AIS DRUG : PRENISON, PREDNISOLON, DEXAMETASON, METAL

PREDNISOLON AND TRADITIONAL MEDICINE

Judging from its function, there are two types of drug classes that can be used as anti-
inflammatories, namely steroidal anti-inflammatory drugs (AIS) and non-steroidal anti-
inflammatory drugs (NSAIDs). Examples of NSAID class drugs are ibuprofen, piroxicam, and
diclofenac sodium. This class of drugs has the side effect of irritating the digestive tract, but the
side effects of ibuprofen are milder when compared to other drugs, so that ibuprofen is often
used in anti-inflammatory preparations. Inflammation is also called inflammation. Inflammation
itself is a biological response that tries to remove something harmful. Inflammation is a form of
the body's attempt to protect itself. The goal of inflammation is to remove harmful stimuli
including damaged, irritant, or pathogenic cells and begin the healing process.

Drugs containing steroids can accelerate osteoporosis, for example prednisolone,

prednisolone, cortisone, including herbs or traditional medicines which usually also contain
steroids, which are given for gout, asthma, colitis or some cancers. The higher the dose and the
longer the use, the greater the risk of osteoporosis.

a. PREDNISSON
Prednisone is a corticosteroid class of drugs which are drugs that are often used.
The clinical use of corticosteroids as an anti-inflammatory is expected to inhibit all
inflammatory processes and reduce capillary permeability that occurs. In addition, this
drug is also used in diseases of the immune system, such as various types of allergies and
lupus. Determination of prednisone levels to ensure the achievement of therapeutic
effects and comfort of drug products needs to be done as a quality control (Azis, 2011).
Prednisone is a synthetic corticosteroid which is generally taken orally and can
also be administered by intramuscular, intra-rectal or topical injection. Prednisone will be
converted to prednisolone in the liver. Prednisone is effectively used as an
immunosuppressant and can affect the body's immune system. Prednisone can be given to
patients with autoimmune diseases, inflammatory diseases (asthma, severe allergies,
systemic lupus erythematosus, rheumatoid arthritis, etc.) uveitis, and to prevent rejection
reactions in heart transplants (Katzung et al., 2012). Prednisone has the molecular
formula C21H26O5 with a molecular weight of 358.43. Another name or chemical name
 for prednisone is 17,21-dihydroxypregna-1,4-diene-3,11,20-trion. Its appearance is in the
form of white or practically white crystalline powder, odorless, melting at 230°C
accompanied by decomposition. This substance is very difficult to dissolve in water,
difficult to dissolve in ethanol, in chloroform, in dioxane and in methanol (Depkes RI,
1995).
Prednison Structure

Prednisone is a drug to help relieve inflammation in several conditions, such as allergies,

autoimmune diseases, arthritis, or contact dermatitis. This drug is available in tablet form and
can only be purchased with a doctor's prescription.

Prednisone is a drug in the corticosteroid class. This drug works by suppressing the
reaction of the immune system so that it can reduce inflammation. Prednisone may be used long-
term or only when symptoms recur, depending on the condition.

Examples of application of Prednisone

Prednisone has an effect as an immunosuppressant when used in large doses. The

mechanism of action as an immunosuppressant, namely corticosteroids can reduce the
 number of lymphocytes, inhibit T lymphocyte cell proliferation, cellular immunity and
gene expression in various cytokines.
b. PREDNISOLONE
Prednisolone is a drug that contains artificial corticosteroid hormones. This drug
is useful for treating several conditions, such as arthritis, blood disorders, immune system
problems, respiratory problems, severe allergies to cancer. Drugs are used with caution if
the magnitude of the benefits obtained outweighs the risks to the fetus. Research on test
animals shows a risk to the fetus and there are no direct studies on pregnant women.
Dosage forms: Tablets, creams, ointments, eye ointments and eye drops.
This drug, which belongs to the corticosteroid category, is useful for reducing the
response of the immune system in the body, so it can reduce various symptoms, such as
pain, swelling, and allergic reactions. Not only that, this problem can also overcome
respiratory problems that are experienced.
How to use Prednisolone
Take this drug orally according to doctor's directions. Be careful in measuring the
dose, it's better to use a measuring device or a special spoon to get the correct dose.
In addition, make sure to read the dosage instructions on the product listed, because the
amount can be different for each product. Even so, still make sure to follow the dosage
given by the doctor no matter what.
Prednisolone Precautions
Avoid taking this drug if you are allergic to the ingredients of this drug, or have a
fungal infection in your body. This drug can weaken the body's immune system, making
it more susceptible to infection. Steroids can also exacerbate an existing infection, or be
susceptible to new disruptions from the problem. Tell your doctor about recent conditions
in the last few weeks.

