プレドニゾロン
Prednisolone
Prednisolone acetate, Prednisolone sodium phosphate
別名: Pred Forte · Pred Mild · Econopred Plus · Mydrapred · PLT · Prednicare · Prednidale · Prednisolone acetate · Prednisolone sodium phosphate · Prednisolonum
VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス
監査済み v13 用量エビデンス
構造化された用量計算エビデンスMedical management of insulinoma after stabilization of hypoglycemic crisis
- divided q12h
必ず考慮する臨床コンテキスト (3)
- Once hypoglycemic crisis stabilized
- may need to increase dose over time
- Ideal to use H2 blocker concurrently
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
概要
プレドニゾロンは、獣医療で広く使用されている強力な中時間作用型合成コルチコステロイドです。眼科領域では、前ぶどう膜炎の治療において最も効果的な薬剤であり、ゴールドスタンダードと見なされています。
製剤間で臨床的に重要な違いがあります：
- 酢酸プレドニゾロン：懸濁液として製剤化されています。優れた抗炎症作用を持ち、無傷の角膜を通過して眼の前眼部へ非常に良好に浸透し、デキサメタゾン製品よりも優れています。
- リン酸ナトリウムプレドニゾロン：水溶液として製剤化されています。無傷の角膜への浸透性は酢酸塩に劣りますが、眼表面の炎症に有用です。
臨床上のポイント：眼への局所投与であっても、鼻涙管や結膜血管を介して全身に吸収される可能性があります。小型動物（20kg未満）では、頻繁な投与により糖尿病のコントロール悪化などの全身性副作用を引き起こす可能性があります。
作用機序
Prednisolone exerts its effects by diffusing across cell membranes and binding to specific cytosolic glucocorticoid receptors.
The receptor-ligand complex translocates to the nucleus → binds to glucocorticoid response elements (GREs) on DNA → alters gene transcription.
Mechanistically, it induces the synthesis of lipocortin-1 (annexin-1), which inhibits the enzyme phospholipase A2. This inhibition prevents the release of arachidonic acid from membrane phospholipids, thereby potently shutting down the downstream synthesis of inflammatory mediators, including prostaglandins and leukotrienes.
安全性・警告
禁忌
- Corneal ulcers (absolute contraindication for topical use)
- Ocular viral infections (e.g., Feline Herpesvirus-1)
- Ocular fungal infections
- Use with extreme caution in patients with uncontrolled diabetes mellitus or systemic infectious diseases
- Pregnant animals
- Renal disease (systemic use)
- Diabetes mellitus (systemic use)
- Ulcerative keratitis (topical ophthalmic use)
- Systemic fungal infections
- Concurrent NSAID administration
有害事象
- Systemic absorption leading to iatrogenic hyperadrenocorticism (PU/PD/PP, panting, alopecia)
- Insulin resistance and destabilization of diabetes mellitus
- Delayed corneal healing
- Potentiation or exacerbation of ocular infections (bacterial, viral, fungal)
- Corneal degeneration or calcification (with long-term topical use)
- Hypothalamic-pituitary axis (HPA) suppression
- Adrenal atrophy
- Proteinuria and glomerular changes (dogs)
- Weight loss and muscle atrophy (catabolic effects)
- Iatrogenic hyperadrenocorticism (Cushing's syndrome)
- Vomiting and diarrhoea
- Gastrointestinal ulceration
- Hyperglycaemia
- Decreased serum T4 values
- Impaired wound healing
- Delayed recovery from infections
- Polyuria/polydipsia (PU/PD)
- Polyphagia
- Immunosuppression
- Muscle wasting
注意事項
Important Warning: Subconjunctival and topical steroids can be absorbed systemically. Use with extreme caution in patients with endocrinopathies (e.g., diabetes mellitus) or infectious diseases.
Even frequent topical steroid application in small animal patients under 20 kg can cause difficulties with diabetes mellitus regulation. Once the peak inflammatory response has been suppressed, consider transitioning to nonsteroidal anti-inflammatory drugs (NSAIDs) for ongoing maintenance treatment to minimize systemic steroid exposure.
医薬品相互作用
Concurrent use may increase the risk of delayed corneal healing or corneal melting, though sometimes used together cautiously for severe inflammation.
Systemically absorbed prednisolone antagonizes insulin, increasing blood glucose and complicating diabetes regulation.
Increased risk of gastrointestinal ulceration if significant systemic absorption of prednisolone occurs.
