From the FDA Drug Label
DOSAGE AND ADMINISTRATION The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT
The patient can be considered for a short course of prednisone, but the dosage requirements are variable and must be individualized based on the disease entity being treated, in this case, bicep tendinitis and muscle strain.
- The decision to prescribe prednisone should be made with caution, considering the patient's recent open heart surgery and current medications, including BP meds, xarelto, and baby aspirin.
- A low dose of prednisone, such as 5-10 mg per day, may be considered for a short period, but the patient should be closely monitored for any adverse effects.
- Regarding robaxin, there is no information in the provided drug label to support or contraindicate its use in this patient, so no conclusion can be drawn 1.
From the Research
A short course of prednisone is not recommended for this post-cardiac surgery patient with bicep tendinitis and muscle strain. The combination of Xarelto (rivaroxaban) and aspirin already increases bleeding risk, and adding prednisone could further elevate this risk while potentially interfering with wound healing after recent cardiac surgery, as noted in a study on the safety of anticoagulants after cardiac surgery 2. Additionally, prednisone can cause fluid retention and hypertension, which may complicate blood pressure management in a patient already on BP medications.
Regarding Robaxin (methocarbamol), it should be used with caution in this patient. While there are no absolute contraindications to using Robaxin with the patient's current medications, it may cause drowsiness and dizziness, which could increase fall risk in a recovering cardiac patient. If prescribed, a lower starting dose (perhaps 500mg 3 times daily rather than 1500mg) would be prudent with careful monitoring for side effects.
Some key points to consider in the management of this patient include:
- The patient's recent cardiac surgery and current anticoagulation therapy with Xarelto and aspirin, which increases the risk of bleeding 3, 2
- The potential risks and benefits of adding prednisone or Robaxin to the patient's medication regimen
- The importance of conservative management, including rest, ice, gentle stretching exercises, and acetaminophen for pain relief, which has minimal interaction with anticoagulants
- The potential benefits of physical therapy focused on gradual strengthening to provide better long-term outcomes without adding medication risks
Conservative management would be more appropriate for this patient, including rest, ice, gentle stretching exercises, and acetaminophen for pain relief. Physical therapy focused on gradual strengthening would likely provide better long-term outcomes without adding medication risks. The patient should also be advised to modify their exercise routine to avoid overexertion of the affected shoulder while continuing cardiac rehabilitation as recommended by their cardiologist.