Prednisolone Side Effects

There are several side effects from taking this drug, such as

• Nauseous.
• Heartburn.
 • Headache.
• Dizzy.
• Experience changes in menstrual periods.
• Difficulty sleeping.
• Excessive sweating.
• Acne growth.

If these side effects continue or even get worse, it's a good idea to tell your doctor
immediately to deal with them.

Example of application of Prednisolone

c. DEKSAMETASON

Dexamethasone or dexamethasone is a corticosteroid drug commonly used to treat

arthritis and allergic reactions. This drug is available in the form of tablets and injections. The
Food and Drug Supervisory Agency (BPOM) stipulates dexamethasone as strong. That is, you
can only get it with a doctor's prescription. Dexamethasone is an effective drug for treating
various types of diseases related to inflammation. The way dexamethasone works is by
preventing the production of compounds that cause inflammation and reduce the body's immune
reactions, such as in allergic reactions. Doctors will recommend dexamethasone for the treatment
of diseases caused by immune problems, such as acute asthma attacks, eczema, and allergic
rhinitis. This drug is even able to control autoimmune disease conditions, such as rheumatoid
arthritis. Dexamethasone is also a drug for endocrine disorders, such as adrenocogenital
hyperplasia and nonsuppurative thyroidis. Doctors may also use this drug for the diagnosis of
Cushing's syndrome. It doesn't stop there, this drug reduces the effects of nausea and vomiting
due to cancer chemotherapy.

Dexamethasone Dosage
In Indonesia, dexamethasone is available in 0.5 mg tablets of 10 items in one strip. 100 ampoules
of 1 ml in size for injection or injection of 5 mg/ml. This is the recommended dosage for the drug
dexamethasone.
Tablet
 Adults: the initial dose varies from 0.5–0.9 mg per day 2–4 times a day, depending on the
condition of the disease. If the disease is classified as mild, the dose is less than 0.75 mg.
If severe, the dose can reach more than 9 mg.
 Children: initial dose of 0.02–0.03 mg/kg body weight 3–4 times a day. Dosage is based
on the severity of the disease and the patient's response to the drug.

Injection
The initial dose can start from 0.75 mg daily, depending on the severity of the disease. If
mild, the dose will be lower than for severe disease. The continued dose will be reduced little by
little until it reaches the lowest dose as directed by the doctor. If you miss a dose, contact your
doctor immediately for further instructions.

Rules for using dexamethasone

Always take dexamethasone as directed by your doctor. It's best to take dexamethasone
with food to help reduce the effects of stomach pain. Take the tablet preparation with a full glass
of water (240 ml), unless your doctor recommends another way. If you are using this medication
once daily, take it in the morning before 9am. If you are taking this medication every day or on a
schedule other than a daily schedule, mark a calendar with reminders. Dosage and length of
treatment based on your medical condition and response to treatment. The doctor may try to
reduce the dose slowly over time to minimize the side effects of the drug. Take tablets and
injections regularly so that the benefits are optimal. It is important to continue taking this
medication at the same time of day, even if you feel better. Ask your doctor about how long you
should take it. Do not stop using dexamethasone without consulting your doctor. Some
conditions can get worse when the drug use suddenly stops.
Example application of Dexamethasone
 d. METHYLPREDNISOLONE
Methylprednisolone is a drug to relieve inflammation in various conditions, including
arthritis, colitis, asthma, psoriasis, lupus, and multiple sclerosis. This drug is also used in the
treatment of severe allergic reactions.
Methylprednisolone works by reducing inflammation-triggering substances in the body.
That way, the symptoms of inflammation, such as pain and swelling, will gradually subside.
Methylprednisolone also has an immunosuppressive effect. This drug is able to suppress
excessive immune system reactions. Thanks to this way of working, this drug can be used to treat
severe allergies or autoimmune diseases, as well as to prevent rejection reactions from the body
after organ transplants.
Trademarks for methylprednisolone: Camelon, Depo Medrol, Hexilon, Intidrol, Lameson,
Medixon, Methylprednisolone, Methylon, Metrison, Novestrol, Phadilon, Rhemafar, Sanexon,
Toras, Urbason, Vadrol, Xilon, Yalone.
This class of drugs is included in prescription drugs under the Corticosteroid category.
Useful for reducing inflammation, preventing the body's rejection of a newly transplanted organ,
and for treating severe allergic reactions. This medicine can be used by adults and children. Drug
preparations in the form of tablets, injections and suspension.

