From the FDA Drug Label
In treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day for 1 month have been shown to be effective (4 mg of methylprednisolone is equivalent to 5 mg of prednisolone)
The recommended oral steroid dose for a multiple sclerosis (MS) flare is 200 mg of prednisolone per day for 1 week, followed by 80 mg every other day for 1 month. Since 4 mg of methylprednisolone is equivalent to 5 mg of prednisolone, the dose can be adjusted accordingly for methylprednisolone. 1 2
From the Research
The recommended oral steroid dose for a multiple sclerosis flare is typically oral methylprednisolone at 1,250 mg daily for 3 days. This high-dose, short-duration corticosteroid therapy aims to reduce inflammation and shorten the duration of MS exacerbations, as supported by a recent study 3. The study compared the effectiveness of two high doses of oral methylprednisolone for MS relapses and found that the standard high dose of 1,250 mg/day for 3 days yielded a superior Expanded Disability Status Scale (EDSS) score improvement on day 7.
Some key points to consider when prescribing oral steroids for MS flares include:
- The medication should be taken in the morning with food to reduce gastrointestinal side effects and minimize sleep disturbances.
- Common side effects include increased appetite, fluid retention, mood changes, elevated blood glucose, and insomnia.
- Steroid treatment does not alter the long-term course of MS but helps manage acute symptoms by suppressing the inflammatory response and reducing edema around demyelinated nerves, which allows for faster recovery of neurological function.
- Patients should continue their regular MS disease-modifying therapies during steroid treatment for a flare, as noted in various studies 4, 5, 6, 7.
- A tapering schedule over 10-14 days may be beneficial for some patients to minimize withdrawal effects, although this is not always necessary.
- Oral methylprednisolone has been shown to be non-inferior to intravenous administration for improvement of disability scores 1 month after treatment, with a similar safety profile 6.
- MS patients have reported excellent compliance with oral prednisone for acute relapses, with a high rate of compliance and a preference for oral medication for future relapses 7.