What is the typical dosage for a 3-day course of steroid treatment?

Steroid Dosing for 3-Day Treatment Course

For a 3-day steroid burst, the recommended dosage is 1-2 mg/kg/day of prednisone (maximum 60 mg/day), typically given as 40-60 mg daily for adults, without requiring a taper for courses under 10 days. 1

Standard 3-Day Dosing Regimens

Adult Dosing

• 40-60 mg/day of prednisone for 3 days is the standard burst regimen for adults and adolescents ≥12 years 1
• Can be administered as a single daily dose or divided into 2 doses 1
• Weight-based dosing: 1-2 mg/kg/day with a maximum of 60 mg/day 1
• For significantly overweight patients, dose based on ideal body weight 1

Severe/Critical Illness Context

• For grade 3-4 immune-related adverse events, use 1-2 mg/kg/day IV methylprednisolone for 3 days, then reduce to 1 mg/kg/day 2
• For septic shock, use IV hydrocortisone <400 mg/day for at least 3 days at full dose, not high-dose short courses 2

Key Clinical Considerations

No Taper Required

• Courses <1 week do not require tapering 1
• Courses up to 10 days probably do not need tapering, especially if the patient is on inhaled corticosteroids 1
• This eliminates compliance concerns with multi-day tapers 1

Route of Administration

• No advantage exists for IV administration over oral therapy if gastrointestinal absorption is intact 1
• Oral prednisone shows excellent compliance rates (94.3%) even at high doses of 1,250 mg daily 3

Common Adverse Effects (Generally Well-Tolerated)

• Reversible abnormalities in glucose metabolism 1
• Increased appetite, fluid retention, weight gain 1
• Mood alteration, hypertension, insomnia, facial flushing 1
• Most serious side effects occur with chronic use rather than short courses 4

Important Caveats

Monitoring Requirements

• Patients with diabetes, hypertension, or peptic ulcer disease require closer monitoring as these conditions can be worsened by systemic corticosteroids 1
• Ensure appropriate follow-up to assess response 1

Avoid Underdosing

• The commonly prescribed methylprednisolone dose pack provides significantly less than the recommended total dose and should be avoided 4
• Adequate dosing is crucial for optimal treatment outcomes 4

Context-Specific Exceptions

• Bullous pemphigoid and severe autoimmune conditions may require longer courses (not 3-day bursts) with doses of 0.75-1 mg/kg daily for weeks 2
• Pediatric nephrotic syndrome requires extended courses (4-6 weeks), not 3-day bursts 5, 6