Corticosteroid pharmacokinetics in liver disease.

Among the corticosteroids, prednisone is the most commonly used in the treatment of chronic active liver disease. However, its pharmacokinetics have only recently been investigated. Prednisone is effectively absorbed and converted to its active therapeutic derivative, prednisolone, in healthy volunteers and in patients with liver disease; the bioavailability of oral prednisone approximates 100% of an intravenous dose and is comparable after administration of either prednisone or prednisolone. Patients with liver disease and hypoalbuminaemia are more likely to suffer major side effects of prednisone as a consequence of decreased protein binding and delayed clearance of prednisolone. Dosage in such patients should be reduced in accordance with serum albumin concentration.