Winpred

Action

Decreases inflammation by reversing increased cell capillary permeability and inhibiting migration of polymorphonuclear leukocytes. Suppresses immune system by reducing lymphatic activity.

Availability

Oral solution: 5 mg/ml, 5 mg/5 ml

Syrup: 5 mg/5 ml

Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg

Indications and dosages

➣ Severe inflammation; immunosuppression

Adults: Dosage individualized based on diagnosis, severity of condition, and response. Usual dosage is 5 to 60 mg P.O. daily as a single dose or in divided doses.

➣ Acute exacerbation of multiple sclerosis

Adults: 200 mg P.O. daily for 1 week, then 80 mg every other day for 1 month

➣ Adjunctive therapy for Pneumocystis jiroveci pneumonia in AIDS patients

Adults: 40 mg P.O. b.i.d. for 5 days, then 40 mg once daily for 5 days, then 20 mg once daily for 11 days

Contraindications

• Hypersensitivity to drug, other corticosteroids, alcohol, bisulfite, or tartrazine (with some products)

• Systemic fungal infections

• Live-virus vaccines (with immunosuppressant doses)

• Active untreated infections (except in selected meningitis patients)

Precautions

Use cautiously in:

• diabetes mellitus, glaucoma, renal or hepatic disease, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, inflammatory bowel disease, thromboembolic disorders, seizures, myasthenia gravis, heart failure, hypertension, osteoporosis, hypothyroidism, ocular herpes simplex, immunosuppression, emotional instability

• pregnant or breastfeeding patients

• children under age 6.

Administration

• Give with food or milk to reduce GI upset.

• Administer once-daily dose early in morning.

Adverse reactions

CNS: headache, nervousness, depression, euphoria, personality changes, psychosis, vertigo, paresthesia, insomnia, restlessness, seizures, meningitis, increased intracranial pressure

CV: hypotension, hypertension, vasculitis, heart failure, thrombophlebitis, thromboembolism, fat embolism, arrhythmias, shock

EENT: posterior subcapsular cataracts (especially in children), glaucoma, nasal irritation and congestion, rebound congestion, sneezing, epistaxis, nasopharyngeal and oropharyngeal fungal infections, perforated nasal septum, anosmia, dysphonia, hoarseness, throat irritation (all with long-term use)

GI: nausea, vomiting, abdominal distention, rectal bleeding, esophageal candidiasis, dry mouth, esophageal ulcer, pancreatitis, peptic ulcer

GU: amenorrhea, irregular menses

Hematologic: purpura

Metabolic: sodium and fluid retention, hypokalemia, hypocalcemia, hyperglycemia, decreased carbohydrate tolerance, diabetes mellitus, growth retardation (in children), cushingoid effects (with long-term use), hypothalamic-pituitary-adrenal suppression (with systemic use longer than 5 days), adrenal suppression (with high-dose, long-term use)

Musculoskeletal: muscle weakness or atrophy, myalgia, myopathy, osteoporosis, aseptic joint necrosis, spontaneous fractures (with long-term use), osteonecrosis, tendon rupture

Respiratory: cough, wheezing, bronchospasm

Skin: rash, pruritus, contact dermatitis, acne, striae, poor wound healing, hirsutism, thin fragile skin, petechiae, bruising, subcutaneous fat atrophy, urticaria, angioedema

Other: bad taste, increased or decreased appetite, weight gain (with long-term use), facial edema, aggravation or masking of infections, hypersensitivity reaction

Interactions

Drug-drug. Amphotericin B, mezlocillin, piperacillin, thiazide and loop diuretics, ticarcillin: additive hypokalemia

Aspirin, other nonsteroidal anti-inflammatory drugs: increased risk of GI discomfort and bleeding

Cardiac glycosides: increased risk of digitalis toxicity due to hypokalemia Cyclosporine: therapeutic benefits in organ transplant recipients, but with increased risk of toxicity

Erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, saquinavir: increased prednisone blood level and effects

Hormonal contraceptives: impaired metabolism and increased effects of prednisone

Isoniazid: decreased isoniazid blood level Live-virus vaccines: decreased antibody response to vaccine, increase risk of adverse effects

Oral anticoagulants: reduced anticoagulant requirements, opposition to anticoagulant action

Phenobarbital, phenytoin, rifampin: decreased prednisone efficacy

Salicylates: reduced salicylate blood level

Somatrem: inhibition of somatrem's growth-promoting effects

Theophylline: altered pharmacologic effects of either drug

Drug-diagnostic tests. Calcium, potassium, thyroid ¹³¹I uptake, thyroxine, triiodothyronine: decreased levels

Cholesterol, glucose: increased levels

Nitroblue tetrazolium test for bacterial infection: false-negative result

Drug-herbs. Alfalfa: activation of quiescent systemic lupus erythematosus

Echinacea: increased immune-stimulating effects

Ephedra (ma huang): decreased drug blood level

Ginseng: potentiation of immunomodulating effect

Licorice: prolonged drug activity

Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers

Patient monitoring

• Monitor weight, blood pressure, and electrolyte levels.

• Watch for cushingoid effects (moon face, central obesity, buffalo hump, hair thinning, high blood pressure, frequent infections).

☞ Check for signs and symptoms of depression and psychosis.

• Assess blood glucose level carefully in diabetic patient.

• Monitor patient for signs and symptoms of infection, which drug may mask or exacerbate.

☞ Assess for early indications of adrenal insufficiency (fatigue, weakness, joint pain, fever, appetite loss, shortness of breath, dizziness, syncope).

• Monitor musculoskeletal status for joint, tendon, and muscle pain.

Patient teaching

• Tell patient to take with food or milk to reduce GI upset.

☞ Teach patient to recognize and immediately report signs and symptoms of early adrenal insufficiency and cushingoid effects.

☞ Inform patient that drug increases his risk of infection. Instruct him to contact prescriber at first sign of infection.

☞ Caution patient not to stop drug suddenly. Advise him to discuss any changes in therapy with prescriber.

☞ Tell patient to immediately report bleeding or joint, muscle, tendon, or abdominal pain.

☞ Advise patient or significant other to immediately report depression or psychosis.

• Caution patient not to take herbs or over-the-counter drugs during therapy.

• Instruct patient to avoid vaccinations during therapy. Tell him that others in household shouldn't receive oral polio vaccine because they could pass poliovirus to him.

• Tell patient he may need higher dosage during periods of stress. Encourage him to wear or carry medical identification stating this.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.