Monday Pharmaceutical Mystery: February 24

Your patient, KM, has multiple sclerosis (MS). He brings in a prescription from his neurologist for prednisone 50 mg, #75 with directions to take 25 tablets daily for 3 days. You are sure this must be a mistake. When you mention to the patient that you have to call the doctor to clarify, he says the prescription is for acute optic neuritis.

Mystery: Why is KM being prescribed such a high dose (1250 mg daily for 3 days) of prednisone?

Solution: The neurologist confirms the dose and treatment for acute optic neuritis. Optic neuritis can occur when the myelin of the optic nerve is damaged by inflammation. Symptoms can include pain and temporary loss of vision in 1 eye.

Signs and symptoms of optic neuritis can be the first indication of MS or can occur later in the course of MS. Optic neuritis can also occur with infections or other autoimmune diseases, such as lupus. Steroids are often used in the treatment of optic neuritis.¹

The indications for prednisone include: severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa, such as optic neuritis (and several other conditions).²

An earlier trial established IV steroid administration as the standard of practice for treating optic neuritis.³ A clinical trial published in JAMA Neurology concluded that comparable doses of oral prednisone may be used instead of IV steroids in the treatment of acute optic neuritis. The authors also stated that patients prefer oral steroids, and that they are also more cost-effective than IV administration.³

REFERENCES

• Mayo Clinic. Optic Neuritis. https://www.mayoclinic.org/diseases-conditions/optic-neuritis/symptoms-causes/syc-20354953 Accessed February 1, 2020.
• DailyMed. Prednisone. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=931ceb82-23b9-46c6-a00b-4cd66ed6f88f Accessed February 1, 2020.
• Morrow, S., etal. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids. JAMA Neurology. 2018 Jun; 75(6): 690—696. doi: 10.1001/jamaneurol.2018.0024 PMCID: PMC5885218 PMID: 29507942 Published online March 5, 2018.