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DOSAGE
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Intermediate Uveitis (CME, Vitritis, etc)
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Posterior Uveitis (Toxoplasmosis)
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(1) Predforte 1% q1-2hr (2) Consider subtenon steroid injection q6-8 weeks until vision/CME stabilized (0.50-1.0mL of triamcinolone 40mg/mL) (3) If no improvement after 3 subtenon injection q1-3 months apart, consider 40-60mg PO qD x 4- weeks, then taper to patient’s response
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(1) Glaucoma Meds for elevated IOP with typical Anterior Uveitis Drop treatment (2) 1st-Line Triple Therapy (4-6 weeks): (a) Pyrimethamine 200mg PO Load, then 25-50 mg PO qDay (b) Folinic Acid 10mg PO q2Day (3) Sulfadiazine 2g PO load, then 1g PO QID (3) After 24 hrs, add on 20-60mg Prednisone qDay after initiating antimicrobial therapy, and then taper for 10 days before stopping antibiotics.
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Do not use high-dosage systemic steroid over 2-3 months.
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Systemic steroids should rarely be used in immunocompromised patients. Consider other alternative regimens for pregnancy or allergies.
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GENERIC
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prednisone anhydrous tablet
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SIZE
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5mg, 10mg, 20mg ,50mg
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Also available as powders, syrups, and solutions
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INDICATIONS
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Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: allergic corneal marginal ulcers, herpes zoster ophthalmicus, anterior segment inflammation, diffuse posterior uveitis and choroiditis, sympathetic ophthalmia, allergic conjunctivitis, keratitis, chorioretinitis, optic neuritis, iritis and iridocyclitis.
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MECHANISM OF ACTION
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synthetic precursor to the glucocorticoid prednisolone
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MICROBIOLOGY
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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 cause profound and varied metabolic effects. In addition, they modify the body’s immune responses to diverse stimuli.
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CONTRAINDICATIONS & WARNINGS
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Depending on dose and duration, side effects may include increased infection risk, weight gain/redistribution, gastrointestinal ulcers or bleeding, osteoporosis, mood alteration/depression/anxiety, mental confusion, insomnia, fluid retention, elevated blood pressure, elevated blood sugar, atherosclerosis, aseptic necrosis, tuberculosis reactivation, glaucoma, posterior subcapsular cataract, facial swelling, fatigue, dry mouth, acne, skin rash, etc
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Adrenal suppression may be expected if prednisone is taken for longer than seven days. Therefore appropriate taper is required to avoid Addison Crisis.
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Prednisone tablets are contraindicated in systemic fungal infections.
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PEDIATRIC USE
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The efficacy and safety of corticosteroids in the pediatric population are based on the well-established course of effect of corticosteroids, which is similar in pediatric and adult populations.
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PREGNANCY
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Teratogenic Effects Category C There are no adequate and well-controlled studies in pregnant women. Corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
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NOTE
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About 50% of uveitis is idiopathic, 20% trauma, 20% systemic, and 10% local ocular such as herpes and toxoplasmosis. Mean age of onset is 30.7 years. Most uveitis cases are anterior uveitis. HLA-B27 related anterior uveitis may need topical treatment for 6 weeks or longer. Mutton fat KP's with flare is most often associated with systemic infection or autoimmune disease.
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