From the Guidelines
The initial dose of prednisone should be 0.5-0.75 mg/kg per day, as recommended by the European Dermatology Forum consensus in collaboration with the European Academy of Dermatology and Venereology 1. This dose is suggested for patients with extensive disease, despite the lack of evidence in this specific context.
- The dose may need to be adjusted based on the individual patient's response to treatment and the severity of their condition.
- It is essential to monitor patients closely for potential side effects, including increased appetite, weight gain, fluid retention, mood changes, elevated blood sugar, and increased risk of infection.
- Regular monitoring of blood pressure, blood glucose, and electrolytes may be necessary during treatment, especially at higher doses or for extended periods.
- The medication should be taken exactly as prescribed, and patients should never stop taking prednisone abruptly as this can cause withdrawal symptoms.
- For short-term use (less than 3 weeks), the medication can often be stopped without tapering, but longer courses require gradual dose reduction to allow the adrenal glands to resume normal function.
- Other studies, such as the British Association of Dermatologists' guidelines for the management of bullous pemphigoid 2012 1 and the KDIGO practice guideline on glomerulonephritis 1, also provide recommendations for prednisone dosing, but the European Dermatology Forum consensus 1 provides the most recent and relevant guidance.
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. The initial dose of prednisone to start with is between 5 mg and 60 mg per day, and it depends on the specific disease being treated 2.
- The dose may be lower for less severe situations, and higher for more severe cases.
- It is recommended to individualize the dosage based on the disease and the patient's response.
From the Research
Initial Dose of Prednisone
The initial dose of prednisone can vary depending on the condition being treated.
- For active proctocolitis, a daily dosage of 40 mg has been shown to be optimal 3.
- For rheumatoid arthritis, the mean initial prednisone dose has declined over time, from 10.3 mg/day in 1980-1984 to 3.6 mg/day in 2000-2004 4.
- For multiple sclerosis, a high dose of 1,250 mg of oral prednisone daily has been used to treat acute relapses, with a high reported compliance rate of 94.3% 5.
- For polymyalgia rheumatica, a starting dose of 12.5 mg/day prednisone has been found to be adequate for 78.3% of patients, with the main factor driving response to prednisone being body weight 6.
Conditions and Corresponding Doses
- Active proctocolitis: 40 mg/day 3
- Rheumatoid arthritis: <5 mg/day, with some patients starting at 10.3 mg/day 4
- Multiple sclerosis: 1,250 mg/day for acute relapses 5
- Polymyalgia rheumatica: 12.5 mg/day, with response driven by body weight 6
- Adrenal insufficiency: typically treated with hydrocortisone (15-25 mg/day) and 9 alpha-fluor-hydrocortisone (0.05-0.2 mg/day) in addition for primary adrenal disorder 7