What is the recommended dose of prednisolone (corticosteroid) for a patient weighing 37 kilograms?

Prednisolone Dosing for 37 kg Patient

For a patient weighing 37 kg, the recommended prednisolone dose depends on the specific condition being treated, but generally ranges from 18.5-37 mg daily for initial therapy of most autoimmune conditions, calculated using weight-based dosing of 0.5-1 mg/kg/day. 1, 2

Weight-Based Dosing Calculations

Standard Dosing Ranges

• Low-dose regimen: 0.5 mg/kg/day = 18.5 mg daily 1, 2
• Moderate-dose regimen: 0.75 mg/kg/day = 27.75 mg daily 3, 1
• High-dose regimen: 1 mg/kg/day = 37 mg daily 3, 1, 2

Disease-Specific Recommendations

For severe/widespread autoimmune conditions (e.g., bullous pemphigoid, pemphigus):

• Initial dose: 27.75-37 mg daily (0.75-1 mg/kg/day) 2
• Do not exceed 37 mg daily (1 mg/kg/day) without considering IV pulse therapy, as higher doses increase mortality risk without additional benefit 3, 2

For moderate autoimmune disease:

• Initial dose: 18.5 mg daily (0.5 mg/kg/day) 2, 4
• Recent evidence suggests doses below 0.5 mg/kg/day may be equally effective with less cumulative steroid exposure 4

For mild/localized disease:

• Initial dose: 11-18.5 mg daily (0.3-0.5 mg/kg/day) 2

For asthma exacerbations:

• Minimum effective dose: 22 mg daily (0.6 mg/kg/day) for up to 2 weeks 5

Pediatric Considerations

If this is a pediatric patient, alternative dosing approaches include:

• Body surface area method: 60 mg/m² for severe conditions 1
• Alternate-day dosing: 27.75-46.25 mg every other day (0.75-1.25 mg/kg) to reduce side effects 1

Critical Safety Thresholds

Maximum safe daily dose: The evidence strongly indicates that doses above 0.75 mg/kg/day (27.75 mg for 37 kg) do not provide additional benefit and significantly increase mortality risk, particularly in elderly patients 3

Common pitfall: A systematic review found that prednisolone doses higher than 0.75 mg/kg daily (equivalent to 52.5 mg for a 70 kg patient, or 27.75 mg for 37 kg) showed no additional efficacy but substantially increased adverse events and mortality 3

Practical Dosing Algorithm

1. Start with 18.5-27.75 mg daily for most autoimmune conditions 1, 2, 4
2. If no response within 5-7 days, increase by 50% increments (to maximum 37 mg daily) 2
3. Once disease controlled (typically 1-4 weeks), begin tapering by 25-33% at appropriate intervals 1
4. Taper schedule: Reduce by one-third to one-quarter down to 15 mg daily, then by 2.5 mg decrements to 10 mg daily, then by 1 mg monthly 1

Important Monitoring and Precautions

Mandatory co-interventions:

• Initiate calcium and vitamin D supplementation at treatment onset 2
• Consider osteoporosis prophylaxis per established guidelines 3

Weight gain risk: Expect 1.6-5 kg weight gain over 2 years, with dose-dependent relationship (higher doses = more weight gain) 3

Hyperglycemia management: If prescribed ≥20 mg/day, initial insulin dose should be 0.5 units/kg bodyweight if hyperglycemia develops 6

Timing consideration: If behavioral issues occur (particularly in adolescents), consider afternoon dosing after school 1