What is the recommended dosing regimen for prednisone (corticosteroid) for a 9-day course?

Prednisone 9-Day Course Dosing Regimen

For a 9-day course of prednisone in adults, prescribe 40-60 mg daily as a single morning dose (or divided into two doses) without tapering at the end of the course. 1

Standard Dosing Protocol

Adults (≥12 years)

• Dose: 40-60 mg per day 1
• Frequency: Single dose in the morning OR divided into 2 doses throughout the day 2
• Duration: 9 days total 1
• Tapering: No taper needed for courses ≤10 days 1

Children (5-11 years)

• Dose: 1-2 mg/kg/day (maximum 60 mg/day) 1
• Frequency: Single or 2 divided doses 1
• Duration: 9 days falls within the 3-10 day range 1
• Tapering: Not required 1

Young Children (0-4 years)

• Dose: 1-2 mg/kg/day (maximum 60 mg/day) 1
• Same principles apply as older children 1

Timing and Administration

Morning administration is critical - give before 9 AM to minimize adrenal suppression, as this aligns with the body's natural cortisol peak between 2 AM and 8 AM 2

Take with food or milk to reduce gastric irritation 2

If using divided doses, space evenly throughout the day (e.g., morning and early afternoon) 2

Key Clinical Principles

No Tapering Required

The evidence is clear that courses of 7-10 days do not require tapering, especially if patients are concurrently taking inhaled corticosteroids 1. A study comparing tapering versus non-tapering 8-day courses found no difference in relapse rates or adrenal suppression 3.

Dose Selection Within Range

• Use 40 mg/day for milder presentations or smaller adults 1
• Use 60 mg/day for more severe presentations or larger adults 1
• The specific indication (asthma exacerbation, allergic reaction, inflammatory condition) may guide where in this range to start 1

Common Pitfalls to Avoid

Don't unnecessarily taper short courses - This adds complexity without benefit for courses ≤10 days and may reduce compliance 1, 3

Don't give evening doses - Late-day dosing increases adrenal suppression risk 2

Don't use divided doses unless necessary - Single morning dosing is simpler and equally effective for most conditions 2, 4

Don't exceed 60 mg/day in children regardless of weight-based calculations 1

Sample Prescription

For an average adult:

• Prednisone 50 mg tablets
• Take 1 tablet by mouth every morning with food
• Dispense: 9 tablets
• No refills

Alternative for divided dosing:

• Prednisone 20 mg tablets
• Take 2 tablets by mouth twice daily (morning and early afternoon) with food
• Dispense: 18 tablets
• No refills