What is the appropriate dosing for Prednisone (corticosteroid)?

From the Guidelines

Prednisone dosing should be initiated at 40 mg/m2 or 1.5 mg/kg (maximum 40 mg on alternate days) for 4-6 weeks, followed by alternate-day medication and tapering of the dose over 2-5 months. This recommendation is based on the highest quality study available, which suggests that this dosing regimen is effective for treating glomerulonephritis 1.

Key Considerations

• The dosing of prednisone may vary depending on the condition being treated, but the recommended dose of 40 mg/m2 or 1.5 mg/kg (maximum 40 mg on alternate days) is a commonly used regimen 1.
• Prednisone should be taken with food to minimize gastrointestinal side effects, and most patients benefit from taking it in the morning to mimic natural cortisol rhythms and reduce sleep disturbances.
• The medication should never be stopped abruptly after prolonged use, as this can cause adrenal crisis, and instead, a gradual taper is necessary, typically reducing by 5-10 mg every 3-7 days depending on dose and duration of therapy.
• Patients should be monitored for side effects including increased blood glucose, hypertension, mood changes, and increased infection risk.
• Calcium and vitamin D supplementation may be recommended for patients on long-term therapy to prevent bone loss.

Additional Guidance

• While another study suggests a daily single dose of 1 mg/kg (maximum 80 mg) or alternate-day single dose of 2 mg/kg (maximum 120 mg) 1, the most recent and highest quality study recommends the initial dose of 40 mg/m2 or 1.5 mg/kg (maximum 40 mg on alternate days) 1.
• It is essential to note that prednisone and prednisolone are equivalent and can be used interchangeably, and all references to prednisone refer to both prednisone and prednisolone.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Gastric irritation may be reduced if taken before, during, or immediately after meals or with food or milk. The maximal activity of the adrenal cortex is between 2 am and 8 am, and it is minimal between 4 pm and midnight. Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity (am) for single dose administration Therefore, it is recommended that prednisone be administered in the morning prior to 9 am and when large doses are given, administration of antacids between meals to help prevent peptic ulcers. Multiple dose therapy should be evenly distributed in evenly spaced intervals throughout the day. Dietary salt restriction may be advisable in patients Do not stop taking this medicine without first talking to your doctor. Avoid abrupt withdraw of therapy. The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated.

IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT

If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly

The appropriate dosing for Prednisone (corticosteroid) is:

• Initial dosage: 5 mg to 60 mg per day, depending on the specific disease entity being treated
• Administration: in the morning prior to 9 am
• Multiple dose therapy: evenly distributed in evenly spaced intervals throughout the day
• Dosage adjustments: necessary based on changes in clinical status, patient's individual drug responsiveness, and effect of patient exposure to stressful situations
• Withdrawal: gradual rather than abrupt after long-term therapy 2 Key points:
• Dosage requirements are variable and must be individualized
• Constant monitoring is needed in regard to drug dosage
• The initial dosage should be maintained or adjusted until a satisfactory response is noted

From the Research

Appropriate Dosing for Prednisone

The appropriate dosing for Prednisone, a corticosteroid, can vary depending on the condition being treated and the individual patient.

• For rheumatoid arthritis, studies suggest that low-dose prednisone, often less than 5 mg/day, can be effective for long-term treatment 3, 4.
• A study from 2011 found that patients treated with <5 mg/day of prednisone had similar improvements in clinical status over 12 months compared to those treated with ≥5 mg/day 3.
• Another study from 2013 found that the mean initial prednisone dosage declined from 10.3 mg/day in 1980-1984 to 3.6 mg/day in 2000-2004, and that most patients received early concomitant methotrexate after 1990 4.
• For newly diagnosed rheumatoid arthritis patients, a 2021 study found that short-term use of low-dose prednisone monotherapy (mean dose 8 mg/day) was effective in inducing remission in the majority of patients 5.
• In contrast, a study from 2012 found that high-dose oral prednisone (1,250 mg daily) was used to treat acute relapses in multiple sclerosis patients, with a high reported compliance rate of 94.3% 6.
• A 1982 study compared prednisolone (8 mg/day) and betamethasone (1 mg/day) in rheumatoid arthritis patients, and found that prednisolone was the drug of choice for chronic dosage due to its lower adrenal suppressive activity 7.

Key Findings

• Low-dose prednisone (<5 mg/day) can be effective for long-term treatment of rheumatoid arthritis.
• Short-term use of low-dose prednisone monotherapy can induce remission in newly diagnosed rheumatoid arthritis patients.
• High-dose oral prednisone can be used to treat acute relapses in multiple sclerosis patients, with a high reported compliance rate.
• Prednisolone may be preferred over betamethasone for chronic dosage in rheumatoid arthritis patients due to its lower adrenal suppressive activity.