Prednisone Dose for Multiple Sclerosis Flare
For acute MS relapses, the recommended dose is 200 mg of prednisone (or prednisolone) daily for 7 days, followed by 80 mg every other day for 1 month. 1
Standard Treatment Regimen
The FDA-approved dosing for MS exacerbations is clearly defined 1:
- Initial phase: 200 mg prednisone daily for 7 consecutive days
- Taper phase: 80 mg every other day for 1 month (approximately 30 days)
This regimen has been validated and represents the standard approach for treating acute MS relapses 1.
Alternative High-Dose Oral Regimens
While the FDA label specifies the above regimen, clinical research supports alternative high-dose oral approaches 2, 3:
- Oral methylprednisolone 500 mg daily for 5 days with a 10-day taper has demonstrated significant improvement in neurological function, with 65% of patients showing improvement by 8 weeks compared to 32% with placebo 2
- Oral methylprednisolone 1,250 mg daily for 3 days is also effective, though a study comparing it to 625 mg daily showed the higher dose produced faster improvement at day 7 3
Clinical Considerations
Compliance is excellent with high-dose oral therapy: A prospective study found 94.3% compliance with 1,250 mg oral prednisone daily (requiring 25 tablets of 50 mg), with two-thirds of patients preferring oral therapy for future relapses 4.
Timing of administration matters: Prednisone should be administered in the morning prior to 9 AM to minimize suppression of adrenocortical activity, as maximal adrenal cortex activity occurs between 2 AM and 8 AM 1.
Oral versus intravenous: High-dose oral methylprednisolone (500 mg daily) produces comparable efficacy to intravenous administration for MS relapses, with no serious adverse events reported 2. Intravenous therapy showed faster improvement at week 1 but equivalent outcomes by week 4 5.
Common Pitfalls to Avoid
- Do not use low doses: Initial doses ≤7.5 mg/day are inadequate for acute MS relapses and should be avoided 1
- Do not abruptly discontinue: Always taper gradually after the initial high-dose period to prevent adrenal insufficiency 1
- Gastric protection: Administer with food or milk to reduce gastric irritation, and consider antacids between meals when using large doses 1
Monitoring During Treatment
Most patients experience at least one side effect, most commonly insomnia, mood changes, and increased appetite 4. These are generally well-tolerated and do not require treatment discontinuation in the vast majority of cases 2, 4.