Prednisone Administration: Once Daily Dosing
Prednisone should be administered as a single daily dose in the morning (before 9 am), rather than divided into multiple doses throughout the day. 1
Rationale for Once Daily Dosing
The FDA drug label for prednisone specifically recommends morning administration as a single dose for several important reasons:
- Morning administration (before 9 am) aligns with the body's natural cortisol rhythm, which has maximal activity between 2 am and 8 am 1
- Single morning dosing minimizes suppression of the hypothalamic-pituitary-adrenal (HPA) axis 1
- Taking the full dose at once provides better therapeutic effect while minimizing adverse effects 1
Specific Dosing Guidelines
Multiple guidelines support once-daily dosing of prednisone:
- For nephrotic syndrome in children, prednisone is recommended as "a single daily dose starting at 60 mg/m² or 2 mg/kg/d to a maximum of 60 mg/d" 2
- For sudden sensorineural hearing loss, prednisone is given at "1 mg/kg/d (usual maximal dose is 60 mg/d) in a single (not divided) dose" 2
- For various pediatric conditions, prednisone is typically administered as a single daily dose, with dosages ranging from 0.5-2 mg/kg/day depending on the condition 3
Administration Considerations
When taking prednisone:
- Take with food or milk to reduce gastric irritation 1
- For long-term therapy, alternate-day therapy (giving twice the usual daily dose every other morning) may be considered to minimize side effects while maintaining therapeutic benefits 1
- Never stop prednisone abruptly due to risk of adrenal insufficiency 3
Special Situations
In certain circumstances, divided dosing may be considered:
- For very high doses (such as in multiple sclerosis exacerbations where 200 mg prednisolone may be used) 1
- When gastric side effects are problematic despite taking with food
Common Pitfalls to Avoid
Divided dosing error: Many providers incorrectly prescribe prednisone in divided doses, which can increase side effects without improving efficacy
Evening dosing: Taking prednisone later in the day can disrupt sleep patterns and cause more significant HPA axis suppression
Abrupt discontinuation: Always taper prednisone gradually after prolonged use to prevent adrenal insufficiency 3
Underdosing: Using inadequate doses (such as the commonly prescribed methylprednisolone dose pack) may provide insufficient treatment 2
By following these evidence-based guidelines for once-daily morning administration of prednisone, you can maximize therapeutic benefits while minimizing potential adverse effects.