Label: PREDNISONE - prednisone tablet 

  • Category: HUMAN PRESCRIPTION DRUG LABEL
  • DEA Schedule: None
  • Marketing Status: Abbreviated New Drug Application

Drug Label Information

Updated 01/13

If you are a consumer or patient please visit this version.

  • DESCRIPTION

    Prednisone is a glucocorticoid. Glucocorticoids are adrenocortical steroids, both naturally occurring and synthetic, which are readily absorbed from the gastrointestinal tract. The molecular formula for prednisone is C21H26O5. Chemically, it is 17, 21-dihydroxypregna-1, 4-diene-3,11,20-trione and has the following structural formula:
    MM1


    Prednisone is a white to practically white, odorless, crystalline powder and has a molecular weight of 358.44. It melts at about 230
    Inactive ingredients:
    1 mg: anhydrous lactose, corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium starch glycolate.|
    2.5 mg:anhydrous lactose, colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and talc.
    5 mg: anhydrous lactose, colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and talc.
    10 mg:anhydrous lactose, colloidal silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium starch glycolate, and talc.
    20 mg: anhydrous lactose, D&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.
    Close
  • CLINICAL PHARMACOLOGY

    Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems.
    Glucocorticoids, such as prednisone, cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli.
    Close
  • INDICATIONS & USAGE

    Prednisone tablets are indicated in the following conditions:
         � Endocrine disorders     
    Congenital adrenal hyperplasia     
    Nonsuppurative thyroiditis     
    Hypercalcemia associated with cancer
         � Rheumatic disorders     
    As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in:     
    Psoriatic arthritis     
    Rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy)     
    Ankylosing spondylitis     
    Acute and subacute bursitis     
    Acute nonspecific tenosynovitis     
    Acute gouty arthritis     
    Post-traumatic osteoarthritis     
    Synovitis of osteoarthritis     
    Epicondylitis
         � Collagen diseases     
    During an exacerbation or as maintenance therapy in selected cases of:     
    Systemic lupus erythematosus     
    Systemic dermatomyositis (polymyositis)     
    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     
    Serum sickness     
    Bronchial asthma     
    Contact dermatitis     
    Atopic dermatitis     
    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     
    Diffuse posterior uveitis and choroiditis     
    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 disorders     
    Idiopathic thrombocytopenic purpura in adults     
    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
         � 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
    Close
  • CONTRAINDICATIONS

    Prednisone tablets are contraindicated in systemic fungal infections and known hypersensitivity to components.
    Close
  • WARNINGS

    In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated.
    Corticosteroids may mask some signs of infection, and new infections may appear during their use. There may be decreased resistance and inability to localize infection when corticosteroids are used.
    Prolonged use of corticosteroids may produce 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.

    Usage in Pregnancy
    Since adequate human reproduction studies have not been done with corticosteroids, the use of these drugs in pregnancy, nursing mothers or women of child-bearing potential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus. Infants born of mothers who have received substantial doses of corticosteroids during pregnancy, should be carefully observed for signs of hypoadrenalism.
    Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may be necessary. All corticosteroids increase calcium excretion.
    While on corticosteroid therapy patients should not be vaccinated against smallpox. Other immunization procedures should not be undertaken in patients who are on corticosteroids, especially on high dose, because of possible hazards of neurological complications and a lack of antibody response.
    The use of prednisone in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate anti-tuberculous regimen.
    If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.
    Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chickenpox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If exposed to chickenpox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated. (See the respective package inserts for complete VZIG and IG prescribing information.) If chickenpox develops, treatment with antiviral agents may be considered.
    Close
  • PRECAUTIONS

    General
    Drug-induced secondary adrenocortical insufficiency may be minimized by gradula reduction of dosage. This type of relative isufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently.

    There is an enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis.
    Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation.
    The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage is possible, the reduction should be gradual.
    Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia.
    Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
    Steroids should be used with caution in nonspecific ulcerative colitis, if there is a probability of impending perforation, abscess or other pyogenic infection; diverticulitis; fresh intestinal anastomoses; active or latent peptic ulcer; renal insufficiency; hypertension, osteoporosis; and myasthenia gravis.
    Growth and development of infants and children on prolonged corticosteroid therapy should be carefully observed.
    Although controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, they do not show that corticosteroids affect the ultimate outcome or natural history of the disease. The studies do show that relatively high doses of corticosteroids are necessary to demonstrate a significant effect. (See DOSAGE AND ADMINISTRATION.)
    Since complications of treatment with glucocorticoids are dependent on the size of the dose and the duration of treatment, a risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used.
    Convulsions have been reported with concurrent use of methylprednisolone and cyclosporin. Since concurrent use of these agents results in a mutual inhibition of metabolism, it is possible that adverse events associated with the individual use of either drug may be more apt to occur.
    Close
  • ADVERSE REACTIONS

