What concentrations can prednisone be compounded into?

Prednisone Compounding Concentrations

Prednisone can be compounded into various concentrations ranging from 1 mg/mL to 5 mg/mL in liquid formulations, with higher concentrations possible for specific clinical needs.

Available Concentrations and Formulations

Liquid Formulations

• Standard liquid concentrations: 1 mg/mL and 5 mg/mL 1
• High-concentration formulations: Up to 100 mg or >250 mg total dose in liquid form for emergency situations 1
• These liquid formulations are particularly valuable for:
  • Patients with difficulty swallowing tablets
  • Emergency situations requiring rapid administration
  • Pediatric patients requiring precise dosing
  • Cases where severe dysphagia may occur (e.g., anaphylaxis, angioedema)

Tablet Formulations

• Commercial tablets are available in multiple strengths:
  • 1 mg, 2.5 mg, 5 mg, 10 mg, and 20 mg 2
  • These can be crushed and compounded into suspensions when needed

Clinical Applications of Different Concentrations

High-Concentration Formulations

• Emergency situations: 50-100 mg prednisolone-equivalent doses for severe urticaria and angioedema 1
• Immune-related adverse events: 1-2 mg/kg/day (typically 60-120 mg for average adults) 3
• Inflammatory conditions:
  • Initial doses of 40-60 mg daily for inflammatory bowel disease 4
  • 60 mg/day for autoimmune hepatitis 4

Standard Concentrations

• Inflammatory arthritis:
  • Mild: 10-20 mg daily 3
  • Moderate: 20 mg daily, potentially increasing to 1 mg/kg/day 3
  • Severe: 1 mg/kg/day 3
• Immune thrombocytopenia: 0.5-2 mg/kg/day, typically 1 mg/kg/day 3

Compounding Considerations

Bioavailability Factors

• Prednisone has excellent oral bioavailability (70-100%) 5, 6
• Liquid formulations may have faster absorption compared to tablets
• Bioavailability is linearly related to the dose of prednisone 6

Stability and Formulation

• Higher concentrations (>5 mg/mL) may require special compounding techniques to maintain stability
• Liquid formulations typically include:
  • Suitable vehicle for suspension
  • Preservatives
  • Flavoring agents to mask bitter taste

Special Populations

Pediatric Considerations

• Lower concentrations (1 mg/mL) allow for precise dosing in children
• Liquid formulations are preferred for children who cannot swallow tablets

Patients with Liver Disease

• No dosage adjustment needed for liquid prednisone formulations in liver disease 6
• Prednisone is effectively absorbed and converted to prednisolone even in chronic active liver disease 6

Practical Applications

Tapering Schedules

• Liquid formulations allow for precise tapering:
  • Typical schedule: reducing by 5 mg weekly until reaching 10 mg/day, then by 2.5 mg weekly until 5 mg/day 4
  • Liquid forms enable exact dosing during the taper

Emergency Kits

• High-concentration liquid prednisone (5 mg/mL) is suitable for self-administration emergency kits 1
• These formulations provide rapid symptom control comparable to intravenous administration 1

Caution

• Higher concentrations may increase the risk of medication errors
• Always verify the concentration when prescribing or administering compounded prednisone
• Consider taste and palatability issues with higher concentrations, which may affect adherence

When prescribing compounded prednisone, specify the exact concentration needed based on the clinical indication, patient's ability to swallow, and dosing requirements.