Steroid Dose Pack Prescribing Information
A typical steroid dose pack consists of oral prednisone starting at 60 mg/day as a single morning dose, followed by a gradual taper over 5-16 days depending on the condition being treated. 1, 2
Standard Dosing Regimens
Short-Term Dose Pack (5-7 days)
- Initial dose: 60 mg prednisone as a single morning dose
- Tapering schedule:
- Day 1: 60 mg
- Day 2: 50 mg
- Day 3: 40 mg
- Day 4: 30 mg
- Day 5: 20 mg
- Day 6: 10 mg
- Day 7: 5 mg (optional)
Extended Dose Pack (10-16 days)
For more severe conditions requiring longer treatment:
- Initial dose: 60 mg prednisone daily for 4-6 days
- Tapering schedule: Reduce by 5-10 mg every 1-3 days until completion
Administration Guidelines
- Timing: Administer in the morning (before 9 AM) to mimic natural cortisol rhythm and minimize HPA axis suppression 1
- Administration: Take with food or milk to reduce gastric irritation 1
- Single vs. divided doses: Single daily dosing is preferred for most conditions and short-term therapy 2
Condition-Specific Considerations
Inflammatory Conditions
- Dermatitis/rash: 0.5-1 mg/kg/day tapered over 2 weeks 2
- Colitis: 1-2 mg/kg/day (up to 60 mg/day), tapered over 4-6 weeks when improved 2
Nephrotic Syndrome
- Initial episode: 60 mg/m² per day (maximum 60 mg) as a single daily dose for 6 weeks, followed by 40 mg/m² on alternate days for 6 weeks, then tapering by 10 mg/m² per week 3, 2
- Relapse: 60 mg/m² daily until remission (at least 3 consecutive days), then alternate-day dosing 3
Duration of Treatment
The duration of treatment depends on the condition being treated:
- Acute inflammatory conditions: 5-7 days is typically sufficient
- More severe conditions: 10-14 days with gradual tapering
- Chronic conditions: May require longer courses with slower tapering
Important Precautions
Tapering
- Always taper: Abrupt discontinuation can lead to adrenal crisis, especially after courses longer than 7-10 days 1
- Tapering rate: For short courses (5-7 days), rapid tapering is acceptable; for longer courses, more gradual tapering is necessary 2
Monitoring
- Short-term therapy: Monitor for behavioral changes, increased appetite, mood swings, and insomnia 2
- Longer courses: Monitor weight, blood pressure, blood glucose, and watch for cushingoid features 2
Common Side Effects
- Short-term: Insomnia, mood changes, increased appetite 4
- Longer-term: Weight gain, fluid retention, hypertension, hyperglycemia, skin thinning, bruising 5
Special Considerations
- Maximum dose: Generally capped at 60 mg/day for adults 2, 1
- Contraindications: Systemic fungal infections, live vaccines, known hypersensitivity to components
- Drug interactions: Medications that affect prednisone metabolism (antiepileptics, antifungals) may require dose adjustments 2
Remember that while steroid dose packs are effective for short-term treatment of inflammatory conditions, they should be used judiciously due to potential side effects, especially with repeated or prolonged use.