What is the recommended dosing for Prelone (prednisolone) in pediatric patients?

Prelone (Prednisolone) Pediatric Dosing

Prednisolone dosing in children is condition-specific and weight-based, typically ranging from 0.5-2 mg/kg/day with a maximum of 60 mg/day for most indications, administered as a single morning dose. 1, 2, 3

General Dosing Principles

• Use ideal body weight for significantly overweight children to avoid unnecessary steroid exposure and increased side effects 1, 4
• The maximum daily dose is typically 60 mg, though up to 80 mg may be considered for specific severe conditions 1, 4
• Body surface area dosing (mg/m²) is preferred over weight-based dosing (mg/kg) because it parallels prednisolone metabolism better and reduces the risk of underdosing in younger children 1
• Prednisolone and prednisone are equivalent and interchangeable at the same dosage 1, 4

Condition-Specific Dosing

Acute Asthma Exacerbations

• Standard dose: 1-2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 3-10 days 1, 2, 3
• No tapering is needed if duration is less than 10 days 1
• Research demonstrates that 1 mg/kg/day is non-inferior to 2 mg/kg/day for acute moderate exacerbations in preschool children, with less frequent vomiting at the lower dose 5
• A study comparing 0.5,1.0, and 2.0 mg/kg/day found no significant differences in recovery patterns, suggesting 0.5 mg/kg/day may be appropriate for acute exacerbations 6

Nephrotic Syndrome

• First episode: 60 mg/m²/day or 2 mg/kg/day (maximum 60 mg/day) as a single morning dose for 4-6 weeks 1, 4, 3
• Continuation phase: 40 mg/m²/day or 1.5 mg/kg/day (maximum 40 mg) on alternate days for 2-5 months with gradual tapering 1, 4
• For infrequent relapses: 60 mg/m²/day or 2 mg/kg/day until remission for at least 3 days, then 40 mg/m²/day or 1.5 mg/kg/day on alternate days for at least 4 weeks 4
• For frequent relapses or steroid-dependent cases: daily prednisolone until remission for 3 days, followed by alternate-day therapy for at least 3 months at the lowest effective dose 4

Autoimmune Hepatitis

• Initial: 1-2 mg/kg/day (maximum 60 mg/day) for two weeks, either alone or with azathioprine 1, 4
• Maintenance: Taper over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day 1, 4

Other Conditions

• For tuberculous pericarditis: Begin with approximately 1 mg/kg/day and taper proportionately over 11 weeks 1
• For Multisystem Inflammatory Syndrome in Children (MIS-C): Methylprednisolone 1-2 mg/kg/day IV in combination with IVIG; escalate to 10-30 mg/kg/day IV for refractory disease 1

Administration Guidelines

• Administer as a single morning dose before 9 AM to align with physiologic cortisol rhythm and minimize hypothalamic-pituitary-adrenal axis suppression 1, 2, 4
• For behavioral side effects (hyperactivity, emotional lability), consider afternoon dosing after school 2
• The FDA-approved initial dose range is 0.14 to 2 mg/kg/day in three or four divided doses (4 to 60 mg/m²/day), though single daily dosing is preferred for most conditions 3

Tapering and Duration

• For courses longer than 2 weeks, gradual tapering is essential to prevent adrenal insufficiency 1, 2
• Reduce the dose by 25-33% at appropriate intervals once clinical response is achieved, with final reductions of 1 mg monthly 1, 2
• For short "burst" therapy (3-10 days), no tapering is required 1
• For courses less than 10 days, the drug can be stopped abruptly 1

Monitoring and Safety

• Essential monitoring includes growth parameters, blood pressure, Cushingoid features, and consideration of calcium and vitamin D supplementation during therapy 1, 2, 4
• Common side effects include weight gain, increased appetite, cosmetic changes, and growth deceleration 1, 2
• Severe side effects are uncommon but more likely after prolonged therapy exceeding 18 months 1
• Bone mineral densitometry should be considered for patients on long-term treatment 4
• For courses longer than 2 weeks, implement osteoporosis prevention measures 2

Critical Pitfalls to Avoid

• Never dose based on actual weight in significantly overweight children—this leads to excessive steroid exposure 1, 4
• Do not routinely use divided doses when single daily morning dosing is appropriate, as this increases HPA axis suppression 1, 4
• Avoid abrupt discontinuation after more than 2 weeks of therapy, as this risks adrenal crisis 1, 2
• Do not exceed 60 mg/day for routine indications without specific justification 1, 4, 3