What is the recommended dose of steroids, such as prednisone, for treating vestibular neuritis?

Steroid Dosing for Vestibular Neuritis

For vestibular neuritis, prednisone should be administered at 1 mg/kg/day (with a maximum dose of 60 mg daily) for 10-14 days, followed by a tapering schedule over a similar time period. 1

Recommended Dosing Regimen

Initial Dosing

• Prednisone: 1 mg/kg/day as a single (not divided) dose
  • Maximum dose: 60 mg daily
  • Duration: 10-14 days at full dose 1
• Equivalent alternatives:
  • Methylprednisolone: 48 mg/day (equivalent to 60 mg prednisone)
  • Dexamethasone: 10 mg/day (equivalent to 60 mg prednisone) 1

Tapering Schedule

A representative tapering regimen includes:

• Maximum dose for 4 days
• Then reduce by 10 mg every 2 days 1

Timing of Treatment

• Treatment should be initiated as early as possible, ideally within 24 hours of symptom onset
• Earlier treatment (within 24 hours) has been associated with better vestibular function recovery compared to treatment initiated between 25-72 hours 2

Evidence for Efficacy

• Methylprednisolone has been shown to significantly improve recovery of peripheral vestibular function in patients with vestibular neuritis 3
• Meta-analyses indicate that steroid treatment results in better recovery than control therapies, with an odds ratio of 2.4 (95% CI 1.3-4.4) for restoration of vestibular function 4
• However, recent evidence from a 2025 randomized placebo-controlled trial found no significant improvement in caloric recovery, vHIT gain recovery, or subjective well-being with corticosteroid treatment 5

Important Considerations

Avoid Underdosing

• Common errors include underdosing with methylprednisolone dose packs
  • A typical dose pack provides only 84 mg over 6 days (equivalent to 105 mg prednisone)
  • This is significantly less than the recommended 540 mg prednisone over 14 days for a 60-kg adult 1

Monitoring for Adverse Effects

• Most serious side effects occur with chronic use
• Adverse events are usually manageable for the short 10-14 day course recommended 1
• Common adverse effects include:
  • Hyperglycemia
  • Weight gain
  • Sleep disturbances
  • Increased appetite 4

Alternative Delivery Methods

• For patients with contraindications to systemic steroids (e.g., poorly controlled diabetes), intratympanic steroid injections may be considered 1
• Intratympanic options:
  • Dexamethasone: 24 mg/mL, 16 mg/mL (compounded), or 10 mg/mL (stock)
  • Methylprednisolone: 40 mg/mL or 30 mg/mL 1

Clinical Decision Making

1. Confirm diagnosis of vestibular neuritis
2. Initiate treatment as early as possible (ideally within 24 hours)
3. Calculate appropriate dose based on patient weight (1 mg/kg/day)
4. Administer full dose for 10-14 days
5. Implement tapering schedule over a similar time period
6. Monitor for adverse effects throughout treatment course

While recent evidence questions the efficacy of corticosteroids for vestibular neuritis 5, the current clinical practice guidelines still recommend their use, particularly when initiated early in the disease course 1, 2.