From the Guidelines
Prednisolone is the best IV steroid alternative to 18mg of prednisone daily, as it can be used in equivalent doses 1.
Key Points
- Prednisolone can replace prednisone in equivalent doses, making it a suitable alternative 1.
- The equivalent dose of prednisolone to 18mg of prednisone daily would be 18mg of prednisolone.
- It is essential to monitor patients on long-term corticosteroid treatment, including prednisolone, for bone disease by baseline and annual bone mineral densitometry of the lumbar spine and hip 1.
- In certain cases, such as severe cytopenia, prednisolone may be preferred over prednisone as the sole medication 1.
- When reducing the dose, it is recommended to taper down by 5mg every week until 10mg/day is achieved, and then further reduction by 2.5mg/week can be considered 1.
From the Research
IV Steroid Alternatives to Prednisone
To find the best IV steroid alternative to 18mg of prednisone daily, we need to consider the bioequivalence and efficacy of different steroids.
- The bioavailability of IV methylprednisolone and oral prednisone has been compared in a study 2, which found that the total amount of steroid absorbed after 1250 mg oral prednisone vs 1 gram IVMP in 16 patients with multiple sclerosis (MS) did not differ significantly.
- Another study 3 compared the efficacy of single dose intravenous methylprednisolone versus oral prednisolone in Bell's palsy and found that they had similar recovery rates.
- A review of five eligible studies 4 comparing oral versus intravenous steroids for acute relapses in patients with clinically definite MS found no significant difference in relapse recovery at week four.
Equivalent Doses
- A study 2 compared the bioavailability of 1250 mg oral prednisone and 1 gram IVMP, suggesting that these doses may be equivalent.
- However, the equivalent dose of IV methylprednisolone to 18mg of prednisone daily is not directly stated in the provided studies.
- A study 5 used 1000 mg of oral or intravenous methylprednisolone once a day for 3 days to treat relapses in patients with multiple sclerosis, but this is a different dosing regimen.
Safety and Efficacy
- The safety and efficacy of oral and intravenous methylprednisolone have been compared in several studies 3, 4, 5, with no significant differences found in clinical, radiological, or pharmacological outcomes.
- However, the specific safety and efficacy of using IV methylprednisolone as an alternative to 18mg of prednisone daily are not directly addressed in the provided studies.