What is the recommended dosing for Orapred (prednisolone)?

Recommended Dosing for Orapred (Prednisolone)

The recommended dosing for Orapred (prednisolone) ranges from 5 to 60 mg per day depending on the specific condition being treated, with initial dosing typically individualized based on disease severity and patient response. 1

General Dosing Guidelines

• The initial dose of prednisolone may vary from 5 to 60 mg per day depending on the specific disease entity being treated 1
• For less severe conditions, lower doses generally suffice, while selected patients may require higher initial doses 1
• Dosage should be maintained or adjusted until a satisfactory response is noted, with subsequent gradual dose reduction to determine the lowest effective maintenance dose 1

Disease-Specific Dosing

Autoimmune Hepatitis

• Initial treatment: 30 mg/day prednisolone, reducing to 10 mg/day over 4 weeks, plus azathioprine 1 mg/kg/day 2
• Higher initial doses (up to 1 mg/kg/day) may be used for more rapid normalization of transaminases 2
• For maintenance, if tolerated, treatment with prednisolone 5-10 mg/day should continue for at least 2 years 2

Nephrotic Syndrome

• For children: 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 tapering 2
• For relapses: Daily prednisolone until remission for at least 3 days, followed by alternate-day prednisolone for at least 3 months 2

Bullous Pemphigoid

• Severe involvement: 0.75-1 mg/kg/day 2
• Moderate disease: 0.3 mg/kg/day 2
• Mild/localized disease: 0.5 mg/kg/day 2
• Tapering: Reduce dose at fortnightly intervals, initially by one-third or one-quarter down to 15 mg daily, then by 2.5 mg decrements to 10 mg daily, followed by 1 mg monthly reductions 2

Asthma Exacerbations

• For acute exacerbations in children: 1-2 mg/kg/day (maximum 60 mg/day) as a short course or "burst" therapy 2
• Continue until peak expiratory flow rate reaches 80% of personal best or symptoms resolve (typically 3-10 days) 2
• No evidence that tapering the dose after improvement prevents relapse 2

Pediatric Dosing

• Initial doses range from 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m²/day) 1
• For nephrotic syndrome: 60 mg/m²/day in three divided doses for 4 weeks, followed by 4 weeks of single-dose alternate-day therapy at 40 mg/m²/day 1
• For asthma uncontrolled by inhaled corticosteroids and long-acting bronchodilators: 1-2 mg/kg/day in single or divided doses 1

Administration Considerations

• Prednisolone is typically administered as a single daily dose 2
• For long-term therapy, alternate-day dosing may help reduce adverse effects 2
• If treatment is to be discontinued after long-term therapy, gradual withdrawal is recommended rather than abrupt cessation 1

Special Considerations and Precautions

• Monitor patients regularly during therapy, with intervals of 1-6 months depending on level of control and treatment required 2
• Consider step-down in therapy once the condition is well-controlled for at least 3 months 2
• Calcium and vitamin D supplementation should be provided to patients on long-term steroid therapy 2
• Bone DEXA scanning should be performed at 1-2 yearly intervals for patients on long-term steroids 2
• Consider corticosteroid-sparing agents for patients requiring long-term therapy, especially in children and elderly patients 3