PREDNISONE/PREDNISOLONE
(Deltasone, Meticorten, Orasone)
Prednisone and prednisolone are synthetic glucocorticoids. Prednisone is biologically inert; it is converted to prednisolone, a biologically active compound, in the liver. Prednisone and prednisolone are used to treat a variety of allergic and inflammatory conditions. Prednisone is given orally but prednisolone may be given either orally or parenterally. The usual systemic dose of either agent is 5-60 mg/d, but doses up to 250 mg/d are sometimes used. Systemic absorption of prednisolone can occur from ophthalmic preparations, but the amount administered is usually small.
Teratogenic Risk
Magnitude of teratogenic risk to child born after exposure during gestation: Unlikely.
Quality and quantity of data on which risk estimate is based: Poor to fair.
Therapeutic doses of prednisone and prednisolone are unlikely to pose a substantial teratogenic risk, but the data are insufficient to state that there is no risk.
The frequency of malformations was not increased among the children of 43 women who had been treated with prednisone during the first four lunar months of pregnancy in one epidemiological study. Malformations do not appear unusually frequent among the infants of women treated with prednisone during pregnancy in uncontrolled series of 20-40 live-births.
Congenital immunodeficiency and lymphopenia have been reported in two infants born to women who had been treated with prednisone and azathioprine during pregnancy. It is uncertain whether or not the maternal immunosuppressive therapy played a role in development of this disease in the infants.
A high frequency of perinatal death has been observed in some series of women treated throughout gestation with prednisone or prednisolone, but the perinatal death cannot be attributed to maternal steroid therapy because these women had serious illnesses requiring treatment, often with several drugs. Premature delivery and fetal growth retardation are also unusually frequent in some series of women treated during pregnancy with prednisone or prednisolone, but the same confounding factors affect interpretation of the studies.
Fetal growth retardation occurs with increased frequency among the offspring of mice and rats treated in pregnancy with prednisone or prednisolone in doses within or above the human therapeutic range. Dose-dependent constriction of the ductus arteriosus was observed among the offspring of pregnant rats injected with prednisolone near term in doses 10-1000 times those used in humans.
Prednisolone, like other corticosteroids, causes an increased frequency of cleft palate in the offspring of pregnant mice treated with 1-40 times the human therapeutic dose. Increased frequencies of cleft palate are also observed among the offspring of pregnant rabbits and hamsters treated with prednisolone in doses respectively < l-2 and 80-240 times that used in humans. An increase in the frequency of genital anomalies has been observed among the offspring of mice treated with 2-10 times the human therapeutic dose of prednisolone during pregnancy. Developmental and other behavioral alterations have been noted in mice born to mothers treated during pregnancy with prednisone or prednisolone in doses 1-4 times those used in humans. The relevance, if any, of these observations to maternal treatment with prednisone or prednisolone in human pregnancy is unknown.
Risk Related to Breast-feeding
Prednisone and its active metabolite, prednisolone, are excreted in breast milk in low concentrations. The amount of prednisone and prednisolone that the nursing infant would be expected to ingest is <1 and between < l-24% of the lowest therapeutic doses of
ANTI-ALLERGIC/ASTHMA
KEYS TO ASTHMA PREVENTION
Although asthma rates continue to increase internationally, there is much that individuals and communities can do to reduce risk:
• Work with local leaders to reduce air pollution in your communities. Regulations on the burning of household and yard trash, field burning, use of wood-burning stoves, and side-stream smoke from cigarettes, all known triggers for asthma attacks, should be analyzed and revised.
• Purchase a good air filter in the home and clean furnace filters regularly. Clean houses often, using a high-suction vacuum rather than a broom to reduce dust particles in suspended air.
• Wash pillows regularly to avoid pesty mites and other debris inside the pillows. Use pillow protectors and mattress protectors, which keep dust mites and other critters out of your face and trapped inside the pillow or mattress. Don't purchase used mattresses, as they may be teeming with mites.
• Avoid having cats or dogs that are known for high dander production in the home. If you must have these pets, keep them off your bed and wash them and their bedding weekly. Vacuum their hair regularly. Have asthma medications handy and know where you left them in case of an emergency.
• Keep your home clean and pest free; cockroaches and other vermin have enzymes in their saliva or particles on their body that may trigger allergic reactions.
• Keep mold concentrations low by using anti-mold cleaners or by running a dehumidifier to keep moisture levels down.
• Avoid mowing the lawn or excessive outdoor exposure to pollen during high-pollen times. Local news stations often provide pollen warnings. If you must be outdoors, wear a pollen mask.
• Get adequate amounts of exercise to keep your lungs functioning well.
• Avoid smokers.
• If you have a fireplace or wood-burning stove, check it regularly to make sure that it is not spewing out smoke and particulate matter.
• Let people close to you know that you are asthmatic, and educate them about what to do if you have an asthmatic attack. Understanding and knowledge are two of the greatest tools that the health consumer has. Make sure your loved ones have access to information.
*6/277/5*
ANTI-ALLERGIC/ASTHMA
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