From the Guidelines
For a 36.9kg child, the recommended prednisolone oral dosage is 1 mg/kg/day, which would be approximately 37 mg daily. This dosage is based on the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris, which suggests starting with prednisolone 1 mg kg-1 per day (or equivalent) in most cases 1. The medication should be taken with food to minimize gastrointestinal side effects.
Key Considerations
- The duration of treatment depends on the condition being treated, with short courses (3-5 days) often used for acute conditions, while longer courses with gradual tapering may be needed for chronic conditions.
- Never stop prednisolone abruptly after prolonged use as this can cause adrenal insufficiency.
- Common side effects include increased appetite, mood changes, and sleep disturbances.
- Blood glucose should be monitored, especially in patients with diabetes or at risk for diabetes.
Dosage Adjustments
- Increase in 50–100% increments every 5–7 days if blistering continues, as suggested by the British Association of Dermatologists' guidelines 1.
- Consider pulsed intravenous corticosteroids if > 1 mg kg-1 oral prednisolone required, or as initial treatment in severe disease followed by 1 mg kg-1 per day oral prednisolone.
- Taper dose once remission is induced and maintained, with absence of new blisters and healing of the majority of lesions (skin and mucosal), aiming to reduce to 10 mg daily or less 1.
From the FDA Drug Label
The range of initial doses is 0. 14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m2bsa/day). The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses
The oral dosage of prednisolone for a 36.9kg patient can be calculated as follows:
- Using the range of initial doses: 0.14 to 2 mg/kg/day, the dose would be 5.16 to 73.8 mg/day.
- Using the NHLBI recommended dosing: 1-2 mg/kg/day, the dose would be 36.9 to 73.8 mg/day. The recommended dosage is 0.14 to 2 mg/kg/day or 1-2 mg/kg/day, which for a 36.9kg patient would be 5.16 to 73.8 mg/day or 36.9 to 73.8 mg/day 2.
From the Research
Oral Dosage of Prednisolone
- The ideal oral dosage of prednisolone for a 36.9kg individual is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, study 4 mentions that 6 mg of prednisolone was administered daily to subjects with inflammatory rheumatologic disease.
- Study 6 investigated the pharmacokinetics and pharmacodynamics of prednisolone after intravenous and oral administration, with oral doses of 20 and 40 mg.
- It is essential to note that the dosage of prednisolone may vary depending on the specific medical condition, age, and other factors, and should be determined by a healthcare professional.
Factors Affecting Prednisolone Dosage
- The pharmacokinetics of prednisolone are dose-dependent and time-dependent, with higher clearance for higher concentrations 6.
- The comparison of 20 mg administered in the morning with the same dose given in the evening shows that the pharmacokinetics of prednisolone after oral administration of equal doses changes during the day 6.
- Study 3 highlights the importance of considering the interconversion of prednisone into prednisolone, as well as the effects of liver function, renal function, and other factors on prednisolone concentrations.
Safety and Efficacy
- Study 7 found that mortality rates were higher with prednisolone compared to hydrocortisone in patients with primary adrenal insufficiency.
- Study 5 concluded that oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma, as they do not reduce symptom duration or severity.
- The safety and efficacy of prednisolone should be carefully evaluated, taking into account the specific medical condition, dosage, and individual patient factors 3, 4, 5, 6, 7.