Monday Pharmaceutical Mystery: February 10

You're a retail pharmacist having a busy day due to the flu season. It's Friday, and the technician informs you that there is no more prednisolone liquid; the bottle is empty. The next shipment of drugs will not arrive until Monday, if the supplier even has some in stock. It seems like many of the drugs used to treat the flu and airway reactive disease are on back order. The technician asks you if he should call the doctor, and have the orders change to prednisone until the next shipment arrives.

The patient is male, age 45 years with severe alcoholic hepatitis, The order is for prednisolone 40 mg per day x28days, then a 16-day prednisolone taper. You decrease the dose by 10 mg per day every 4 days until a dose of 10 mg per day is reached, then 5 mg per day every 3 days, then stop.

Mystery: Is changing the prednisolone taper to a prednisone taper a good option due to the drug shortage?

Solution: Prednisolone is preferred over prednisone because the latter requires conversion to prednisolone (the active form) in the liver, a process that may be impaired in alcoholic hepatitis. Methylprednisolone is also an used to treat severe alcoholic hepatitis and that would be a better substitute than prednisone in this particular situation.

REFERENCE

Singal AK. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol. 2018 Feb;113(2):175-194. doi: 10.1038/ajg.2017.469. Epub 2018 Jan 16.

ACG Clinical Guideline: Alcoholic Liver Disease