Appendix F

Rx Prednisone

Prednisone is an oral corticosteroid anti-inflammatory agent. It suppresses migration of polymorphonuclear leukocytes and reverses the capillary permeability associated with inflammation. It also suppresses the immune system by reducing activity and volume of the lymphatic system.

Indications: Systemic treatment of acute exacerbations of moderate to severe oral lichen planus.

Contraindications: Hypersensitivity to the drug or any of its components. Fungal, viral or bacterial infections of the oral cavity or throat.

Warnings/Precautions: Use with caution in patients with heart failure, diabetes, GI diseases, hepatic impairment, myasthenia gravis, MI, patients at risk for osteoporosis, seizure disorders, or thyroid disease. Use with caution in patients with glaucoma, cataracts, latent TB, psychiatric disturbances, or secondary infection. May induce hypothalamic-pituitary-adrenal (HPA) axis suppression, particularly in patients receiving supraphysiological doses for prolonged periods. If present, withdrawal and discontinuation of prednisone should be done slowly and carefully.

Drug interactions: Barbiturates, phenytoin, and rifampin increase metabolism of prednisone. Decreases activity of salicylates, vaccines, and toxoids.

Administration:
Dosage form – 1mg, 2.5mg, 5mg, 10mg, 20mg tablets.
Oral – Empirical for RAU or OLP severe episodic outbreak - 0.5 mg/kg/day as a single dose in the morning, tapered down over 2 weeks.

Monitor efficacy: Improved oral comfort, lesion resolution.

Monitor toxicity: Candida superinfection, perioral dermatitis, Cushing’s syndrome (hypertension, obesity, facial plethora, muscle weakness, back pain, striae, bruising, and psychological symptoms).

Length of treatment: Under 14 days.

Cessation of treatment: Tapering not necessary.

Instructions to the patient: Use only as instructed.

For additional information see DailyMed