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 maintenance therapy typically uses 4-5 mg/day or less. 1, 2

Standard Dosing by Clinical Indication

Acute Inflammatory Conditions

• Initial dose: 0.5-1 mg/kg/day (typically 30-60 mg/day for a 70 kg adult) for most severe inflammatory conditions 1, 2
• The FDA label specifies a range of 5-60 mg/day (prednisolone base) depending on disease severity, with lower doses for less severe conditions 2
• For sudden hearing loss: 1 mg/kg/day (maximum 60 mg/day) for 7-14 days, then taper over a similar period 1
• For 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

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, considering IV pulsed corticosteroids if exceeding 1 mg/kg/day 1, 3

Severe Atopic Dermatitis

• For extensive disease (>20-30% body surface area): 0.5-1 mg/kg/day for minimum 2-3 weeks with gradual taper 4
• Treatment duration less than 2 weeks leads to rebound dermatitis and should be avoided 4
• Chronic intermittent systemic corticosteroids should not be used for any dermatologic condition 4

Pediatric Dosing

• Initial range: 0.14-2 mg/kg/day in 3-4 divided doses (4-60 mg/m²/day) 2
• For 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
• For asthma uncontrolled by inhaled corticosteroids: 1-2 mg/kg/day in single or divided doses for 3-10 days (no taper needed after short bursts) 2

Critical Dosing Thresholds and Safety Limits

Maximum Safe Dosing

• Doses above 0.75 mg/kg/day (52.5 mg/day for 70 kg patient) provide no additional benefit 1
• Doses above 30 mg/day are associated with significant mortality, particularly in elderly patients 1
• Never exceed 1 mg/kg/day without considering pulsed IV methylprednisolone due to increased mortality risk 1, 3

Long-Term Maintenance Dosing

• For adrenal insufficiency replacement: 4-5 mg/day as single morning dose, or 3 mg morning + 1-2 mg at 2 pm 1
• For polymyalgia rheumatica/temporal arteritis: maintenance doses average 5.7 mg/day in year 1 and 4.3 mg/day in year 2 5
• For rheumatoid arthritis: doses <5 mg/day appear effective and acceptable for long-term use 6
• Doses of 5-15 mg/day show dose-dependent adverse events, with doses >10 mg/day having significantly higher risk (OR 32.3) 7

Tapering Protocols

Standard Taper

• Reduce daily dose by one-third to one-quarter until reaching 15 mg/day 1
• Then reduce by 2.5 mg steps until 10 mg/day 1
• Then reduce by 1 mg/month until minimum effective dose 1
• Gradual withdrawal is mandatory after long-term therapy to prevent adrenal insufficiency 2

Dose Adjustment Principles

• Constant monitoring required for disease activity, patient responsiveness, and stress exposure 2
• May need temporary dose increases during stressful situations unrelated to primary disease 2
• For inadequate response, increase by 50-100% rather than small increments 1, 3

Administration Strategies

Timing Options

• Single morning dose: standard for most conditions 1, 3
• Divided doses: necessary for severe diseases requiring continuous control 1
• Alternate-day dosing: reduces side effects in long-term therapy 1, 3

Critical Pitfalls to Avoid

Dosing Errors

• Do not use high-dose oral corticosteroids for chronic atopic dermatitis due to severe rebound risk 4
• Do not prescribe courses shorter than 2-3 weeks for dermatologic conditions 4
• Do not assume higher doses are better—a dose-response paradox exists in pemphigus vulgaris where low and high doses show equivalent outcomes at 5 years 3

Monitoring Requirements

• Mandatory calcium and vitamin D supplementation for all long-term therapy patients 1, 3
• Regular DEXA scans for osteoporosis screening 1, 3
• Monitor for overdose signs: weight gain, insomnia, peripheral edema 1
• Monitor for underdose signs: lethargy, nausea, loss of appetite, weight loss, increased pigmentation 1
• Hyperglycemia and weight gain are most frequent side effects, even with short courses 1