Increased risk of gastrointestinal ulceration
Increased risk of hypokalaemia
Increased risk of hypokalaemia
Increased risk of hypokalaemia
Enhanced metabolism of corticosteroids
Enhanced metabolism of corticosteroids
Decreased metabolism of corticosteroids
Synergistic immunosuppression; may alter pharmacokinetics
監視
- Resolution of clinical signs of uveitis (aqueous flare, miosis, pain, photophobia)
- Intraocular pressure (IOP) to monitor for secondary glaucoma
- Fluorescein staining (to ensure no corneal ulceration develops)
- Blood glucose and water intake/urine output in diabetic or small patients
- Clinical response to therapy
- Haematocrit (in cases of IMHA)
- Blood glucose (risk of hyperglycaemia)
- Serum T4 values (may be decreased)
- Renal parameters and urinalysis (proteinuria in dogs)
- Signs of GI ulceration (vomiting, melaena)
- Haematology at each visit (including 4 and 8 weeks after cessation of therapy)
- PCV (Packed Cell Volume)
- Liver parameters (especially if combined with azathioprine)
- Clinical signs of anaemia or GI bleeding
薬物動態
半減期
吸収
Prednisolone acetate is highly lipophilic and readily penetrates the intact corneal epithelium to reach therapeutic concentrations in the aqueous humor. Systemic absorption occurs via drainage through the nasolacrimal duct into the nasal mucosa and GI tract.
分布
Distributes widely into ocular tissues (anterior segment). Systemically absorbed drug distributes throughout total body water and binds to plasma proteins (transcortin and albumin).
代謝
Systemically absorbed prednisolone is metabolized primarily in the liver.
消失
Excreted primarily by the kidneys as conjugated metabolites.
過剰投与
Acute overdose from topical ophthalmic application is highly unlikely to cause severe toxicity. However, chronic overdosage or overly frequent application (especially in small patients <20 kg) can lead to systemic absorption resulting in iatrogenic hyperadrenocorticism (Cushing's syndrome), adrenal suppression, and destabilization of blood glucose in diabetic patients. If a corneal ulcer is present, overuse can lead to rapid corneal melting and perforation.
製品
製剤
- Ophthalmic suspension (0.12%, 0.125%, 1%)
- Ophthalmic solution (0.125%, 1%)
- Ophthalmic drops combined with atropine
- Ophthalmic suspension: 0.5%, 1% (5 ml, 10 ml bottles)
- Topical preparations (dermatological, otic, ophthalmic)
- Injectable solution: prednisolone sodium succinate 10 mg/ml
- Injectable suspension: 7.5 mg/ml (plus 2.5 mg/ml dexamethasone)
- Oral tablets: 1 mg, 5 mg, 25 mg
- Oral compound: PLT (contains cinchophen)
- Oral suspension
動物用医薬品
- PLT (compound with cinchophen)
- Prednicare
- Prednidale
ヒト用医薬品
- Prednisolone Acetate Drops: 0.12% Suspension (Pred Mild®)
- Prednisolone Acetate Drops: 0.125% Suspension (Econopred®)
- Prednisolone Acetate Drops: 1% Suspension (Econopred Plus®, Pred Forte®, generic)
- Prednisolone Sodium Phosphate Drops: 0.125% & 1% Solution (various)
- Prednisolone (0.25%) and Atropine (1%) Drops (Mydrapred®)
- Pred-forte (ophthalmic suspension 0.5%, 1%)
- Prednisolone tablets
規制ステータス
規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
保管・安定性
Store at room temperature (15°-25°C / 59°-77°F). Protect from freezing. Keep the bottle tightly closed when not in use. Suspensions must be stored upright.
飼主向け情報
重要な手順：酢酸塩の懸濁液（例：Pred Forte）を使用する場合、毎回使用する前にボトルを強く振ってください。薬の成分が底に沈殿しているため、振らずに使用すると水分だけを点眼することになります。
- 投与方法：使用前に手を洗ってください。汚染を防ぐため、点眼容器の先端がペットの目や、まぶた、その他の表面に触れないようにしてください。
- 投与間隔：複数の目薬を使用する場合は、それぞれの薬の間隔を少なくとも5〜10分空けてください。
- 潰瘍のサインに注意：ステロイドは治癒を遅らせます。ペットの目がさらに赤くなったり、白く濁ったり、目を細めたりこすったりし始めた場合は、直ちに使用を中止し、獣医師に連絡してください。これは角膜の傷や潰瘍を示している可能性があります。
- 全身性の症状：目薬であっても体内に吸収されることがあります。ペットの飲水量、尿量、食欲の増加がないか観察し、見られた場合は獣医師に報告してください。
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