalmic Diseases: Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa, such as: allergic conjunctivitis, keratitis, allergic corneal marginal ulcers, herpes zoster ophthalmicus, iritis and iridocyclitis, chorioretinitis, anterior segment inflammation, optic neuritis, sympathetic ophthalmia.
- Respiratory Diseases: Symptomatic sarcoidosis, Loeffler’s syndrome not manageable by other means, berylliosis, fulminating or disseminated pulmonary tuberculosis (when used concurrently with appropriate antituberculous chemotherapy), aspiration pneumonitis.
- Hematologic Diseases: Idiopathic and secondary thrombocytopenia in adults, acquired (autoimmune) hemolytic anemia, erythroblastopenia (RBC anemia), congenital (erythroid) hypoplastic anemia.
- Neoplastic Diseases: For palliative management of: leukemias and lymphomas in adults, acute leukemia of childhood.
- Edematous States: To induce a diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.
- Gastrointestinal Diseases: To tide the patient over a critical period of the disease in: ulcerative colitis, regional enteritis (Crohn’s disease).
- Nervous System: Acute exacerbations of multiple sclerosis.
- Miscellaneous: Tuberculous meningitis with subarachnoid block or impending block (when used concurrently with appropriate antituberculous chemotherapy), trichinosis with neurologic or myocardial involvement.
Dosage and direction
Dosage must be individualized based on the specific disease, its severity, and the patient’s response. The lowest possible effective dose should be used.
- General Principles: Therapy is not a substitute for standard treatments. Dosing may be single daily or divided throughout the day. For chronic conditions, withdrawal from therapy must be gradual.
- Initial Dose: Can range widely from 5 mg to 60 mg of prednisone per day, depending on the disease being treated. For less severe diseases, lower doses (5-15 mg) may suffice. For severe conditions (e.g., lupus, pemphigus), initial doses may be 40-60 mg/day or higher.
- Dosage Adjustment: The dosage should be decreased or increased in small increments until the clinical response is adequate or until significant drug-related adverse effects appear.
- Alternate-Day Therapy (ADT): For patients on long-term therapy, switching to a single dose every other morning may be considered. This can help minimize HPA axis suppression and reduce the incidence of certain side effects like the Cushingoid state.
- Monitoring: Patients should be closely monitored for response and for the development of side effects. Dose adjustments should be made under direct physician supervision.
- Discontinuation: Long-term therapy MUST NOT be stopped abruptly. Tapering is required to avoid adrenal insufficiency. The rate of tapering is dependent on the dose, duration of therapy, and the underlying disease.
Precautions
- Adrenal Suppression: Corticosteroids can suppress the HPA axis. The degree of suppression is dependent on dose, frequency, and timing of administration. This effect can persist for months after discontinuation. Patients are at risk of adrenal insufficiency during and particularly after withdrawal of treatment. In stressful situations (surgery, trauma, severe illness) during or within a year of cessation of therapy, supplemental systemic corticosteroids are required.
- Infections: Deltasone suppresses the immune system, decreasing resistance to infections. Latent diseases (e.g., tuberculosis) may be reactivated. Viral infections, especially chickenpox and measles, can have a more serious or even fatal course in non-immune patients on corticosteroids. Avoid exposure.
- Vaccinations: Administration of live or live-attenuated vaccines is contraindicated. Killed or inactivated vaccines may be administered, but the response may be diminished.
- Ocular Effects: Prolonged use may cause 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.
- Cardiovascular/Renal: Use with caution in patients with hypertension, congestive heart failure, or renal insufficiency due to the drug’s mineralocorticoid activity (sodium and water retention).
- Endocrine: May produce hyperglycemia, manifesting as glucose intolerance. May suppress growth in pediatric patients. Monitor thyroid function tests, as thyroid hormones may alter corticosteroid metabolic clearance.
- Gastrointestinal: Use with caution in patients with peptic ulcer disease, diverticulitis, fresh intestinal anastomoses, and inflammatory bowel disease (risk of perforation). Corticosteroids may mask symptoms of perforation.
- Musculoskeletal: Prolonged use can lead to osteoporosis, vertebral compression fractures, aseptic necrosis of bone (particularly femoral and humeral heads), and steroid myopathy.
- Neuropsychiatric: May cause euphoria, insomnia, mood swings, personality changes, severe depression, or frank psychotic manifestations. May also increase intracranial pressure.
- Dermatologic: Impaired wound healing. Thin, fragile skin; petechiae and ecchymoses; facial erythema.
