How should prednisone be used?

Prednisone Usage Guidelines

Prednisone should be administered based on the specific condition being treated, with dosage ranging from 5-60 mg daily, typically given as a single morning dose before 9 am to minimize adrenal suppression, and with duration determined by the underlying condition. 1

Dosing Recommendations by Condition

Asthma Exacerbations

• Adults: 40-80 mg/day for 5-10 days without tapering 2
• Administration: Single daily dose in the morning
• Duration: Until peak expiratory flow reaches 70% of predicted or personal best
• No tapering needed for short courses (≤10 days) 2
• Alternative: Dexamethasone 12 mg as single dose may be considered for improved compliance 3

Glomerulonephritis

• Initial therapy: 60 mg/day (or 2 mg/kg/day to maximum 60 mg) as single daily dose 4
• Duration: Daily for 4-6 weeks 4
• Maintenance: Switch to alternate-day dosing at 40 mg/m² or 1.5 mg/kg (maximum 40 mg) 4
• Taper: Continue for 2-5 months with gradual dose reduction 4

Nephrotic Syndrome in Children

• Initial episode: 60 mg/m² or 2 mg/kg/day (maximum 60 mg) until remission for at least 3 days 4
• Infrequent relapses: Same initial dose until remission for 3 days, then alternate-day dosing for at least 4 weeks 4
• Frequent relapses: Daily prednisone until remission for 3 days, then alternate-day dosing for at least 3 months 4

Autoimmune Hepatitis

• Initial: 1-2 mg/kg daily (up to 60 mg/day) 4
• Maintenance: Taper to 0.1-0.2 mg/kg daily or 5 mg daily 4
• Combination therapy: Consider adding azathioprine 1-2 mg/kg daily to reduce steroid-related side effects 4

Post-Infectious Cough

• Severe paroxysms: 30-40 mg/day for a short period when other causes ruled out 4

Administration Guidelines

Timing and Method

• Optimal timing: Morning administration (before 9 am) to minimize adrenal suppression 1
• With food: Take with food or milk to reduce gastric irritation 1
• Oral administration: Preferred and equally effective as IV therapy unless GI absorption is impaired 2

Tapering Recommendations

• Short courses (≤10 days): No tapering generally required 2
• Longer courses: Decrease initial dose in small increments at appropriate intervals 1
• Avoid abrupt withdrawal: Gradually taper dose when discontinuing long-term therapy 1

Monitoring During Treatment

• Blood glucose: Monitor regularly, especially in diabetic patients (2-3 fold increase expected) 2
• Blood pressure: Regular monitoring, particularly in hypertensive patients 2
• Bone health: Baseline and annual bone mineral densitometry for long-term treatment 4
• Clinical response: Adjust dosage based on disease activity and patient response 1

Common Pitfalls to Avoid

• Delaying corticosteroid administration in acute conditions requiring immediate intervention 2
• Using IV instead of oral administration when GI absorption is adequate 2
• Unnecessary tapering for short courses (≤10 days) 2
• Failing to monitor for side effects, particularly in high-risk patients (diabetics, elderly) 2
• Not providing gastric protection when using high doses or prolonged therapy 1

Side Effects to Monitor

• Short-term: Behavioral changes, sleep disturbances, mood changes, hyperglycemia 2
• Long-term: Growth suppression in children, adrenal suppression, decreased bone mineral density, weight gain 4, 2
• Cosmetic changes: Facial rounding, dorsal hump formation, striae, weight gain, acne (occur in 80% after 2 years) 4
• Severe complications: Osteopenia with vertebral compression, brittle diabetes, psychosis, hypertension 4

Prednisone is a powerful medication that requires careful administration and monitoring. The dosage and duration should be tailored to the specific condition being treated, with attention to minimizing side effects through appropriate dosing schedules and monitoring.