What is the typical dosing regimen for Prelone (prednisolone)?

Prelone (Prednisolone) Dosing

Prednisolone dosing is highly condition-specific, ranging from 5-60 mg/day, with the FDA-approved range being 5-60 mg/day (1.67-20 mL of oral solution) depending on disease severity, and most conditions requiring initial doses of 0.5-1 mg/kg/day. 1

General Dosing Principles

Adult Dosing by Indication

Autoimmune Hepatitis:

• Initial dose: 30 mg/day, tapering to 10 mg/day over 4 weeks 2
• Higher initial doses up to 1 mg/kg/day may be used for more rapid normalization of transaminases 2
• Maintenance: 5-10 mg/day combined with azathioprine for at least 2 years 2
• For patients intolerant of azathioprine: 60 mg/day, reducing over 4 weeks to 20 mg/day 2

Tuberculous Pericarditis:

• 60 mg/day for 4 weeks 2, 3
• Then 30 mg/day for 4 weeks 2, 3
• Then 15 mg/day for 2 weeks 2, 3
• Then 5 mg/day for week 11 (final week) 2, 3
• This regimen significantly reduces mortality (3% vs 14%) 3

Multiple Sclerosis Acute Exacerbations:

• 200 mg/day for 1 week 1
• Followed by 80 mg every other day for 1 month 1

General Inflammatory Conditions:

• Initial dose range: 5-60 mg/day depending on severity 1
• Weight-based dosing: 0.5-1 mg/kg/day for most conditions 3
• Maximum usual dose: 60 mg/day 3, 1

Pediatric Dosing

General Range:

• 0.14-2 mg/kg/day in 3-4 divided doses 1
• Equivalent to 4-60 mg/m²/day body surface area 1

Nephrotic Syndrome:

• 60 mg/m²/day in 3 divided doses for 4 weeks 1
• Followed by 40 mg/m²/day as single dose alternate-day therapy for 4 weeks 1

Asthma (Uncontrolled):

• 1-2 mg/kg/day in single or divided doses 1
• Continue "burst" therapy for 3-10 days until peak expiratory flow reaches 80% of personal best 1
• No evidence that tapering prevents relapse 1

Infantile Spasms:

• 8 mg/kg/day (maximum 60 mg/day) divided in 3 daily doses for 14 days 4
• Response rate of 59% in treatment-naive patients 4

Tapering Strategy

Standard Taper:

• Reduce by one-third to one-quarter until reaching 15 mg/day 3
• Then reduce by 2.5 mg steps until 10 mg/day 3
• Then reduce by 1 mg/month until minimum effective dose 3
• For autoimmune hepatitis: reduce by 2.5 mg/day each month with monitoring 2

Important Caveat: After long-term therapy, withdraw gradually rather than abruptly 1

Administration Timing

Standard Approach:

• Single morning dose for most conditions 3
• Divided doses may be necessary for severe diseases requiring continuous control 3

Alternative Regimen:

• Twice daily fractionated dosing (e.g., 2 x 1.25 mg/day) may allow lower total daily dose and appears less diabetogenic than once-daily dosing 5

Dose Equivalencies

5 mL of prednisolone oral solution (15 mg prednisolone base) equals: 1

• Prednisone: 15 mg
• Methylprednisolone: 12 mg
• Dexamethasone: 2.25 mg
• Hydrocortisone: 60 mg
• Cortisone: 75 mg

Critical Monitoring Requirements

Mandatory for All Long-Term Therapy:

• Calcium and vitamin D supplementation 2, 3
• DEXA scans every 1-2 years 2, 3
• Active treatment of osteopenia/osteoporosis 2

Signs of Overdose: 3

• Weight gain, insomnia, peripheral edema

Signs of Underdose: 3

• Lethargy, nausea, loss of appetite, weight loss, increased pigmentation

Important Clinical Pitfalls

Dose Ceiling Effect:

• Doses above 0.75 mg/kg/day (52.5 mg for 70 kg patient) provide no additional benefit 3
• Doses above 30 mg/day associated with significant mortality, particularly in elderly patients 3

Non-Response Management:

• If no response within 5-7 days, increase dose by 50-100% increments 3
• Consider IV pulsed corticosteroids if dose exceeds 1 mg/kg/day 3

Frail Elderly Patients:

• Use caution with standard dosing; consider lower initial doses 2