What is the dosage and treatment duration of Meticorten (Prednisone)?

Meticorten (Prednisone) Dosage and Treatment Schedule

The initial dosage of prednisone ranges from 5 mg to 60 mg per day depending on the specific disease being treated, administered as a single morning dose prior to 9 am to minimize adrenocortical suppression. 1

General Dosing Principles

Initial Dosing

• Starting dose varies by indication: 5-60 mg/day based on disease severity 1
• Timing is critical: Administer in the morning before 9 am as a single dose, since maximal adrenal cortex activity occurs between 2 am and 8 am 1
• Maximum single dose: Should not exceed 60 mg for most conditions 2, 1
• Take with food or milk to reduce gastric irritation 1

Maintenance and Tapering Strategy

• After achieving response: Decrease dosage in small increments at appropriate intervals until the lowest effective dose is reached 1
• Tapering must be gradual rather than abrupt, especially after long-term therapy 1
• Critical threshold for tapering: When reaching 10-15 mg/day, use very slow decrements of 1.0-2.5 mg at intervals of 2-6 weeks 3
• Below 25 mg/day: Taper by 2.5 mg every 2-4 weeks 3
• Below 15 mg/day: Taper by 1.25-2.5 mg every 2-6 weeks 3

Disease-Specific Dosing Regimens

Autoimmune Hepatitis (Adults)

Combination therapy (preferred):

• Week 1: 30 mg/day prednisone + 50 mg/day azathioprine 3
• Week 2: 20 mg/day prednisone + 50 mg/day azathioprine 3
• Week 3-4: 15 mg/day prednisone + 50 mg/day azathioprine 3
• Maintenance: 10 mg/day prednisone + 50 mg/day azathioprine until endpoint 3
• Average treatment duration: 18-24 months 3

Monotherapy (if azathioprine contraindicated):

• Week 1: 60 mg/day 3
• Week 2: 40 mg/day 3
• Week 3-4: 30 mg/day 3
• Maintenance: 20 mg/day and below 3

Autoimmune Hepatitis (Children)

• Initial: 1-2 mg/kg/day (maximum 60 mg/day) for 2 weeks 3
• Maintenance: Taper over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 3
• Continue until: Normal liver tests for 1-2 years with no flares 3

Nephrotic Syndrome (First Episode in Children)

• Daily phase: 60 mg/m²/day (maximum 60 mg) as single daily dose for 6 weeks 3
• Alternate-day phase: 40 mg/m² on alternate days for 6 weeks 3
• Tapering: Reduce by 10 mg/m² per week to 5 mg on alternate days 3
• Total duration: 16 weeks 3

Nephrotic Syndrome (Relapses in Children)

• Infrequent relapses: 60 mg/m²/day (maximum 60 mg) until remission for 3 days, then 40 mg/m² on alternate days for at least 4 weeks 3
• Frequent relapses/steroid-dependent: Daily prednisone until remission for 3 days, followed by alternate-day therapy for at least 3 months 3

Rheumatoid Arthritis (Long-term Management)

• Low-dose approach: <5 mg/day for long-term maintenance is effective and well-tolerated 4, 5, 6
• Initial dose: 10 mg/day or less, with trend toward lower initial doses (3.6 mg/day) in recent practice 6
• Divided dosing: May use 5 mg twice daily for better inflammation control 4
• Early active RA: 10 mg/day as monotherapy shows clinical benefit and retards radiologic progression 7

Multiple Sclerosis (Acute Exacerbations)

• High-dose regimen: 200 mg/day for 1 week, followed by 80 mg every other day for 1 month 1

Pericarditis (Recurrent)

• Starting dose: 0.25-0.50 mg/kg/day 3
• Tapering schedule:

  • 50 mg: decrease by 10 mg/day every 1-2 weeks 3

  • 50-25 mg: decrease by 5-10 mg/day every 1-2 weeks 3
  • 25-15 mg: decrease by 2.5 mg/day every 2-4 weeks 3
  • <15 mg: decrease by 1.25-2.5 mg/day every 2-6 weeks 3

Critical Safety Considerations

Bone Protection (Mandatory for All Patients)

• Calcium supplementation: 800-1,500 mg/day 3
• Vitamin D: 400-1,000 IU/day 3
• Bisphosphonates: Recommended for men ≥50 years and postmenopausal women on ≥5-7.5 mg/day long-term 3
• Monitoring: Baseline and annual bone mineral densitometry of lumbar spine and hip 3

Monitoring Requirements

• Dosage adjustments needed for: Changes in clinical status, disease exacerbations, individual drug responsiveness, and stressful situations 1
• Each tapering step: Should only occur if patient is asymptomatic and inflammatory markers (e.g., CRP) are normal 3
• Constant monitoring required throughout treatment course 1

Withdrawal Precautions

• Never stop abruptly after long-term therapy 1
• Gradual withdrawal is mandatory to allow HPA axis recovery 1
• Patient vulnerability: During and after tapering, patients are vulnerable to stressful situations due to adrenal suppression 1

Alternate-Day Therapy

• Purpose: Minimize pituitary-adrenal suppression, Cushingoid effects, and growth suppression in children 1
• Dosing: Administer twice the usual daily dose every other morning 1
• Rationale: Anti-inflammatory effects persist longer than metabolic effects, allowing HPA axis recovery on off-steroid days 1

Common Pitfalls to Avoid

• Underdosing: Ensure adequate initial dosing based on disease severity; methylprednisolone dose packs often provide insufficient total steroid exposure 3
• Premature tapering: Especially dangerous when using higher initial doses, as it increases recurrence risk 3
• Ignoring circadian rhythm: Morning administration is essential to minimize adrenal suppression 1
• Abrupt discontinuation: Always taper gradually, particularly after prolonged therapy 1
• Inadequate bone protection: Calcium and vitamin D should be initiated simultaneously with prednisone 3