From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
The recommended steroid dose and taper regimen for spinal inflammation is not explicitly stated in the provided drug label. However, the label does provide general guidance on dosage and tapering.
- The initial dosage of prednisone may vary from 5 mg to 60 mg per day, depending on the disease entity being treated.
- The dosage should be individualized based on the disease and patient response.
- After a favorable response, the dosage should be decreased in small increments at appropriate time intervals to reach the lowest dosage that maintains an adequate clinical response.
- If after long-term therapy, the drug is to be stopped, it is recommended to withdraw gradually rather than abruptly 1.
From the Research
The recommended steroid regimen for spinal inflammation typically involves oral prednisone starting at 40-60mg daily for 5-7 days, followed by a gradual taper over 2-3 weeks, as supported by the most recent and highest quality study 2. A common tapering schedule would reduce the dose by 10mg every 3-5 days until reaching 20mg, then decrease by 5mg every 3-5 days until discontinuation. For severe cases, methylprednisolone may be given intravenously at 1000mg daily for 3-5 days before transitioning to oral steroids, as indicated by studies such as 3 and 4. During treatment, patients should take a proton pump inhibitor like omeprazole 20mg daily to protect the stomach and consider calcium/vitamin D supplementation to prevent bone density loss. The high initial dose is necessary to quickly reduce inflammation and pain, while the gradual taper allows the body to resume normal cortisol production and minimizes withdrawal symptoms. Some studies, such as 5, highlight the variability in practice patterns regarding steroid dose selection and frequency of administration, emphasizing the need for evidence-based guidelines. Patients should be monitored for side effects including mood changes, sleep disturbances, increased blood glucose, and fluid retention, as noted in 2. Steroid treatment should be accompanied by appropriate analgesics and possibly muscle relaxants based on symptom severity. It's also important to consider the potential risks and benefits of steroid treatment, as discussed in 6, particularly in patients with certain comorbidities or those taking disease-modifying antirheumatic drugs. Overall, the goal of steroid treatment for spinal inflammation is to rapidly reduce inflammation and pain while minimizing side effects and promoting optimal recovery, as supported by the available evidence 2.