What is the typical dosing range for prednisone (corticosteroid)?

Prednisone Dosing Guidelines

The typical dosing range for prednisone varies from 5 mg to 60 mg per day, depending on the specific disease entity being treated, with dosage requirements being highly variable and requiring individualization based on the disease and patient response. 1

General Dosing Principles

• Prednisone is typically administered as a single daily dose in the morning (before 9 am) to minimize adrenal suppression 1
• Initial dosage should be maintained or adjusted until a satisfactory response is noted, with subsequent tapering to the lowest effective maintenance dose 1
• For long-term therapy, alternate-day dosing may help reduce adverse effects 2
• Gastric irritation may be reduced if taken before, during, or immediately after meals or with food or milk 1

Disease-Specific Dosing

Inflammatory/Autoimmune Conditions

• Sudden Sensorineural Hearing Loss: 1 mg/kg/day (maximum 60 mg daily) for 7-14 days, followed by tapering over a similar period 3
• Nephrotic Syndrome: Initial treatment of 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) for 4-6 weeks, followed by alternate-day dosing 3, 2
• Bullous Pemphigoid:
  • Severe: 0.75-1 mg/kg/day
  • Moderate: 0.5 mg/kg/day
  • Mild/localized: 0.3 mg/kg/day 3
• Pemphigus Vulgaris: 1-2 mg/kg/day for severe cases; 0.5-1 mg/kg/day for milder cases 3
• Autoimmune Hepatitis: Initial treatment of 30 mg/day, reducing to 10 mg/day over 4 weeks 2
• Multiple Sclerosis acute exacerbations: 200 mg prednisolone daily for a week followed by 80 mg every other day for 1 month (equivalent prednisone dosing) 1
• Rheumatoid Arthritis: Lower doses (<5 mg/day) have shown effectiveness for long-term management 4

Respiratory Conditions

• Asthma exacerbations in children: 1-2 mg/kg/day (maximum 60 mg/day) until symptoms resolve, typically 3-10 days 2

Tapering Recommendations

• Initial tapering should aim to reduce the dose to 10 mg/day within 4-8 weeks 5
• For doses below 10 mg, slower tapering at 1 mg every 4 weeks is recommended to minimize risk of adrenal insufficiency 5
• A practical tapering schedule from 40 mg: 40 mg daily for 1-2 weeks, then taper by 5 mg every 1-2 weeks 5
• If long-term therapy is to be stopped, gradual withdrawal is recommended rather than abrupt discontinuation 1

Special Considerations

Pediatric Dosing

• Dosing for children is typically weight-based (mg/kg) or body surface area-based (mg/m²) 3
• For nephrotic syndrome in children: 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) 2

Elderly and Comorbid Patients

• Lower doses may be appropriate to minimize adverse effects 3
• Consider corticosteroid-sparing agents for patients requiring long-term therapy 3, 5

Monitoring and Adverse Effects

• Patients on long-term steroid therapy should receive calcium and vitamin D supplementation 2
• Bone DEXA scanning should be performed at 1-2 yearly intervals for long-term users 2
• Common adverse effects include skin thinning, bruising, hypertension, diabetes, and cataracts 6, 4
• Higher doses (>10 mg/day) are associated with significantly increased risk of adverse events compared to lower doses 6

Historical Trends in Dosing

• The mean initial prednisone dosage for rheumatoid arthritis has declined from 10.3 mg/day in 1980-1984 to 3.6 mg/day in 2000-2004, reflecting a trend toward lower effective doses 4
• Lower doses (<5 mg/day) have shown similar effectiveness to higher doses in long-term management of rheumatoid arthritis 4

Common Pitfalls to Avoid

• Tapering too quickly, especially at doses below 10 mg, which increases risk of adrenal insufficiency and disease relapse 5
• Failing to monitor for signs of disease relapse during the tapering process 5
• Underdosing when switching between different corticosteroids 5
• Abrupt withdrawal of therapy, which can lead to adrenal crisis 1