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Prednisolone, a dehydrated derivative of hydrocortisone, exhibits a range of therapeutic effects including anti-inflammatory, anti-allergic, desensitizing, anti-shock, and immunosuppressive properties.

Prednisolone's impact encompasses diverse physiological aspects. It heightens protein breakdown and triggers the activation of hepatic enzymes responsible for amino acid metabolism. Moreover, the drug curtails protein synthesis while augmenting protein degradation in lymphoid, connective, muscular, and cutaneous tissues. Prolonged use of this medication may contribute to the degradation of these tissues.

The drug instigates an elevation in available glucose, propelling gluconeogenesis in the liver. This process accelerates protein catabolism, thereby increasing the pool of amino acids crucial for gluconeogenesis. Concurrently, glucose uptake in various tissues diminishes, culminating in elevated hepatic glycogen stores, heightened blood glucose levels, and escalated insulin resistance.

Prednisolone promotes lipolysis and the release of fatty acids from adipose tissue, thereby amplifying plasma free fatty acid (FFA) levels. Extended Prednisolone administration could potentially lead to a preponderance of upper body fat distribution. Additionally, the drug contributes to reduced blood calcium levels, retards bone growth in children and adolescents, and fosters osteoporosis across all age groups.

The impact of Prednisolone extends to augmenting the effects of both endogenous and exogenous catecholamines.

Usage Indications

Glucocorticoids serve as treatment options for an array of conditions, encompassing:

  • Primary and secondary adrenal insufficiency, including conditions like Addison's disease and adrenogenital syndrome.
  • Non-purulent thyroiditis.
  • Intense allergic reactions such as serum sickness, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, and angioedema.
  • Rheumatic ailments, including rheumatoid arthritis, rheumatic myocarditis, dermatomyositis, systemic lupus erythematosus, granulomatous arteritis, polyarteritis nodosa, relapsing polychondritis, ankylosing spondylitis, and psoriatic arthritis.
  • Vasculitis, severe seborrheic dermatitis, and erythema multiforme (Stevens-Johnson syndrome).
  • Dermatitis variations including atopic, contact, or exfoliative dermatitis, as well as conditions like pemphigus.
  • Gastrointestinal disorders such as ulcerative colitis and Crohn’s disease.

Administration and Dosages

The dosing regimen should be tailored individually based on the specific disease and the individual's response to treatment. Regular reassessment of the prescribed dose is important, considering that disease severity may evolve or complications might arise during the course of treatment. Once the desired therapeutic outcome is achieved, a gradual reduction to the minimum effective dose is advisable.

Oral administration is the preferred route, with the medication being ingested with a small quantity of liquid after meals.

For adults, the typical daily dosage ranges between 5 to 60 mg, contingent upon the severity of the ailment. It is recommended to align Prednisolone intake with the body's circadian rhythms, favoring a higher dose in the morning.

If Prednisolone has been used for over three weeks, a gradual withdrawal process is vital to avoid the onset of withdrawal syndrome, which can have severe consequences if discontinued abruptly.

Dosage reduction should be carried out systematically over weeks, or possibly months, taking into account variables such as dosage strength, duration of treatment, disease intensity, and individual responsiveness. In instances where Prednisolone has been administered for three weeks or less, abrupt discontinuation is less likely to result in clinically significant suppression of the hypothalamic-pituitary-adrenal (HPA) axis. However, it's important to acknowledge that individual responses to corticosteroids and their discontinuation may vary.

As a precaution, individuals at risk of adrenal insufficiency should cautiously taper the dose, especially in cases of prolonged treatment or high doses.

For gradual dose reduction, a personalized dosage regimen should be established. Most patients tolerate a 2.5 mg reduction of prednisone every 3 to 7 days well, until reaching a dosage of 5 to 10 mg per day. Those receiving high doses of Prednisolone should embark on a gradual dose reduction over a span of 9 to 12 months.