Prednisone Dosing for Ulcerative Colitis Flare
For patients with moderate to severe ulcerative colitis flares, prednisolone 40 mg daily with a taper over 6-8 weeks is the recommended treatment regimen. 1
Initial Dosing Based on Disease Severity
- For moderate to severe UC flares: Prednisolone 40 mg daily as a single morning dose 1
- For mild to moderate UC flares that have failed 5-ASA therapy: Prednisolone 40 mg daily 1
- Single daily dosing is preferred over split dosing as it causes less adrenal suppression while maintaining efficacy 1, 2
Duration and Tapering
- Total treatment duration should be 6-8 weeks with a gradual taper 1
- A typical tapering schedule involves starting at 40 mg daily for 1-2 weeks, then reducing by 5 mg weekly until discontinuation 1, 2
- Rapid tapering increases the risk of relapse, while prolonged use increases the risk of steroid-related adverse effects 1, 2
Monitoring Response
- Patients should be evaluated for symptomatic response within 2 weeks of starting corticosteroid therapy 1
- If no adequate response is seen within 2 weeks, treatment modification or escalation should be considered 1
- Approximately 50% of patients will experience short-term corticosteroid-related adverse effects (acne, edema, sleep disturbance, mood changes, glucose intolerance) 1
Alternative Corticosteroid Options
- For patients wishing to avoid systemic effects, topically-acting oral corticosteroids can be considered: 1, 2
- Budesonide MMX 9 mg daily for 8 weeks
- Beclomethasone dipropionate 5 mg daily for 4 weeks
Important Considerations and Pitfalls
- Corticosteroids should not be used for maintenance therapy as they are ineffective for this purpose and associated with significant adverse effects 1
- Patients requiring two or more courses of corticosteroids in the past year, or who become corticosteroid-dependent, require treatment escalation to steroid-sparing therapies 1, 2
- Higher doses (>40-60 mg/day) of prednisolone show no additional benefit but increase the risk of adverse effects 1
- Historical studies using cortisone required higher doses (equivalent to 100 mg/day) due to lower potency compared to prednisolone 1
- In patients with severe disease not responding to oral therapy, intravenous corticosteroids should be considered before proceeding to rescue therapies 3
Evidence Quality
The recommendation for prednisolone 40 mg daily with a 6-8 week taper is based on high-quality evidence from multiple clinical guidelines 1. This dosing regimen has been shown to be more effective than lower doses (20 mg/day) while avoiding the increased adverse effects seen with higher doses 1.