What is the recommended dose of prednisone (corticosteroid) for treating Bell's palsy?

Prednisone Dosing for Bell's Palsy

For Bell's palsy, the recommended prednisone regimen is 60 mg daily for 5 days followed by a 5-day taper, and it must be initiated within 72 hours of symptom onset for optimal effectiveness. 1, 2, 3

First-Line Treatment Recommendations

• Oral corticosteroids are strongly recommended for all patients 16 years and older with Bell's palsy when started within 72 hours of symptom onset 1, 2, 3
• The specific recommended regimen is either:
  • Prednisone 60 mg daily for 5 days followed by a 5-day taper, OR
  • Prednisolone 50 mg daily for 10 days 1, 2, 3
• Early corticosteroid treatment significantly improves the chances of complete recovery (83% at 3 months with steroids vs 63.6% with placebo) 3, 4

Timing of Treatment is Critical

• Treatment must be initiated within 72 hours of symptom onset for effectiveness 1, 2, 3
• Starting steroid treatment beyond the 72-hour window provides minimal benefit and exposes patients to medication risks 1, 3
• Clinical trials demonstrating steroid efficacy specifically enrolled patients within this 72-hour window 1, 4

Special Populations

• For children: Evidence for steroid use is less conclusive as children have higher rates of spontaneous recovery (up to 90%) 3, 5
• For pregnant women: Treatment should be individualized with careful assessment of benefits and risks, but the same dosing regimen applies when treatment is deemed appropriate 3

Combination Therapy Considerations

• Antiviral therapy alone should NOT be prescribed as it is ineffective 1, 2, 3
• Combination therapy with oral antivirals and corticosteroids may be considered as an option within 72 hours of symptom onset 2, 3
• If using combination therapy, recommended antiviral regimens include:
  • Valacyclovir 1 g three times daily for 7 days, OR
  • Acyclovir 400 mg five times daily for 10 days 6

Follow-up and Monitoring

• Implement eye protection for patients with impaired eye closure to prevent corneal damage 1, 3
• Use lubricating ophthalmic drops for daytime protection and ophthalmic ointments for nighttime protection 1, 3
• Consider referral to a facial nerve specialist if:
  • New or worsening neurologic findings develop
  • Ocular symptoms develop
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 2, 3

Common Pitfalls to Avoid

• Delaying treatment beyond the 72-hour window significantly reduces effectiveness 1, 2
• Using antiviral therapy alone is ineffective and not recommended 1, 2, 3
• Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 1, 3
• Not referring patients with incomplete recovery after 3 months for specialist evaluation 1, 3