    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
    May suppress reactions to skin tests
    Neurological:
    Convulsions
    Increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment
    Vertigo
    Headache
    Endocrine:
    Menstrual irregularities
    Development of Cushingoid state
    Suppression of growth in children
    Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness
    Decreased carbohydrate tolerance
    Manifestations of latent diabetes mellitus
    Increased requirements for insulin or oral hypoglycemic agents in diabetics
    Ophthalmic:
    Posterior subcapsular cataracts
    Increased intraocular pressure
    Glaucoma
    Exophthalmos
    Metabolic:
    Negative nitrogen balance due to protein
    Additional Reactions:
    Urticaria and other allergic, anaphylactic or hypersensitivity reactions
    To report SUSPECTED ADVERSE REACTIONS, contact West-ward Pharmaceutical Corp. at 1-877-233-2001, or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
    Close
  • DOSAGE & ADMINISTRATION

    The initial dosage of prednisone may vary from 5 mg to 60 mg per day depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, prednisone should be discontinued and the patient transferred to other appropriate therapy.
    IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT.
    After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patientcondition. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.

    Multiple Sclerosis
    In the treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day for 1 month have been shown to be effective. (Dosage range is the same for prednisone and prednisolone.)

    ADT(Alternate Day Therapy)
    ADT is a corticosteroid dosing regimen in which twice the usual daily dose of corticoid is administered every other morning. The purpose of this mode of therapy is to provide the patient requiring long-term pharmacologic dose treatment with the beneficial effects of corticoids while minimizing certain undesirable effects, including pituitary-adrenal suppression, the Cushingoid state, corticoid withdrawal symptoms, and growth suppression in children.
    The rationale for this treatment schedule is based on two major premises: (a) the anti-inflammatory or therapeutic effect of corticoids persists longer than their physical presence and metabolic effects and (b) administration of the corticosteroid every other morning allows for re-establishment of more nearly normal hypothalamic-pituitary-adrenal (HPA) activity on the off-steroid day.
    A brief review of the HPA physiology may be helpful in understanding this rationale. Acting primarily through the hypothalamus a fall in free cortisol stimulates the pituitary gland to produce increasing amounts of corticotropin (ACTH) while a rise in free cortisol inhibits ACTH secretion. Normally the HPA system is characterized by diurnal (circadian) rhythm. Serum levels of ACTH rise from a low point about 10 pm to a peak level about 6 am. Increasing levels of ACTH stimulate adrenocortical activity resulting in a rise in plasma cortisol with maximal levels occurring between 2 am and 8 am. This rise in cortisol dampens ACTH production and in turn adrenocortical activity. There is a gradual fall in plasma corticoids during the day with lowest levels occurring about midnight.
    The diurnal rhythm of the HPA axis is lost in Cushing's disease, a syndrome of adrenocortical hyperfunction characterized by obesity with centripetal fat distribution, thinning of the skin with easy bruisability, muscle wasting with weakness, hypertension, latent diabetes, osteoporosis, electrolyte imbalance, etc. The same clinical findings of hyperadrenocorticism may be noted during long-term pharmacologic dose corticoid therapy administered in conventional daily divided doses. It would appear, then, that a disturbance in the diurnal cycle with maintenance of elevated corticoid values during the night may play a significant role in the development of undesirable corticoid effects. Escape from these constantly elevated plasma levels for even short periods of time may be instrumental in protecting against undesirable pharmacologic effects.
    During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every 6 hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenocortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenocortical suppression for 1to 1days following a single dose) and thus are recommended for alternate day therapy.
    The following should be kept in mind when considering alternate day therapy:
    1) Basic principles and indications for corticosteroid therapy should apply. The benefits of ADT should not encourage the indiscriminate use of steroids.
    2) ADT is a therapeutic technique primarily designed for patients in whom long-term pharmacologic corticoid therapy is anticipated.
    3) In less severe disease processes in which corticoid therapy is indicated, it may be possible to initiate treatment with ADT. More severe disease states usually will require daily divided high dose therapy for initial control of the disease process. The initial suppressive dose level should be continued until satisfactory clinical response is obtained, usually four to ten days in the case of many allergic and collagen diseases. It is important to keep the period of initial suppressive dose as brief as possible particularly when subsequent use of alternate day therapy is intended. Once control has been established, two courses are available: (a) change to ADT and then gradually reduce the amount of corticoid given every other day or (b) following control of the disease process reduce the daily dose of corticoid to the lowest effective level as rapidly as possible and then change over to an alternate day schedule. Theoretically, course (a) may be preferable.
    4) Because of the advantages of ADT, it may be desirable to try patients on this form of therapy who have been on daily corticoids for long periods of time (eg, patients with rheumatoid arthritis). Since these patients may already have a suppressed HPA axis, establishing them on ADT may be difficult and not always successful. However, it is recommended that regular attempts be made to change them over. It may be helpful to triple or even quadruple the daily maintenance dose and administer this every other day rather than just doubling the daily dose if difficulty is encountered. Once the patient is again controlled, an attempt should be made to reduce this dose to a minimum.
    5) As indicated above, certain corticosteroids, because of their prolonged suppressive effect on adrenal activity, are not recommended for alternate day therapy (eg, dexamethasone and betamethasone).
    6) The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is minimal between 4 pm and midnight. Exogenous corticosteroids suppress adrenocortical activity the least, when given at the time of maximal activity (am).
    7) In using ADT it is important, as in all therapeutic situations to individualize and tailor the therapy to each patient. Complete control of symptoms will not be possible in all patients. An explanation of the benefits of ADT will help the patient to understand and tolerate the possible flare-up in symptoms which may occur in the latter part of the off-steroid day. Other symptomatic therapy may be added or increased at this time if needed.
    8) In the event of an acute flare-up of the disease process, it may be necessary to return to a full suppressive daily divided corticoid dose for control. Once control is again established alternate day therapy may be reinstituted.
    9) Although many of the undesirable features of corticosteroid therapy can be minimized by ADT, as in any therapeutic situation, the physician must carefully weigh the benefit-risk ratio for each patient in whom corticoid therapy is being considered.
    Close
  • HOW SUPPLIED


