What is the appropriate dosage and usage of Prednisone (corticosteroid) for various medical conditions?

Prednisone Dosage and Usage Guidelines for Various Medical Conditions

Prednisone dosage should be tailored to the specific condition being treated, with initial doses ranging from 5-60 mg daily depending on disease severity, followed by a gradual taper to the lowest effective maintenance dose. 1

General Dosing Principles

• Initial dosage varies from 5-60 mg daily based on disease entity and severity
• Administer in the morning before 9 AM to minimize adrenal suppression
• Take with food or milk to reduce gastric irritation
• For multiple daily doses, space evenly throughout the day
• Never stop abruptly; always taper gradually

Condition-Specific Dosing

Autoimmune Hepatitis

• Initial therapy: 40 mg daily or 0.6-0.8 mg/kg daily for first 4 weeks 2
• Maintenance: Taper from 20 mg daily by 5 mg weekly until 10 mg/day, then by 2.5 mg weekly to 5 mg daily 3
• Combination therapy: Prednisone with azathioprine preferred (fewer side effects than high-dose prednisone alone) 3

Pediatric Autoimmune Hepatitis

• Initial dose: 1-2 mg/kg daily (up to 60 mg/day) for two weeks 3
• Maintenance: Taper over 6-8 weeks to 0.1-0.2 mg/kg daily or 5 mg daily 3
• Consider early use of azathioprine (1-2 mg/kg daily) to minimize growth effects 3

Multiple Sclerosis

• Acute exacerbations: 200 mg prednisolone daily for one week, followed by 80 mg every other day for one month 1
• Relapse treatment: 1,250 mg oral prednisone daily shows excellent compliance despite requiring multiple tablets 4

Other Conditions

• Bullous pemphigoid: 0.75-1 mg/kg for severe cases, 0.5 mg/kg for moderate cases, 0.3 mg/kg for mild cases 2
• Duchenne muscular dystrophy: 0.75 mg/kg/day more effective than 0.3 mg/kg/day 2, 5
• Alcoholic hepatitis: 40 mg/day for 28 days, then tapered 2
• Nephrotic syndrome: 2 mg/kg/day (maximum 60 mg/day) 2
• Dermatitis/rash: 0.5-1 mg/kg/day tapered over 2 weeks 2
• Colitis: 1-2 mg/kg/day, tapered over 4-6 weeks when improved 2
• Rheumatoid arthritis: Low-dose (<5 mg/day) may be effective for long-term management 6

Dosing Regimens

Daily Dosing

• Standard approach for most acute conditions
• Take as a single morning dose (before 9 AM) to minimize adrenal suppression 1

Alternate Day Therapy

• Twice the usual daily dose administered every other morning
• Helps minimize pituitary-adrenal suppression, Cushingoid state, and growth suppression in children 1
• Beneficial when long-term therapy is required

Weekend-Only Dosing

• 5 mg/kg/weekend day may be as effective as daily 0.75 mg/kg/day for some conditions 5
• May allow for better linear growth in children while maintaining efficacy

Fractionated Dosing

• Twice-daily administration may allow for lower total daily dose in some conditions
• May be equally effective with fewer side effects in certain kidney conditions 7

Tapering Guidelines

• After favorable response, decrease initial dose in small increments at appropriate intervals
• For long-term therapy, taper gradually rather than abruptly to prevent adrenal insufficiency 1
• Typical tapering schedule:
  • 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 2

Monitoring and Side Effects

Common Side Effects

• Cosmetic changes (facial rounding, striae, weight gain, acne) occur in 80% of patients after 2 years 3
• Severe side effects with prolonged therapy (>18 months) may include:
  • Osteopenia with vertebral compression
  • Diabetes
  • Hypertension
  • Psychosis
  • Increased infection risk 3

Monitoring Recommendations

• Blood pressure at each clinic visit
• Glucose levels (urine dipstick)
• Bone mineral density for long-term use (baseline and annual) 3, 2
• Watch for signs of infection, mood changes, and sleep disturbances 2

Special Considerations

• Low-dose prednisone (5 mg daily) can suppress bone formation 8
• Consider prophylaxis against Pneumocystis jirovecii in immunocompromised patients on higher doses 2
• Avoid live vaccines during treatment 2

Treatment Failure

• Defined as failure to achieve control despite 3 weeks of prednisolone 1.5 mg/kg/day 2
• Consider alternative therapies or increasing dose if no response within 5-7 days 2

Contraindications and Cautions

• Active untreated infections
• Patients already receiving exogenous steroids
• Patients with endocrine disorders where steroid administration may interfere with glucose-insulin regulation 2
• Use with caution in patients with diabetes, hypertension, glaucoma, or psychiatric disorders 2