Recommended Prednisolone Dosing for a 50 kg Child
For a 50 kg child, the recommended dose of prednisolone is 1-2 mg/kg/day (50-100 mg/day), with a practical maximum of 60 mg/day as a single daily dose. 1, 2
General Dosing Principles
- For significantly overweight children, dosing should be based on ideal body weight to avoid unnecessary steroid exposure 2
- The maximum daily dose is typically 60 mg, regardless of weight, though in specific conditions higher doses may occasionally be considered 2, 1
- Prednisolone and prednisone are equivalent and used in the same dosage 2
Condition-Specific Dosing
Asthma
- For acute asthma exacerbations: 1-2 mg/kg/day (50-60 mg/day) as a single daily dose 3, 1
- Lower doses of 0.5 mg/kg/day (25 mg/day) have been shown to be as effective as higher doses for acute asthma exacerbations with fewer side effects 4, 5
- For maintenance: taper by reducing the dose by 25-33% at appropriate intervals once clinical response is achieved 6
Nephrotic Syndrome
- First episode treatment: 2 mg/kg/day (60 mg/day maximum) as a single daily dose for 4-6 weeks, followed by 1.5 mg/kg/day (40 mg maximum) on alternate days for 2-5 months with tapering 3, 2
- For relapses: 2 mg/kg/day (60 mg/day maximum) until remission for at least 3 days, then 1.5 mg/kg/day on alternate days for at least 4 weeks 3, 2
Administration Considerations
- Administer as a single daily dose in the morning to minimize adrenocortical suppression 2
- For a 50 kg child, the dose would typically be 50-60 mg/day (using 1-2 mg/kg/day dosing) 1
- During upper respiratory infections in children with frequently relapsing conditions, daily prednisolone may be given to prevent relapse 2
Important Monitoring and Precautions
- Monitor for steroid-related adverse effects regularly, especially with prolonged use 2
- Common side effects include:
- Cushingoid features
- Growth deceleration
- Weight gain/increased appetite
- Hypertension
- Gastric irritation 3
- Consider corticosteroid-sparing agents for children who develop steroid-related adverse effects with frequent or prolonged use 2
- Vomiting is more common with higher doses (2 mg/kg/day vs. 1 mg/kg/day), so using the lowest effective dose is recommended 5
Tapering Recommendations
- Once response is achieved, gradually taper by reducing the dose by 25-33% at appropriate intervals 6
- For longer courses, reduce by approximately one-third to one-quarter down to 15 mg daily, then reduce by 2.5 mg decrements down to 10 mg daily, and finally reduce by 1 mg each month until reaching the minimum effective dose 6
- Avoid abrupt discontinuation after long-term therapy 1
Alternative Formulations
- If compliance is a concern, a single dose of oral dexamethasone (0.3 mg/kg) has been shown to be non-inferior to a 3-day course of prednisolone (1 mg/kg/day) for acute asthma exacerbations 7
- Oral prednisolone has been found to be as effective as intravenous methylprednisolone in equivalent doses for hospitalized children with asthma 8