Prednisone Dosing Guidelines
The typical dosing range for prednisone varies from 5 mg to 60 mg per day, depending on the specific condition being treated, with dosage requiring individualization based on disease severity and patient response. 1
General Dosing Principles
- Initial dosage typically ranges from 5-60 mg daily, with higher doses (up to 1-2 mg/kg/day) used for more severe conditions 1
- Maximum recommended daily dose is generally 60 mg for adults 2, 1
- Prednisone should be administered in the morning prior to 9 am to minimize adrenal suppression 1
- For single daily dosing, morning administration is preferred as it aligns with the body's natural cortisol rhythm 1
Disease-Specific Dosing
Nephrotic Syndrome
- Initial treatment: 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks 2
- Followed by alternate-day dosing at 40 mg/m² or 1.5 mg/kg (maximum 40 mg on alternate days) for 2-5 months with gradual tapering 2
- For relapses: 60 mg/m² or 2 mg/kg/day until remission for at least 3 days, then taper 2
Sudden Sensorineural Hearing Loss
- Recommended dose: 1 mg/kg/day (maximum 60 mg daily) for 7-14 days, followed by tapering over a similar period 2
- A representative tapering regimen: maximum dose for 4 days, then 10 mg taper every 2 days 2
Bullous Pemphigoid
- Severe disease: 0.75-1 mg/kg/day 2
- Moderate disease: 0.5 mg/kg/day 2
- Mild/localized disease: 0.3 mg/kg/day 2
- Taper by one-third to one-quarter down to 15 mg daily at fortnightly intervals, then by 2.5 mg decrements to 10 mg daily, followed by 1 mg monthly reductions 2
Pemphigus Vulgaris
- Common practice: 1-2 mg/kg/day (or equivalent) 2
- Milder cases may be treated with 0.5-1 mg/kg/day 2
- Treatment failure defined as lack of response after 3 weeks of prednisolone 1.5 mg/kg/day 2
Rheumatoid Arthritis
- Low-dose therapy: <5 mg/day for long-term management 3, 4
- Historical trend shows declining initial doses from 10.3 mg/day (1980-1984) to 3.6 mg/day (2000-2004) 4
- Long-term maintenance at doses <5 mg/day can be effective with fewer adverse effects 3, 4
Multiple Sclerosis (Acute Exacerbations)
- High-dose protocol: 1,250 mg daily for acute relapses 5
- Alternative regimen: 200 mg daily for one week followed by 80 mg every other day for one month 1
Tapering Recommendations
- After favorable response, gradually decrease initial dose in small increments at appropriate intervals 1
- For long-term therapy, consider alternate-day dosing to minimize adverse effects 1
- Never stop prednisone abruptly; always taper gradually to avoid adrenal insufficiency 1
Safety Considerations and Adverse Effects
- Adverse effects are dose-dependent, with significantly higher risk at doses >10 mg/day 6
- Common adverse effects include bruising, skin thinning, insomnia, mood changes, and increased appetite 5, 3
- More serious adverse events (fractures, serious infections, GI bleeding) increase with doses ≥5 mg/day and duration >1 year 6
- Risk factors for adverse events include higher doses (>10 mg/day), longer duration of treatment, and more severe underlying disease 6
- Gastric irritation may be reduced by taking with food or milk 1
Special Considerations
- For children, dosing is typically weight-based (mg/kg) or body surface area-based (mg/m²) 2
- In elderly patients or those with comorbidities, lower doses may be appropriate to minimize adverse effects 2
- Consider corticosteroid-sparing agents for patients requiring long-term therapy 2