Prednisone and Heart Rate in Children
Prednisone does not lower resting heart rate in children; in fact, it can cause bradycardia as a side effect, particularly at standard to high doses. 1
Evidence of Bradycardia with Prednisone
The most relevant evidence comes from a documented case of a 14-year-old boy with nephrotic syndrome who developed significant bradycardia (heart rate 50-60 bpm, less than 50% of baseline) after receiving oral prednisone 80 mg/day divided into three doses. 1 The bradycardia resolved when the dose was reduced to 60 mg every other day, demonstrating a clear dose-dependent relationship. 1
This bradycardia represents an adverse effect rather than a therapeutic benefit - the patient's heart rate dropped to pathologically low levels requiring dose reduction. 1
Mechanism and Clinical Context
- Corticosteroids, including oral prednisone, can cause cardiac arrhythmias, with bradycardia being the most commonly reported rhythm disturbance. 1
- While most reported cases of steroid-induced bradycardia occur with high-dose intravenous administration, bradyarrhythmias can occur even with standard doses of oral prednisone. 1
- The bradycardia typically occurs without other significant corticosteroid side effects and may not produce symptoms despite the significantly reduced heart rate. 1
Standard Pediatric Prednisone Dosing
For context, typical pediatric prednisone dosing varies by indication:
- Acute asthma exacerbation: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 2
- Nephrotic syndrome: 60 mg/m² or 2 mg/kg daily (maximum 60 mg/day) until remission 2
- Infantile hemangiomas: 2-3 mg/kg/day appears optimal 2
- Immune thrombocytopenia: 1-2 mg/kg/day, with higher doses (4 mg/kg/day) for 3-4 days showing 72-88% response rates 2
Important Clinical Caveats
Prednisone should never be used as a heart rate-lowering agent in children with tachycardia. The bradycardia that can occur is an adverse effect requiring monitoring and potential dose adjustment, not a therapeutic benefit. 1
For pediatric tachycardia management:
- Supraventricular tachycardia: Adenosine (150-250 mcg/kg) is first-line, with higher initial doses needed in children compared to adults 3
- Rate control in atrial fibrillation/flutter: Beta blockers or calcium channel antagonists are recommended 2
- Digoxin and propranolol have similar efficacy in infants with SVT without preexcitation 3
Monitor heart rate when prescribing prednisone at doses ≥2 mg/kg/day, as clinically significant bradycardia can develop even without other steroid toxicity. 1 If bradycardia occurs (heart rate <50% of baseline), consider dose reduction or alternative therapy. 1