What is the typical dosing range for prednisone (corticosteroid) in various medical conditions?

Prednisone Dosing Guidelines for Various Medical Conditions

Prednisone dosing should be tailored based on the specific medical condition being treated, with initial doses typically ranging from 5-60 mg/day for adults and 1-2 mg/kg/day (maximum 60 mg/day) for children, followed by appropriate tapering schedules to minimize adverse effects. 1

General Dosing Principles

Adult Dosing

• Initial dose: 5-60 mg/day depending on disease severity 1
• Timing: Administration in the morning (before 9 am) is recommended to minimize adrenal suppression 1
• Administration: Take with food or milk to reduce gastric irritation 1

Pediatric Dosing

• Initial dose: 1-2 mg/kg/day or 60 mg/m²/day as a single daily dose (maximum 60 mg/day) 2
• Adult dosing begins at age 15 years 2
• Single daily dosing is preferred over divided doses for most conditions 2

Condition-Specific Dosing

Autoimmune Hepatitis

• Adults: Initial dose of 40-60 mg/day
• Pediatrics: 1-2 mg/kg/day (up to 60 mg/day) 2
• Tapering: Reduce by 5 mg weekly until 10 mg/day, then 2.5 mg weekly 2

IgG4-Related Sclerosing Cholangitis

• Initial dose: 40 mg daily or 0.6-0.8 mg/kg daily for first 4 weeks 3
• Lower initial doses (10-20 mg daily) may be effective, especially in elderly patients with comorbidities 3
• Evaluate treatment response after 2-4 weeks before tapering 3
• Consider steroid-sparing agents (azathioprine, 6-mercaptopurine, mycophenolate mofetil) during prednisone tapering 3

Pemphigus Vulgaris

• Initial dose: 1-2 mg/kg/day (common practice worldwide) 3
• For milder cases: 0.5-1 mg/kg/day 3
• If no response within 5-7 days, increase dose in 50-100% increments 3
• Treatment failure defined as no response despite 3 weeks of prednisolone 1.5 mg/kg/day 3
• Consider pulsed intravenous corticosteroids (methylprednisolone 250-1000 mg/day for 2-5 days) for severe cases 3

Bullous Pemphigoid

• Severe: 0.75-1 mg/kg/day (41-55 mg/day)
• Moderate: 0.5 mg/kg/day (27.5 mg/day)
• Mild: 0.3 mg/kg/day (16.5 mg/day) 2

Multiple Sclerosis (Acute Exacerbations)

• 200 mg prednisolone daily for one week, followed by 80 mg every other day for 1 month 1
• Alternative high-dose regimen: 1,250 mg oral prednisone daily (shown to have high compliance despite requiring multiple tablets) 4

Nephrotic Syndrome (Pediatric)

• 2 mg/kg/day (maximum 60 mg/day) as a single daily dose 2
• Typical 5-day course using weight-based dosing 2

Rheumatoid Arthritis (Long-term Low-dose)

• Maintenance dose: <5 mg/day has shown effectiveness with acceptable side effect profile 5
• Dose-dependent risk of adverse events increases significantly at doses >5 mg/day 6

Polymyalgia Rheumatica/Temporal Arteritis

• Maintenance dose correlates strongly with initial dose 7
• PMR maintenance: 5.7 mg/day (first year), 4.3 mg/day (second year) 7
• Temporal arteritis maintenance: 6.6 mg/day (first year), 4.1 mg/day (second year) 7

Tapering Strategies

• Gradual tapering is essential to prevent adrenal crisis 2
• After favorable response, decrease initial dose in small increments at appropriate intervals 1
• For long-term therapy, consider alternate-day therapy (twice the usual daily dose every other morning) to minimize side effects 1
• For autoimmune hepatitis: Taper by 5 mg weekly until 10 mg/day, then 2.5 mg weekly 2

Monitoring and Side Effects

• Common side effects: Weight gain, behavioral changes, increased appetite, mood swings 2
• Long-term use risks: Osteoporosis, diabetes, hypertension, cataracts, adrenal suppression 2, 1
• Dose-dependent adverse events: Fractures, serious infections, GI bleeding/ulcers 6
• Monitoring recommendations:
  • Blood pressure and glucose
  • Bone mineral density testing for long-term therapy
  • Regular eye examinations
  • Growth monitoring in children 2

Special Considerations

• Consider twice daily fractionated administration for certain conditions (e.g., glomerulonephritis) to allow lower total daily dose with similar efficacy 8
• For patients requiring long-term therapy, consider steroid-sparing agents to minimize side effects 3, 2
• Doses >10 mg/day significantly increase risk of adverse events (OR = 32.3) compared to doses of 5-10 mg/day (OR = 4.5) 6

Remember that dosing must be individualized based on disease severity, patient response, and risk factors for adverse effects. Regular monitoring is essential for all patients on long-term prednisone therapy.