Warning Before Using Methylprednisolone

Methylprednisolone is classified as a prescription drug and should not be used carelessly. The
following are things to note before using methylprednisolone:
• Tell your doctor about any allergies you have. Methylprednisolone should not be used
in people who are allergic to this drug or to the drug prednisone.
• Tell your doctor if you have had or are currently having an infection, especially a yeast
infection, intestinal worms, abscess, or herpes. Also tell if you have close contact with
someone with tuberculosis, smallpox or measles.
• Tell your doctor if you have diabetes, hypertension, kidney disease, liver disease, heart
disease, osteoporosis, cataracts, glaucoma or thyroid disease.
• Tell your doctor if you have or have ever had colitis, peptic ulcer, diverticulitis,
clotting disorder, myasthenia gravis, pheochromocytoma, depression, psychosis or
seizures.
• Tell your doctor that you are using methylprednisolone before having any
vaccinations, surgeries or medical procedures.
• Do not consume alcoholic beverages after using methylprednisolone, because it can
increase the risk of bleeding in the digestive tract.
• Tell your doctor if you are pregnant, breastfeeding or planning a pregnancy.
• Talk to your doctor about using methylprednisolone if you are taking other
medications, including supplements and herbal products. The goal is to anticipate drug
interactions.
 • Avoid close contact with people with easily transmitted infections, such as the flu,
chickenpox or measles, if you are taking methylprednisolone long term. Also consult
with your doctor before using any type of vaccine.
• Immediately report to your doctor if you experience an allergic drug reaction, serious
side effect, or overdose, after using methylprednisolone.

Dosage and Rules for Use Methylprednisolone

The dose of methylprednisolone given by doctors can vary, depending on the conditions
being treated, the degree of severity of the disease, and the patient's response to the drug. In
children, the dose of methylprednisolone is adjusted according to the patient's body weight. In
general, the following is the dosage of methylprednisolone based on the drug preparation and
intended use:

Tablet or suspension form

Purpose: Relieves inflammation and allergic reactions

• Adult: Dose 4–48 mg per day. In severe acute conditions, higher doses of up to
100 mg per day may be given.

• Children: 0.5–1.7 mg/kgBW per day, divided into 2 consumption schedules.

Syringe form
The dose of injectable methylprednisolone is determined by the doctor based on the
patient's condition. The following is the method and purpose of administering
methylprednisolone:
• Methylprednisolone given by injection into muscle is intended for inflammatory
and autoimmune conditions and severe asthma.
• Methylprednisolone in the form of intravenous injection is used to treat
inflammatory conditions, multiple sclerosis, severe asthma, and to prevent
rejection reactions after organ transplantation.
• Methylprednisolone in the form of injection directly into the joint is intended for
conditions of severe osteoarthritis, rheumatoid arthritis, or bursitis.
• Methylprednisolone in the form of injection directly into the affected area is given
for keloid conditions, alopecia areata, skin symptoms of lupus, lichen planus, skin
psoriasis, lichen simplex, and granuloma annulare.
How to Use Methylprednisolone Properly

The injectable type of methylprednisolone will be given directly by a doctor or medical

officer under the supervision of a doctor. This medication can be given by injection into a vein,
joint, muscle, or directly into the affected area of the skin. If you are prescribed
methylprednisolone to be taken by mouth, use this drug according to the doctor's instructions
and the instructions for use listed on the drug packaging. Do not reduce or increase the dose
consumed except on the advice of a doctor. For methylprednisolone tablets, take the drug with
food or milk to prevent stomach ulcers. For methylprednisolone in suspension, shake the bottle
before taking the drug. If you have one, use the measuring spoon that came in the package for
an accurate dose. If you forget to take methylprednisolone suspension or tablets, take this
medicine as soon as you remember. However, if the next scheduled medication is near, ignore
the missed dose and do not double the next dose. Do not stop medication without your doctor's
permission. The doctor will reduce the dose of methylprednisolone gradually to prevent
symptoms from worsening. If you are taking methylprednisolone long-term, your doctor may
order you to have regular blood tests and eye exams. Follow the control schedule given by the
doctor so that the condition and results of therapy can be monitored properly. Store
methylprednisolone suspension or tablets in a cool place. Do not store this medicine in a damp
place or in direct sunlight. Keep this drug out of reach of children.

Methylprednisolone Interactions with Other Drugs

The use of methylprednisolone with other drugs can cause interaction effects, such as:

• Increased risk of seizures when used with ciclosporin

• Increased risk of hypokalemia when used with amphotericin B or diuretics

• Increased risk of gastrointestinal bleeding when used with non-steroidal anti-

inflammatory drugs

• Increased risk of developing muscle disorders when high doses of

methylprednisolone are used with muscle relaxants

• Increased risk of side effects when used with tacrolimus, cyclophosphamide,

ketoconazole or cimetidine
 • Increased risk of bleeding when used with anticoagulant drugs, such as
warfarin

