What is the typical dose of prednisone (corticosteroid) for various medical conditions?

Prednisone Dosing for Common Medical Conditions

Prednisone dosing varies from 5-60 mg/day depending on the specific disease being treated, with individualization based on disease severity and patient response being essential. 1

General Dosing Principles

Administer prednisone in the morning (prior to 9 AM) as a single daily dose to minimize adrenal suppression, since maximal adrenal cortex activity occurs between 2 AM and 8 AM. 1

• Take with food or milk to reduce gastric irritation 1
• When large doses are required, administer antacids between meals to prevent peptic ulcers 1
• Never stop abruptly after long-term therapy; taper gradually to avoid withdrawal symptoms and adrenal insufficiency 1
• For chronic therapy exceeding 7.5 mg daily for more than 3 weeks, anticipate hypothalamic-pituitary-adrenal axis suppression 2

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Disease-Specific Dosing Regimens

Asthma Exacerbations

Adults

For acute asthma exacerbations in adults, use prednisone 40-60 mg daily as a single dose or in 2 divided doses for 5-10 days without tapering. 3

• For severe exacerbations requiring hospitalization: 40-80 mg/day until peak expiratory flow reaches 70% of predicted or personal best 3
• Oral administration is equally effective as intravenous therapy and is strongly preferred 3
• No tapering necessary for courses less than 7-10 days, especially if patient is on inhaled corticosteroids 3
• Higher doses (>80 mg/day) provide no additional benefit 3

Children

For pediatric asthma exacerbations, use prednisone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) for 3-10 days without tapering. 3

• Continue until peak expiratory flow reaches 70% of predicted or personal best 3
• The 5-day regimen at these doses represents standard of care for outpatient burst therapy 3

Important Pitfall: Delaying systemic corticosteroids during acute exacerbations leads to poorer outcomes, as anti-inflammatory effects take 6-12 hours to become apparent. 3

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Nephrotic Syndrome (Children)

Initial Treatment (Steroid-Sensitive Nephrotic Syndrome)

Start with prednisone 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks. 2

• Continue daily dosing until complete remission is achieved for at least 3 days 2
• After achieving remission, switch to alternate-day therapy: 40 mg/m² or 1.5 mg/kg (maximum 40 mg on alternate days) for 2-5 months with gradual tapering 2

Frequent Relapses or Steroid-Dependent Disease

Treat relapses with daily prednisone until remission for at least 3 days, followed by alternate-day prednisone for at least 3 months. 2

• Use the lowest alternate-day dose to maintain remission without major adverse effects 2
• For steroid-dependent patients who fail alternate-day therapy, use the lowest daily dose to maintain remission 2
• During upper respiratory infections, increase to daily prednisone to reduce relapse risk 2

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Autoimmune Hepatitis

Adults

For autoimmune hepatitis, use combination therapy with prednisone 30 mg/day plus azathioprine 50 mg/day initially, as this regimen has lower corticosteroid-related side effects (10% vs 44%) compared to high-dose prednisone alone. 2

• Alternative monotherapy: prednisone 60 mg/day if azathioprine is contraindicated 2
• Taper prednisone by 5 mg/week from 20 mg/day down to 10 mg/day, then by 2.5 mg/week to 5 mg/day 2
• Continue maintenance until disease resolution, treatment failure, or drug intolerance 2

Children

For pediatric autoimmune hepatitis, start with prednisone 1-2 mg/kg/day (up to 60 mg/day) for 2 weeks, either alone or with azathioprine 1-2 mg/kg/day. 2

• Taper over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 2
• Early use of azathioprine is recommended to minimize growth suppression and bone development issues from prolonged corticosteroid therapy 2
• Continue until liver tests normalize for 1-2 years with no flares 2

Critical Pitfall: Cosmetic changes occur in 80% of patients after 2 years of corticosteroid treatment; severe complications (osteoporosis, diabetes, psychosis) typically occur after >18 months of prednisone 20 mg/day alone. 2

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Pemphigus Vulgaris

For pemphigus vulgaris, initiate treatment with prednisolone 1-2 mg/kg/day (or equivalent prednisone), with most experienced clinicians choosing 1 mg/kg/day. 2

• For milder cases: 0.5-1 mg/kg/day may be sufficient 2
• If no response within 5-7 days, increase dose in 50-100% increments until disease control is achieved 2
• Disease control is defined as no new lesions and onset of healing in pre-existing lesions 2
• Treatment failure is defined as failure to achieve control despite 3 weeks of prednisolone 1.5 mg/kg/day 2

Important Note: If doses above 1 mg/kg/day are required, consider pulsed intravenous corticosteroids (methylprednisolone 10-20 mg/kg or 250-1000 mg for 2-5 days). 2

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Tuberculous Pericarditis

For tuberculous pericarditis, use prednisone 60 mg/day for 4 weeks, followed by 30 mg/day for 4 weeks, 15 mg/day for 2 weeks, and 5 mg/day for the final week (total 11 weeks). 2

• Children should receive approximately 1 mg/kg body weight with proportionate tapering 2
• This regimen reduces mortality (3% vs 14% in placebo) and need for repeated pericardiocentesis 2
• Adjunctive prednisolone should be given alongside standard antituberculosis therapy 2

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Multiple Sclerosis (Acute Exacerbations)

For acute exacerbations of multiple sclerosis, use prednisolone 200 mg/day for 1 week, followed by 80 mg every other day for 1 month. 1

• Prednisone can be used at equivalent doses 1

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Vasculitis (ANCA-Associated)

For ANCA-associated vasculitis with pulmonary-renal syndrome, corticosteroid therapy should be given for at least 12 weeks. 2

• Start with oral prednisone 60 mg or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose 2
• Give daily for 4-6 weeks, then switch to alternate-day dosing at 40 mg/m² or 1.5 mg/kg (maximum 40 mg on alternate days) 2
• Continue alternate-day therapy for 2-5 months with gradual tapering 2

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Maintenance and Long-Term Considerations

For patients on chronic medium/high-dose glucocorticoid therapy (>7.5 mg/day for >3 weeks), monitor for adrenal insufficiency and provide stress-dose coverage during acute illness. 2

• Baseline and annual bone mineral densitometry of lumbar spine and hip is recommended 2
• Consider calcium and vitamin D supplementation 2
• In acute situations, increase dosage for 3 days or switch to intravenous hydrocortisone (e.g., 25 mg twice daily for patients on 10 mg/day prednisone) 2

Alternate-Day Therapy: For long-term treatment, consider alternate-day dosing (twice the usual daily dose every other morning) to minimize pituitary-adrenal suppression, Cushingoid features, and growth suppression in children. 1

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Common Adverse Effects by Dose and Duration

Osteoporosis risk: 16 events per 100 patient-years with chronic medium-dose therapy vs 3 per 100 patient-years in glucocorticoid-naive patients 2

Hypertension risk: 3-28 events per 100 patient-years with chronic medium-dose therapy 2

Diabetes risk: 0-3 events per 100 patient-years with chronic medium-dose therapy 2