What is the recommended daily dose of prednisolone?

Recommended Daily Dose of Prednisolone

The recommended daily dose of prednisolone varies by condition, but generally ranges from 0.5-1 mg/kg/day for severe conditions, with typical adult doses between 5-60 mg daily depending on the specific disease being treated. 1

Dosing Principles

Initial Dosing by Condition

• Severe autoimmune conditions:

  • 0.75-1 mg/kg/day for severe disease 2
  • 0.5 mg/kg/day for mild/localized disease 2
  • 0.3 mg/kg/day for moderate disease 2

• Inflammatory bowel disease:

  • 40 mg/day for active proctocolitis 3
  • Single morning dose preferred over divided doses 3

• Rheumatoid arthritis:

  • 5-10 mg daily or 5 mg twice daily for early polyarticular disease 4
  • Doses <5 mg/day may be effective for long-term maintenance 5

• Polymyalgia rheumatica:

  • 12.5-25 mg prednisone equivalent daily initially 2
  • Higher initial dose for high relapse risk/low adverse event risk
  • Lower initial dose for patients with comorbidities 2

• Autoimmune hepatitis:

  • 60 mg (1 mg/kg) initially, then taper according to schedule 2

• Nephrotic syndrome in children:

  • 60 mg/m²/day in three divided doses for 4 weeks, followed by alternate-day therapy at 40 mg/m²/day 1

Tapering Recommendations

After achieving disease control, prednisolone should be tapered to minimize adverse effects:

1. Initial tapering: Reduce to 10 mg/day within 4-8 weeks 2
2. Maintenance tapering: Once remission is achieved, taper by 1 mg every 4 weeks until discontinuation 2
3. For relapse: Increase to pre-relapse dose and gradually decrease to the dose at which relapse occurred 2

Administration Considerations

Single vs. Divided Doses

• Single morning dose is generally preferred as it:

  • Causes less adrenal suppression 3
  • Is more convenient for patients 3
  • Shows equivalent efficacy to divided doses for most conditions 3

• Consider divided doses only in specific situations:

  • Prominent night pain while on low doses (<5 mg daily) 2
  • Some evidence suggests twice daily administration may allow lower total daily dose (2.5 mg/day vs 4 mg/day) with similar efficacy 6

Monitoring and Safety

• Regular monitoring of:

  • Blood pressure
  • Glycemic control
  • Serum potassium 2
  • Bone mineral density (for long-term use)

• Osteoporosis prevention:

  • Ensure calcium intake of 800-1000 mg daily
  • Vitamin D supplementation (800 IU daily)
  • Consider bisphosphonates for high-risk patients or those on prolonged therapy 2

• Adrenal suppression risk:

  • All patients on prolonged courses require tapering when stopping
  • Watch for withdrawal symptoms (weakness, fatigue, nausea, arthralgia) 2

Important Caveats

• Initial dosing should be based on disease severity, patient age, and comorbidities
• Doses >30 mg/day are generally not recommended for initial treatment of most conditions unless specifically indicated 2
• Low doses (<7.5 mg/day) are generally insufficient for initial control of inflammatory conditions 2
• For children, dosing is typically weight-based (0.14-2 mg/kg/day) or by body surface area (4-60 mg/m²/day) 1
• Budesonide may be considered as an alternative to prednisolone in specific conditions to reduce systemic effects 2

Remember that prednisolone and prednisone are bioequivalent and can be used interchangeably at the same dosage 2.