• Decreased levels and effectiveness of methylprednisolone when used with

rifampicin, phenobarbital or phenytoin

• Decreased effectiveness of anticholinesterase drugs, such as pyridostigmine,

in treating myasthenia gravis

• Decreased effectiveness of the drugs isoniazid, aspirin, pancuronium, or

vecuronium

• Decreased effectiveness of live vaccines, such as influenza vaccine or BCG

vaccine
Methylprednisolone Side Effects and Dangers
Side effects that may arise from using the drug methylprednisolone include:
• Nausea or vomiting
• Dizzy
• Headache
• Bloated
• Stomach ache or heartburn
• Muscle ache
• Hard to sleep
• Increased blood sugar levels
• Susceptibility to infection
• Irregular menstrual cycles
• Appears pimples
• Swelling of the hands or feet due to fluid accumulation
Check with your doctor if the side effects above don't go away or get worse. Immediately
consult a doctor if an allergic drug reaction or more serious side effects occur, such as:
• Visual disturbances, such as blurred vision, eye pain or narrowing of the field
of view (tunnel vision)
• Dry, red, thin, scaly, or easily bruised skin
• Low potassium levels (hypokalemia), which may be characterized by an
irregular heartbeat, feeling weak or cramps in the legs
• Mood swings, major depression, unusual thoughts or behavior
• Vomiting blood, vomiting like coffee grounds, or bloody bowel movements
• Swollen legs, rapid weight gain, or shortness of breath
• Seizures
• Fast, slow, or irregular heartbeat (arrhythmia)
• Moon face, which is swelling of the face so that the face looks rounder
 • Symptoms of infection, such as fever, chills, sores that are difficult to heal, or
cough
Long-term use of corticosteroids in children can cause growth and development
disorders. Therefore, children must be closely monitored while using this drug.

e. Traditional Medicine

1. Definition of Traditional Medicine

Traditional medicines are ingredients or ingredients in the form of plant ingredients,

animal ingredients, mineral ingredients, galenic preparations or mixtures of these materials
which have been used for generations for treatment based on experience (BPOM, 2014). The
characteristic of traditional medicine is that the raw materials are still in the form of simplicia,
most of which have not been standardized and have never been studied. The dosage forms are
still simple in the form of powders, pills, decoctions or chopped simplicia, their efficacy claims
are still based on empirical data. Traditional medicine itself is divided into three namely, herbal
medicine, standardized herbal medicine and phytopharmaca. (Anggraeni et al, 2015).

Jamu (empirical-based herbal medicine) is a traditional medicine that is provided

traditionally which contains all the plant ingredients that make up the herbal medicine which is
hygienic (free of contamination) and is used traditionally. For Indonesian people, herbal
medicine is a recipe passed down from generation to generation so that it can be maintained and
developed. The herbal ingredients themselves are taken from plants in Indonesia, both from
roots, leaves, flowers, and bark. Herbal medicine plays an important role in traditional health
care and will continue to do so amid the development of modern medicine. The materials used
do not contain synthetic chemicals but use a variety of plants taken directly from nature and the
side effects are relatively smaller. There are various kinds of herbal medicine, namely:
(Bambang, RS, 1986; Hermanto and Subroto, 2007).

1.1 Painkillers or Anti-Pain

There are many types of medicinal herbs used for treatment. The benefits of herbal
medicine that are often in demand by the public are herbs to relieve aches and pains. An example
of herbal medicine that is useful as a medicine for aches and pains is herbal turmeric tamarind.
Apart from being used as a medicine for aches and pains, this herb can also be used as an herb to
eliminate body odor and treat pain during menstruation (Hartati and Balittro, 2013).

1.2 Drugs for Stamina Enhancer

Apart from herbal medicine, it is also used to increase stamina and body immunity. Nasi
kencur herb is one of the herbs that is believed to have properties to increase stamina and also to
maintain health. This herbal medicine is the most well-known herbal medicine and is widely
used by the community as a supplement to increase stamina and maintain endurance (Sudarmin,
2012).

1.3 Drugs for Beauty

In addition to treating diseases, herbal medicine is also often used in body beauty
treatments. Many are found in ancient recipes for the use of herbal plants as a beauty drug that is
often used in the royal palace environment. One example of a well-known herb is mangir which
is made from turmeric which is used to beautify the skin in women (Hartati and Balittro, 2013).

2. Criteria for Herbal Medicine

Herbal medicine must meet the criteria, namely, be safe according to the specified
requirements, have proven efficacy claims based on empirical data and meet the applicable
quality requirements. It must have a logo and the words "JAMU". The logo is in the form of
"Twigs of leaves lie in a circle", and is placed at the top left of the container, package or
brochure and is printed in green, on a white background or other color that contrasts sharply with
the text (BPOM RI, 2004).

Herb logo
2.1 Benefits of Jamu

Jamu is a traditional herb as a means of treatment used by the community with the aim of
being able to treat minor ailments, prevent illness, maintain resilience and body health. And the
efficacy has been tested by time, era and history, as well as direct empirical evidence on humans
for hundreds of years (BPOM RI, 2004).