Recommended Prednisolone Dosing for Various Medical Conditions
The recommended prednisolone dosage varies by condition, with typical doses ranging from 0.3-2 mg/kg/day for most conditions, with higher doses (up to 60 mg/day) for severe conditions and lower doses (as little as 2.5-5 mg/day) for maintenance therapy. Dosing must be tailored to disease severity and patient characteristics.
Dermatological Conditions
Bullous Pemphigoid
- Severe involvement: 0.75-1 mg/kg/day 1
- Moderate disease: 0.5 mg/kg/day 1
- Mild/localized disease: 0.3 mg/kg/day 1
- Taper after disease control (typically 4 weeks): reduce by one-third or one-quarter down to 15 mg daily, then by 2.5 mg decrements to 10 mg daily, then by 1 mg monthly 1
Pemphigus Vulgaris
- Initial therapy: 1-2 mg/kg/day 1
- Milder cases may be treated with 0.5-1 mg/kg/day 1
- If no response within 5-7 days, increase dose in 50-100% increments 1
- Treatment failure defined as failure to achieve control despite 3 weeks of prednisolone 1.5 mg/kg/day 1
- Consider pulsed IV methylprednisolone (10-20 mg/kg or 250-1000 mg) for severe cases 1
Pediatric Conditions
General Pediatric Dosing
- Range of initial doses: 0.14-2 mg/kg/day in 3-4 divided doses (4-60 mg/m²/day) 2
- Maximum dose generally capped at 60 mg/day for children 2
Nephrotic Syndrome in Children
- Standard regimen: 2 mg/kg/day (maximum 60 mg/day) 2, 3
- Maintenance: 60 mg/m²/day in three divided doses for 4 weeks, followed by 4 weeks of single-dose alternate-day therapy at 40 mg/m²/day 3
Asthma in Children
- 1-2 mg/kg/day in single or divided doses until peak flow reaches 80% of personal best 2
- Duration typically 3-10 days (no tapering necessary for short courses) 2
Rheumatological Conditions
Polymyalgia Rheumatica/Temporal Arteritis
- Initial doses correlate with maintenance requirements 4
- Maintenance dose: 5.7 mg/day (first year) and 4.3 mg/day (second year) for PMR 4
- Maintenance dose: 6.6 mg/day (first year) and 4.1 mg/day (second year) for temporal arteritis 4
- Low-dose long-term therapy (2-5 mg/day) may be effective for rheumatoid arthritis 5
Hepatic Conditions
Autoimmune Hepatitis
- Initial dose: 40 mg daily or 0.6-0.8 mg/kg daily for first 4 weeks 2
- In children: 2 mg/kg daily (up to 60 mg/day) 2
Alcoholic Hepatitis
- 40 mg/day for 28 days, then tapered 2
Multiple Sclerosis
- Acute exacerbations: 200 mg daily for one week, followed by 80 mg every other day for one month 3
Important Dosing Considerations
Tapering Guidelines
- Never stop prednisolone abruptly due to risk of adrenal insufficiency 2
- For long-term therapy, taper gradually:
- Reduce by one-third or one-quarter down to 15 mg daily
- Then by 2.5 mg decrements to 10 mg daily
- Then by 1 mg monthly 1
Alternative Dosing Strategies
- Twice-daily fractionated dosing may allow for lower total daily doses (2.5 mg/day vs. 4.0 mg/day) with similar efficacy and fewer side effects 6
Monitoring Requirements
- Blood pressure at each visit
- Glucose levels (urine dipstick)
- Bone density for long-term use
- Signs of infection, mood changes, sleep disturbances 2
Pitfalls and Caveats
Steroid-related adverse effects: Dose-dependent immunosuppressive and metabolic effects occur with all regimens 1
Relapse during tapering: About 50% of patients will relapse during dose reduction, indicating the previous dose was the minimal effective dose 1
Individualized dosing: While individualization is important, evidence supports specific starting doses based on disease severity 1, 2
Pulsed therapy: Monthly oral dexamethasone pulses showed no additional benefit and more adverse effects compared to conventional oral corticosteroids in pemphigus vulgaris 1
Treatment failure: If standard doses fail, consider adjunctive immunosuppressive therapy rather than further increasing prednisolone dose 1