What is the typical dosing range for prednisolone (corticosteroid)?

Prednisolone Dosing Guidelines

Prednisolone dosing ranges from 5-60 mg/day depending on the condition being treated, with most inflammatory conditions requiring 0.5-1 mg/kg/day initially, while replacement therapy for adrenal insufficiency requires only 4-5 mg/day. 1, 2

Standard Dosing by Clinical Indication

Acute Inflammatory Conditions

• Initial dose: 1 mg/kg/day (maximum 60 mg/day) for 7-14 days, followed by tapering over a similar period for conditions like sudden hearing loss 1
• The FDA label confirms the typical range is 5-60 mg/day (equivalent to 1.67-20 mL of oral solution), with dosing individualized based on disease severity 2
• For severe autoimmune conditions requiring higher doses, do not exceed 1 mg/kg/day without considering IV pulse methylprednisolone, as doses above 0.75 mg/kg/day (52.5 mg for a 70 kg patient) provide no additional benefit and doses above 30 mg/day significantly increase mortality, particularly in elderly patients 1, 3

Autoimmune Dermatologic Conditions

• Severe/extensive bullous pemphigoid: 0.75-1 mg/kg/day 1, 3
• Moderate bullous pemphigoid: 0.3 mg/kg/day 1, 3
• Mild/localized bullous pemphigoid: 0.5 mg/kg/day 1, 3
• Pemphigus vulgaris: 1-2 mg/kg/day initially, with milder cases potentially managed at 0.5-1 mg/kg/day 1, 3
• If no response within 5-7 days, increase by 50-100% increments, but consider IV pulse therapy if exceeding 1 mg/kg/day 1, 3

Specific Disease Protocols

• Tuberculous pericarditis: 60 mg/day for 4 weeks, then 30 mg/day for 4 weeks, then 15 mg/day for 2 weeks, then 5 mg/day for week 11—this regimen reduces mortality from 14% to 3% 1
• Dermatomyositis/polymyositis: 0.5-1 mg/kg/day initially 3
• Severe atopic dermatitis (>20-30% BSA): 0.5-1 mg/kg/day for minimum 2-3 weeks with gradual taper to prevent rebound 4
• Multiple sclerosis exacerbations: 200 mg/day for 1 week, then 80 mg every other day for 1 month 2

Pediatric Dosing

• General range: 0.14-2 mg/kg/day in 3-4 divided doses (4-60 mg/m²/day) 2
• Nephrotic syndrome: 60 mg/m²/day in 3 divided doses for 4 weeks, followed by 40 mg/m²/day as single-dose alternate-day therapy for 4 weeks 2
• Asthma exacerbations: 1-2 mg/kg/day in single or divided doses for 3-10 days until symptoms resolve or peak flow reaches 80% of personal best 2

Replacement Therapy

• Primary adrenal insufficiency: 4-5 mg/day as single morning dose, or 3 mg in morning and 1-2 mg at 2 PM 1
• Prednisolone should only be used in selected cases with marked energy fluctuations; hydrocortisone is preferred 1

Tapering Strategy

Reduce daily dose by one-third to one-quarter until reaching 15 mg/day, then by 2.5 mg steps until 10 mg/day, then by 1 mg/month until the minimum effective dose is achieved. 1

• For long-term therapy (>2 weeks), gradual withdrawal is mandatory to prevent adrenal crisis 2
• Alternate-day dosing can reduce adverse effects in long-term therapy 1, 3
• After long-term use, maintenance doses typically range from 4-8 mg/day for conditions like polymyalgia rheumatica and temporal arteritis 5, 6

Critical Dosing Principles

Weight-Based Considerations

• Response to prednisone is strongly predicted by body weight, with the effective dose being approximately 0.19 mg/kg for responders versus 0.16 mg/kg for non-responders 7
• Lower body weight patients (particularly women) may respond adequately to lower absolute doses 7

Duration Considerations

• Never prescribe oral corticosteroids for less than 2 weeks for dermatologic conditions, as this leads to severe rebound dermatitis 4
• Most patients with polymyalgia rheumatica and temporal arteritis require treatment for more than 2 years, with lower initial doses associated with lower maintenance doses 5, 6

Common Pitfalls to Avoid

• Avoid chronic intermittent systemic corticosteroids for any dermatologic condition—this pattern increases adverse effects without improving outcomes 4
• Do not use oral corticosteroids as standard treatment for chronic atopic dermatitis due to rebound risk 4
• Monitor for signs of overdose (weight gain, insomnia, peripheral edema) and underdose (lethargy, nausea, loss of appetite, increased pigmentation) 1
• Mandatory calcium and vitamin D supplementation for all patients on long-term therapy, with regular DEXA scans for osteoporosis monitoring 1, 3
• Hyperglycemia and weight gain are the most frequent side effects, occurring even with short courses 1

Bioequivalence Reference

Prednisolone 15 mg is bioequivalent to prednisone 15 mg, methylprednisolone 12 mg, dexamethasone 2.25 mg, hydrocortisone 60 mg, and cortisone 75 mg for oral/IV administration 1, 2