Prednisone contraindications

Systemic corticosteroids are a useful option in patients with contraindications to NSAIDs or colchicine (primarily renal impairment) or polyarticular attacks, especially in elderly patients. A single intramuscular injection of a long-acting corticosteroid such as triamcinolone hexacetonide may be used. Oral agents may be needed, especially for severe attacks. Prednisone 40 to 60 mg (or an equivalent dose of another agent) is given daily, with a gradual taper over 2 weeks. 

UDCA + prednisone In 1994 F.H.J. Wolfhagen et al. succeeded in favourably influencing the course of disease with a combination of UDCA and prednisone (10 mg/ day) in those cases which had not previously been treatable in a satisfactory way. (290) The combination of UDCA -F budesonide has also proved successful. (64,177) Budesonide shows a 15-times higher affinity to the glu-cocorticosteroid receptor as well as a distinct first-pass effect of >90%. The systemic side effects are low. In cirrhosis, budesonide is contraindicated. 

Corticosteroids may be used to treat acute attacks of gouty arthritis, but they are reserved primarily for resistant cases or for patients with a contraindication to colchicine and NSAID therapy. Doses of 40 to 80 USP units of adrenocorticotropic hormone gel are given intramuscularly every 6 to 8 hours for 2 to 3 days, and then the doses are reduced in stepwise fashion and discontinued. Intra-articular administration of triamcinolone hexacetonide in a dose of 20 to 40 mg may be useful in treating acute gout limited to one or two joints. Prednisone may be administered orally in doses of 30 to 60 mg for 3 to 5 days in patients with multiple-joint involvement. Because rebound attacks may occur on steroid withdrawal, the dose should be tapered gradually by 5-mg decreases over 10 to 14 days and discontinued. 

Green, leafy vegetables are high in vitamin K and would be contraindicated in anticoagulant treatment with Coumadin but not with prednisone treatment. 

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