From the Guidelines
The formulation for a 28-day course of prednisolone for alcoholic hepatitis is 40 mg/day.
Calculation of the Formulation
To calculate the total volume of prednisolone required for a 28-day course, we can use the following formula: Total volume = Dose x Number of days / Concentration Given the available strength of 15mg/5ml, the concentration is 15mg/5ml = 3mg/ml. Total volume = 40 mg/day x 28 days / 3 mg/ml = 373.33 ml Since the total volume is not a whole number, we can round it up to the nearest whole number to ensure the patient receives the full dose.
Administration
The patient should take 40 mg of prednisolone per day for 28 days, which is equivalent to 13.33 ml (or approximately 13-14 ml) of the 15mg/5ml solution per day.
Evidence
This recommendation is based on the evidence from multiple studies, including those cited in 1, 1, 1, 1, and 1, which suggest that a dose of 40 mg/day of prednisolone for 28 days is effective in improving short-term survival in patients with severe alcoholic hepatitis.
Important Considerations
It is essential to note that the efficacy of steroids has not been evaluated in patients with severe alcoholic hepatitis and concomitant pancreatitis, gastrointestinal bleeding, renal failure, or active infection, which were exclusion criteria in many of the early studies of alcoholic hepatitis 1. Additionally, patients with a contraindication to glucocorticoids may be treated with alternative therapies, such as pentoxifylline, although its effectiveness is debated 1.
The FDA Drug Labels for prednisolone (PO) do not address this question.
From the Research
Formulation for a 28-day course of prednisolone
- The available strength of prednisolone is 15mg/5ml.
- According to the studies, the recommended dose of prednisolone for severe alcoholic hepatitis is 40mg daily for 28 days 2, 3, 4.
- To calculate the volume of prednisolone required per day, we can use the following formula: Volume (ml) = Dose (mg) / Concentration (mg/ml).
- Since the concentration is 15mg/5ml, we can first calculate the concentration in mg/ml: 15mg / 5ml = 3mg/ml.
- Then, we can calculate the volume required per day: Volume (ml) = 40mg / 3mg/ml = 13.33ml.
- Therefore, the formulation for a 28-day course of prednisolone would be 13.33ml of 15mg/5ml prednisolone solution per day for 28 days.