What is the recommended dose of Omnacortil (prednisolone) syrup?

Omnacortil (Prednisolone) Syrup Dosing

For most pediatric conditions, prednisolone syrup is dosed at 1-2 mg/kg/day (maximum 60 mg/day), given as a single morning dose or divided doses depending on the specific condition being treated. 1, 2

Standard Dosing by Indication

Acute Inflammatory Conditions (Asthma, Allergic Reactions, Croup)

• Initial dose: 1-2 mg/kg/day (maximum 60 mg/day) 1, 3, 2
• For asthma exacerbations specifically: 1-2 mg/kg/day in single or divided doses for 3-10 days 2
• For severe croup: maximum 60 mg as a single dose 4
• Single morning dose preferred to minimize adrenocortical suppression 4

Crohn's Disease (Pediatric)

• 1 mg/kg/day (maximum 40 mg/day) once daily for most children 1
• May increase to 1.5 mg/kg/day (maximum 60 mg/day) if response is unsatisfactory 1
• Taper according to standardized protocols after achieving remission 1

Nephrotic Syndrome (Pediatric)

• 60 mg/m²/day in three divided doses for 4 weeks 2
• Followed by 40 mg/m²/day as single-dose alternate-day therapy for 4 weeks 2

Administration Guidelines

Timing and Duration

• Give as single morning dose when possible to reduce adrenal suppression 4
• For courses less than 1 week: no tapering needed 5
• For courses up to 10 days: tapering likely unnecessary, especially if on concurrent inhaled corticosteroids 5
• For longer courses: taper gradually rather than stopping abruptly 2

Route Considerations

• Oral administration is preferred unless the child is vomiting or in severe respiratory distress 4
• No proven advantage for IV over oral administration if gastrointestinal absorption is intact 5

Age-Specific Considerations

Infants (1-3 months)

• Limited data available for this age group 1
• Literature suggests 60-65 mg/kg/day, though pharmacokinetic data may favor higher doses 6
• Use with caution and close monitoring 6

Neonates (Under 1 month)

• No established dosing guidelines for routine use 6
• 30 mg/kg/day achieves therapeutic concentrations in neonates, but further studies needed 6
• Avoid unless absolutely necessary 6

Children 4 months and older

• Standard dosing applies: 1-2 mg/kg/day (maximum 60 mg/day) 2, 6
• Prescriptions exceeding 95 mg/kg/day should be avoided due to cumulative toxicity risk 6

Important Safety Considerations

Maximum Doses

• Absolute maximum: 60 mg/day for most pediatric conditions 1, 4, 3
• Higher doses (up to 120 mg) only used in specific adult protocols or severe conditions 2, 7
• Never exceed 95 mg/kg/day to avoid hepatic and renal toxicity 6

Monitoring Requirements

• Constant monitoring needed for dosage adjustments based on clinical response 2
• Watch for changes in disease activity, individual drug responsiveness, and exposure to stressful situations 2
• Consider bone protection (calcium, vitamin D) for prolonged courses 1

Common Pitfalls to Avoid

• Do not use for maintenance therapy in chronic conditions like Crohn's disease 1
• Avoid abrupt discontinuation after long-term use 2
• Do not assume IV is superior to oral—it increases costs without proven benefit 5, 7
• Be cautious with "on-demand" charting that could lead to cumulative overdosing 6