    Prednisone Tablets, USP 1 mg" White, Round Tablets; Debossed "WW 10" on one side and Scored on the other side. Each tablet contains 1 mg of prednisone for oral administration.
    Bottles of 1000 tablets
    Unit Dose Boxes of 100 tablets
    Prednisone Tablets, USP 2.5 mg: White, Round Tablets; Debossed "WW 25" on one side and Scored on the other side. Each tablet contains 2.5 mg of prednisone for oral administration.
    Bottles of 100 tablets
    Bottles of 500 tablets
    Bottles of 1000 tablets
    Prednisone Tablets, USP 5 mg: White, Round Tablets; Debossed "West-ward 475" on one side and Scored on the other side. Each tablet contains 5 mg of prednisone for oral administration.
    Bottles of 100 tablets
    Bottles of 1000 tablets
    Unit Dose Boxes of 100 tablets
    Prednisone Tablets, USP 10 mg: White, Round Tablets; Debossed "WEST-WARD 473" on one side and Scored on the other side. Each tablet contains 10 mg of prednisone for oral administration.
    Bottles of 100 tablets
    Bottles of 500 tablets
    Bottles of 1000 tablets
    Unit Dose Boxes of 100 tablets
    Prednisone Tablets, USP 20 mg: Peach, Round Tablets; Debossed "West-ward 477"on one side and Scored on the other side. Each tablet contains 20 mg of prednisone for oral administration.
    Bottles of 100 tablets
    Bottles of 500 tablets
    Bottles of 1000 tablets
    Unit Dose Boxes of 100 tablets
    Close
  • STORAGE AND HANDLING

    Store at 20-25 C(68-77 F)[See USP Controlled Room Temperature]. Protect from light and moisture.
    Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
    Close
  • PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION

    DRUG: PREDNISONE
    GENERIC: PREDNISONE
    DOSAGE: TABLET
    ADMINSTRATION: ORAL
    NDC: 24236-248-13
    STRENGTH:10 mg
    COLOR: white
    SHAPE: ROUND
    SCORE: Two even pieces
    SIZE: 9 mm
    IMPRINT: 16
    QTY: 16

    MM2



    MM3

    Close
  • INGREDIENTS AND APPEARANCE
    PREDNISONE 
    prednisone tablet
    Product Information
    Product Type HUMAN PRESCRIPTION DRUG LABEL Item Code (Source) NDC:24236-248(NDC:0143-1473)
    Route of Administration ORAL DEA Schedule     
    Active Ingredient/Active Moiety
    Ingredient Name Basis of Strength Strength
    PREDNISONE (PREDNISONE) PREDNISONE 10 mg
    Inactive Ingredients
    Ingredient Name Strength
    ANHYDROUS LACTOSE  
    D&C YELLOW NO. 10  
    FD&C YELLOW NO. 6  
    MAGNESIUM STEARATE  
    CELLULOSE, MICROCRYSTALLINE  
    SODIUM STARCH GLYCOLATE TYPE A POTATO  
    Product Characteristics
    Color white Score 2 pieces
    Shape ROUND (TABLET) Size 9mm
    Flavor Imprint Code WESTWARD;473
    Contains     
    Packaging
    # Item Code Package Description Marketing Start Date Marketing End Date
    1 NDC:24236-248-13 16 in 1 BLISTER PACK
    Marketing Information
    Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
    ANDA ANDA088832 01/18/2013
    Labeler - REMEDYREPACK INC. (829572556)
    Close