What is the dose of corticosteroids (corticiid) when pulsing a patient?

Corticosteroid Pulse Therapy Dosing

The standard dose for corticosteroid pulse therapy is intravenous methylprednisolone 10-20 mg/kg or 250-1000 mg per day, administered over at least 30 minutes for 1-5 consecutive days. 1, 2

Dosing Specifics

Methylprednisolone (First-Line Agent)

• Dose range: 250-1000 mg IV daily
• Weight-based dosing: 10-20 mg/kg daily
• Administration: Over at least 30 minutes to reduce risk of cardiac arrhythmias
• Duration: 1-5 consecutive days
• Frequency: Daily or every other day

High-Dose Therapy for Critical Conditions

• For life-threatening conditions: 30 mg/kg IV administered over at least 30 minutes
• May be repeated every 4-6 hours for up to 48-72 hours 3

Alternative Corticosteroids

• Dexamethasone: 2-5 mg/kg (50-200 mg) - equivalent to 625 mg prednisone 2
• Hydrocortisone: 500 mg IV every 6 hours (pediatric dose: 30 mg/kg) 4

Indications for Pulse Therapy

Pulse therapy is typically reserved for:

• Severe autoimmune diseases (e.g., pemphigus vulgaris) 1
• Refractory disease not responding to conventional oral corticosteroid doses
• When rapid disease control is needed
• When prednisolone doses above 1 mg/kg/day are required 1

Clinical Considerations

Administration Safety

• Administer over at least 30 minutes to prevent cardiac arrhythmias
• Cardiac arrhythmias and cardiac arrest have been reported with rapid administration (>0.5 g over <10 minutes) 3
• Monitor for bradycardia during and after administration

Efficacy Considerations

• Clinical improvement is typically seen within one week of pulse therapy 1
• The median cumulative dose to achieve complete response is approximately 3.2 g 5
• No significant association between higher doses and better clinical response has been found 5

Follow-Up Therapy

• Pulse therapy is generally followed by oral corticosteroids at conventional doses
• Maintenance therapy with oral prednisolone (1-2 mg/kg/day) is typically initiated after pulse therapy
• Gradual tapering of oral corticosteroids is recommended rather than abrupt discontinuation 3

Monitoring and Adverse Effects

Common Adverse Effects

• Infections (most common serious adverse effect, 13.4% of patients) 5
• Hyperglycemia (especially in diabetic patients)
• Adrenal suppression (typically resolves within 2 weeks) 6
• Electrolyte disturbances

High-Risk Patients

• Diabetic patients have significantly higher risk of adverse effects (81% vs. non-diabetics) 5
• Patients with history of cardiac arrhythmias
• Elderly patients

Special Populations

Pediatric Patients

• Initial dose range: 0.11-1.6 mg/kg/day divided into 3-4 doses 3
• Alternative: 30 mg/kg methylprednisolone as a single IV dose 4
• Be aware that methylprednisolone contains benzyl alcohol, which may be problematic in neonates 3

Pregnancy

• Use with caution and only when benefits outweigh risks
• Consider alternative immunosuppressive agents when appropriate

Important Cautions

• Severe infections have been associated with cumulative doses above 1.5 g 5
• Patients should not stop treatment abruptly due to risk of adrenal crisis
• Consider prophylaxis for Pneumocystis pneumonia and gastric protection for prolonged courses

Pulse corticosteroid therapy provides rapid immunosuppression and anti-inflammatory effects but should be used judiciously with careful consideration of both benefits and risks.