Orapred (Prednisolone) Dosing for a 4-Year-Old
For a 4-year-old child, the standard prednisolone dose is 1-2 mg/kg/day (maximum 60 mg/day), with the specific dose and duration depending on the condition being treated. 1, 2
Condition-Specific Dosing
Asthma Exacerbations (Most Common Use)
- Dose: 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) 1
- Duration: 3-10 days (typically 5 days for outpatient "burst" therapy) 1, 2
- No tapering needed for courses less than 1 week, and probably unnecessary for courses up to 10 days, especially if the child is on inhaled corticosteroids 1
- Can be given as a single daily dose or divided into 2 doses 1
Other Respiratory Conditions
- For viral respiratory infection-induced lower airway disease: 2 mg/kg/day for 3 days has been shown effective 3
- This dosing reduced hospitalization length and symptom duration in children 6-35 months old 3
Nephrotic Syndrome
- First episode: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single daily morning dose for 4-6 weeks 4, 5
- Followed by 40 mg/m²/day or 1.5 mg/kg/day on alternate days for 2-5 months with tapering 4, 5
Practical Dosing Example for a 4-Year-Old
Assuming an average 4-year-old weighs approximately 16-18 kg:
For asthma exacerbation:
- At 1 mg/kg/day: 16-18 mg/day
- At 2 mg/kg/day: 32-36 mg/day
- Typically given as 30-40 mg/day divided into 2 doses (15-20 mg twice daily) 1
Orapred oral solution concentration: 15 mg/5 mL 2
- For 30 mg/day: 10 mL/day (5 mL twice daily)
- For 40 mg/day: 13.3 mL/day (approximately 6.7 mL twice daily)
Critical Dosing Principles
Weight-Based Considerations
- For significantly overweight children, use ideal body weight to avoid unnecessary steroid exposure 4, 5
- The FDA label specifies the range as 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m² BSA/day) 2
Administration Timing
- Give as a single morning dose when possible to minimize adrenocortical suppression 4
- For asthma exacerbations, divided dosing (twice daily) is commonly used 1
Important Safety Considerations
Common Side Effects to Monitor
- Cushingoid features, growth deceleration, weight gain/increased appetite, hypertension, and gastric irritation 5
- Regular monitoring for steroid-related adverse effects is essential, especially with prolonged use 4, 5
Stopping Therapy
- For short courses (<1 week), no taper is needed 1
- For courses up to 10 days, tapering is probably unnecessary if the child is on inhaled corticosteroids 1
- If stopping after long-term therapy, withdraw gradually rather than abruptly 2
Common Pitfalls to Avoid
- Do not use simple mg/kg scaling from adult doses without considering the child's maturation and size-specific pharmacokinetics 6
- Do not exceed 60 mg/day maximum for routine pediatric conditions 1, 4, 2
- Do not continue therapy without clinical response after a reasonable period; consider alternative therapy 2
- Avoid dosing based on total body weight in overweight children; use ideal body weight instead 4, 5