Recommended Dosing for Orapred (Prednisolone) in Children
The recommended dosing for Orapred (prednisolone) in children is 0.5-2 mg/kg/day with a maximum of 60 mg/day, with the specific dose depending on the condition being treated.
General Dosing Guidelines
Prednisolone dosing varies based on the specific condition being treated:
- Initial dosing range: 0.14-2 mg/kg/day in three or four divided doses (4-60 mg/m² BSA/day) 1
- Maximum dose: Generally capped at 60 mg/day for children 2
- Administration: Typically given as a single morning dose to minimize hypothalamic-pituitary-adrenal axis suppression 2
Condition-Specific Dosing
Nephrotic Syndrome
- Initial episode: 2 mg/kg/day (maximum 60 mg/day) 3, 2
- Standard regimen: 60 mg/m²/day given in three divided doses for 4 weeks, followed by 4 weeks of single-dose alternate-day therapy at 40 mg/m²/day 1
- Relapse treatment: 60 mg/m² daily until remission (urine dipstick trace/negative for at least 3 consecutive days), then 40 mg/m² on alternate days for 4 weeks with tapering 3
Asthma Exacerbations
- Acute management: 1-2 mg/kg/day in single or divided doses (maximum 60 mg/day) until peak expiratory flow reaches 70% of predicted or personal best 3
- Short course ("burst") therapy: 1-2 mg/kg/day for 3-10 days 3
- Important note: No need to taper for courses less than 1 week; for courses up to 10 days, tapering is generally unnecessary if patients are concurrently taking inhaled corticosteroids 3
Viral Respiratory Infections
- Lower airway disease: 2 mg/kg/day for 3 days has been shown effective in children 6-35 months 4
Formulation Considerations
Orapred is available as an oral solution (15 mg/5 mL) that has demonstrated better palatability compared to generic prednisolone:
- Reduced vomiting: Studies show significantly less vomiting with Orapred (5.4%) compared to generic prednisolone (17.7%) 5
- Better taste: Children report better taste scores with Orapred compared to generic prednisolone 5
Important Clinical Considerations
- Duration of therapy: Should be individualized based on clinical response and the specific condition being treated
- Tapering: For longer courses (>1 week), consider gradual tapering to prevent adrenal insufficiency 2
- Monitoring: Regular monitoring is essential for all patients on long-term prednisolone therapy, including blood pressure, glucose levels, and growth in children 2
- Steroid-sparing agents: Consider for patients who develop significant steroid-related adverse effects, especially in frequently relapsing conditions 3, 2
Cautions
- Adverse effects: Monitor for osteoporosis, infections, cardiovascular events, and metabolic changes
- Infections: Use with caution in patients with active infections
- Live vaccines: Should be avoided during treatment
- Abrupt discontinuation: Never stop prednisolone abruptly; always taper gradually to prevent adrenal insufficiency 2
Remember that dosing should be adjusted based on clinical response, and the lowest effective dose should be used to maintain remission while minimizing adverse effects.