From the Guidelines
The recommended dose of prednisone for treating Bell's palsy is 60 mg daily for 5 days, followed by a taper over the next 5 days, as stated in the clinical practice guideline 1. This dose is based on high-quality randomized controlled trials that show a significant improvement in facial nerve function when treated with prednisolone within 72 hours of symptom onset 1. The medication should be started as soon as possible after symptom onset, ideally within 72 hours, for maximum effectiveness. The benefits of treatment after 72 hours are less clear, but initiating treatment within this timeframe is crucial for optimal recovery 1. Corticosteroids like prednisone work by reducing inflammation of the facial nerve within the facial canal, which is thought to be the primary mechanism of Bell's palsy. This anti-inflammatory effect helps to decrease swelling around the nerve, improving blood flow and reducing pressure on the nerve, which allows for better nerve function and faster recovery. Potential side effects include increased blood sugar, mood changes, insomnia, and increased appetite, but these are generally temporary and resolve after completing the course of medication. It is essential to note that the evidence for steroid use in children is limited, and the need for steroid treatment is unclear 1. However, given the presumed similar disease process of Bell's palsy in adults and children, oral steroids may be considered in pediatric patients with a large role for caregiver involvement in the decision-making process. Patients should complete the full course of treatment even if symptoms begin to improve, and the medication is typically taken orally, once daily with food to minimize gastrointestinal side effects. Some key points to consider when treating Bell's palsy with prednisone include:
- Starting treatment within 72 hours of symptom onset
- Using a dose of 60 mg daily for 5 days, followed by a taper
- Completing the full course of treatment
- Monitoring for potential side effects
- Involving caregivers in the decision-making process for pediatric patients.
From the Research
Recommended Dose of Prednisone for Bell's Palsy
The recommended dose of prednisone for treating Bell's palsy varies across different studies. Some key findings include:
- A dose of 1 mg/kg body weight for up to 70 or 80 mg/day is suggested by one study 2.
- Another study recommends an oral corticosteroid regimen of prednisone, 50 to 60 mg per day for five days, followed by a five-day taper 3.
- A systematic review and meta-analysis found that high-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in the treatment of Bell's palsy 4.
- A randomized controlled trial found that oral prednisolone, 50 mg per day, for 10 days, significantly improves the chances of complete recovery at 3 and 9 months 5, 6.
Key Considerations
Some important considerations when using prednisone to treat Bell's palsy include:
- Early treatment, ideally within 72 hours of symptom onset, is crucial for optimal recovery 2, 3, 5, 6.
- The use of antivirals, such as acyclovir or valacyclovir, in combination with prednisone, may not provide additional benefits 3, 5, 6.
- High-dose corticosteroids may be associated with a higher risk of adverse events, such as transient elevated liver enzymes and fecal occult blood 4.