Contraindications
Deltasone is contraindicated in patients with:
- Systemic fungal infections (unless used for the management of drug reactions to amphotericin B).
- Known hypersensitivity to prednisone or any component of the formulation.
- Administration of live or live-attenuated vaccines during immunosuppressive therapy.
- Important Note: There may be no absolute contraindications in life-threatening situations. In such cases, the potential benefits must be weighed against the risks.
Possible side effect
Side effects are dose and duration-dependent.
- Common: Fluid and electrolyte disturbances (sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension); musculoskeletal (muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones); gastrointestinal (peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis); dermatologic (impaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema, increased sweating); neurological (convulsions, increased intracranial pressure with papilledema, vertigo, headache); endocrine (menstrual irregularities, development of cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsiveness); ophthalmic (posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos); metabolic (negative nitrogen balance due to protein catabolism).
- Less Common: Hypersensitivity reactions; thromboembolism; psychic disturbances; latent diabetes mellitus; increased appetite and weight gain.
Drug interaction
- Anticoagulants: Corticosteroids may alter the response to coumarin anticoagulants; monitoring of INR is recommended.
- Antidiabetic Agents (Insulin, Oral Hypoglycemics): Concomitant use may increase blood glucose levels, necessitating dosage adjustments of antidiabetic drugs.
- Enzyme Inducers (Phenobarbital, Phenytoin, Rifampin): Drugs that induce hepatic enzymes may increase the clearance of corticosteroids, necessitating an increase in corticosteroid dosage.
- Enzyme Inhibitors (Ketoconazole, Itraconazole): May decrease the metabolism of corticosteroids and increase the risk of side effects.
- NSAIDs (e.g., Aspirin, Ibuprofen, Naproxen): Concurrent use increases the risk of GI ulceration and bleeding. Aspirin clearance may be increased.
- Diuretics (especially potassium-depleting, e.g., Furosemide, Hydrochlorothiazide): Enhances potassium depletion.
- Live Vaccines: Corticosteroids may impair the immune response to live vaccines and increase the risk of vaccine-induced infections.
- Cardiac Glycosides (Digoxin): Increased risk of arrhythmias due to hypokalemia.
- Anticholinesterases: May produce severe weakness in patients with myasthenia gravis.
Missed dose
- If a dose is missed, it should be taken as soon as remembered.
- However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule should be resumed.
- Do not double the dose to make up for a missed one.
- Consult a physician for specific guidance, especially if on a tapering schedule.
Overdose
- Acute overdosage is unlikely to be acute life-threatening.
- Manifestations: May exacerbate the known side effects, leading to severe hypertension, edema, hypokalemia, hyperglycemia, and euphoria or other psychiatric symptoms.
- Management: There is no specific antidote. Treatment is supportive and symptomatic. Gastric lavage or emesis may be considered if ingestion is recent. Electrolytes and fluid balance must be monitored and corrected. Hemodialysis does not remove corticosteroids effectively.
Storage
- Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).
- Protect from light and moisture.
- Keep in the original container, tightly closed.
- Keep out of reach of children and pets.
- Do not flush medications down the toilet or pour them into a drain unless instructed to do so.
Disclaimer
This information is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various pharmacological references but may not be exhaustive or fully up-to-date. The author and publisher are not responsible for any errors or omissions or for any consequences from the application of this information.
Reviews
- Clinical Efficacy (Rheumatology): “Prednisone remains the gold standard for rapidly inducing remission in acute flares of polymyalgia rheumatica and giant cell arteritis. Its speed of action is unparalleled, though the side effect profile mandates a ‘start high, taper fast’ strategy under close supervision.” – Board-Certified Rheumatologist
- Patient Experience (Pulmonary): “As an asthma specialist, Deltasone is our rescue medication for severe exacerbations. Patients often report dramatic improvement in breathing within 24 hours. The key challenge is patient education on the short-term nature of such courses to avoid long-term dependency and side effects.” – Pulmonologist, MD
- Dermatological Use: “For severe, acute contact dermatitis or pemphigus, high-dose prednisone can be a lifesaver. It controls blistering and inflammation effectively. However, the subsequent taper is a delicate process, and we concurrently employ steroid-sparing agents to minimize cumulative exposure.” – Dermatologist
- Endocrine Perspective: “While vital for adrenal insufficiency, the iatrogenic Cushing’s syndrome induced by supraphysiologic doses is a significant management problem. We constantly balance the therapeutic benefit against metabolic consequences like diabetes and osteoporosis.” – Endocrinologist