What is the maximum dose of prednisone (corticosteroid) per day?

Maximum Dose of Prednisone

The maximum daily dose of prednisone is generally capped at 60 mg per day, though specific dosing must be tailored to the disease entity being treated. 1

Dosing Guidelines

Prednisone dosing varies widely based on the condition being treated:

• Initial therapy ranges:

  • 5 mg to 60 mg per day depending on disease severity 1
  • For severe conditions: 0.75-1 mg/kg/day
  • For moderate conditions: 0.5 mg/kg/day
  • For mild conditions: 0.3 mg/kg/day 2

• Condition-specific dosing examples:

  • Multiple sclerosis acute exacerbations: 200 mg prednisolone daily for a week (equivalent prednisone dose) 1
  • Nephrotic syndrome: 2 mg/kg/day with maximum 60 mg/day 2, 3
  • Colitis: 1-2 mg/kg/day 2
  • Autoimmune hepatitis: 40 mg daily or 0.6-0.8 mg/kg daily 2

Administration Considerations

• Timing: Administer in the morning before 9 am to minimize adrenal suppression 1
• Gastric protection: Take with food or milk to reduce gastric irritation; consider antacids between meals for higher doses 1
• Duration: The initial dosage should be maintained until a satisfactory response is noted, then gradually tapered 1

Dosage Adjustments

• Treatment failure is defined as lack of response after 3 weeks of prednisone at 1.5 mg/kg/day 2
• If insufficient response is seen within 5-7 days, doses may be increased in 50-100% increments 2
• Dosage requirements are variable and must be individualized based on:
  • Disease severity
  • Patient response
  • Clinical status changes
  • Exposure to stressful situations 1

Important Cautions

• Never stop prednisone abruptly due to risk of adrenal insufficiency 2
• Higher doses increase risk of adverse effects including immunosuppression, metabolic effects, hypertension, and glucose intolerance 2
• For long-term therapy, alternate day dosing may help minimize adverse effects while maintaining therapeutic benefit 1

Special Populations

• Children: Maximum dose generally capped at 60 mg/day 2
• Pregnancy: Use with caution, weighing risks and benefits 2
• Pre-existing conditions: Use with caution in patients with diabetes, hypertension, glaucoma, or psychiatric disorders 2

While some conditions may temporarily require higher doses (such as MS exacerbations), the standard maximum daily dose of 60 mg provides a reasonable upper limit for most clinical scenarios, balancing efficacy with the risk of adverse effects.