What is the dosage table for prednisolone (corticosteroid)?

From the Guidelines

Prednisolone dosage should be started at 1 mg/kg-1 per day (or equivalent) in most cases, with adjustments made based on patient response and disease severity, as recommended by the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 1.

Key Considerations for Prednisolone Dosage

• The optimal corticosteroid dosing schedule is not established, but dosing schedules are largely empirical and based on practical experience 1.
• For adults with acute inflammatory conditions, a typical starting dose is not explicitly defined in the provided guidelines, but the British Association of Dermatologists suggests starting with prednisolone 1 mg kg-1 per day (or equivalent) in most cases 1.
• The dose should be increased in 50–100% increments every 5–7 days if blistering continues, and consideration should be given to pulsed intravenous corticosteroids if > 1 mg kg-1 oral prednisolone is required, or as initial treatment in severe disease followed by 1 mg kg-1 per day oral prednisolone 1.
• The goal is to taper the dose once remission is induced and maintained, aiming to reduce to 10 mg daily or less, while assessing the risk of osteoporosis immediately 1.

Monitoring and Side Effects

• Patients should be monitored for blood pressure changes, blood glucose levels, and signs of infection while taking prednisolone.
• Side effects include increased appetite, weight gain, mood changes, elevated blood sugar, and with long-term use, osteoporosis and increased infection risk.
• Prednisolone should be taken with food to minimize gastrointestinal irritation, preferably in the morning to mimic natural cortisol patterns and reduce insomnia.
• The medication should never be stopped abruptly after prolonged use, as this can cause adrenal crisis; instead, doses should be gradually reduced under medical supervision.

From the FDA Drug Label

The initial dose of prednisolone sodium phosphate oral solution, (15 mg prednisolone base) may vary from 1. 67 mL to 20 mL (5 to 60 mg prednisolone base) per day depending on the specific disease entity being treated. The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The standard regimen used to treat nephrotic syndrome in pediatric patients is 60 mg/m2/day given in three divided doses for 4 weeks, followed by 4 weeks of single dose alternate-day therapy at 40 mg/m2/day The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses

The dosage table for prednisolone is as follows:

• Adults: 5 to 60 mg prednisolone base per day
• Pediatric patients:
  • 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day)
  • For nephrotic syndrome: 60 mg/m2/day given in three divided doses for 4 weeks, followed by 4 weeks of single dose alternate-day therapy at 40 mg/m2/day
  • For asthma: 1–2 mg/kg/day in single or divided doses 2

From the Research

Dosage Information

• The dosage of prednisolone can vary depending on the condition being treated and the individual patient's response to the medication 3.
• Low-dose prednisolone treatment, typically 7.5 mg/day, is often used in the treatment of rheumatoid arthritis 4.
• Higher doses of prednisolone, such as 30 mg/day or 60 mg/day, may be used in certain situations, but can increase the risk of adverse effects such as diabetes and cardiovascular events 5.
• Even low doses of prednisolone, such as 6 mg/day, can have adverse effects on fat metabolism and increase the risk of insulin resistance and cardiovascular disease 6.

Specific Dosage Regimens

• One study used a dosage of 7.5 mg/day in patients with early rheumatoid arthritis, with a follow-up period of 10 years 4.
• Another study compared the effects of 30 mg/day and 60 mg/day of prednisolone in patients with early active rheumatoid arthritis, with a treatment period of 1 week 5.
• A third study used a dosage of 6 mg/day in patients with rheumatoid arthritis, with a treatment period of 7 days to assess the acute effects of prednisolone, and compared the results to patients on long-term prednisolone treatment (6.5 ± 1.8 mg/day for >6 months) 6.

Considerations for Dosage

• The dosage of prednisolone should be individualized based on the patient's response to the medication and the presence of any adverse effects 3.
• Patients on prednisolone should be monitored regularly for signs of adverse effects, such as changes in blood sugar levels or increases in blood pressure 4, 5, 6.
• The use of prednisolone should be carefully considered in patients with a history of cardiovascular disease or diabetes, as it may increase the risk of adverse events 4, 6.