From the Guidelines
The recommended dose of prednisone for Bell's palsy is 60 mg daily for 5 days, followed by a taper over the next 5 days, as this regimen has been shown to significantly improve facial nerve function and reduce recovery time 1.
Treatment Initiation and Monitoring
Treatment should be initiated as soon as possible after symptom onset, ideally within 72 hours, for maximum effectiveness. The complete regimen typically involves taking the full dose once daily in the morning with food to minimize gastrointestinal side effects. For adults, a common approach is 60 mg daily for 5 days followed by a taper of 10 mg less each day for 5 days (60,50,40,30,20,10 mg).
Mechanism of Action and Side Effects
Corticosteroids like prednisone work by reducing inflammation of the facial nerve within the facial canal, which is thought to be the primary mechanism of Bell's palsy. This anti-inflammatory effect helps decrease nerve compression and improves the chances of complete recovery. Patients should be monitored for potential side effects including mood changes, increased blood sugar, insomnia, and fluid retention. Those with diabetes, hypertension, or peptic ulcer disease may require additional monitoring or dose adjustments.
Key Considerations
- The use of oral corticosteroids has been strongly recommended for patients 16 years and older with new-onset Bell’s palsy, based on high-quality randomized controlled trials with a preponderance of benefit over harm 1.
- Goals of treatment for Bell’s palsy patients include decreasing recovery time and improving facial nerve functional recovery, which can be achieved with the recommended prednisone regimen 1.
- Studies have shown that treatment with prednisolone within 72 hours of symptom onset can significantly improve facial nerve function, with 83% of participants recovering facial nerve function 3 months after treatment compared to 63.6% of those randomized to placebo 1.
From the Research
Treatment of Bell's Palsy with Prednisone
- The optimal dose of prednisone for the treatment of Bell's palsy is not universally agreed upon, but several studies provide guidance on the effective dosage range.
- A study published in the American Family Physician 2 recommends an oral corticosteroid regimen of prednisone, 50 to 60 mg per day for five days, followed by a five-day taper.
- Another study published in Otology & Neurotology 3 compared the use of high-dose to standard-dose corticosteroids for the treatment of Bell's palsy in adults and found that high-dose corticosteroids (≥80 mg) were associated with a significant decrease in nonrecovery at 6 months follow-up.
- A systematic review and meta-analysis published in Otology & Neurotology 4 found that high-dose corticosteroids (initial prednisolone of 100 mg or more daily) were associated with a significantly decreased nonrecovery at 6 months after disease onset, compared with standard-dose corticosteroids (initial prednisolone of 50-60 mg).
Comparison of High-Dose and Standard-Dose Corticosteroids
- The study published in Otology & Neurotology 3 found that high-dose corticosteroids were associated with a significant decrease in nonrecovery at 6 months follow-up, with an odds ratio of 0.17 (95% confidence interval = 0.05-0.56, p = 0.004).
- The systematic review and meta-analysis published in Otology & Neurotology 4 found that high-dose corticosteroids were associated with a significantly decreased nonrecovery at 6 months after disease onset, with an odds ratio of 0.42 (95% confidence interval 0.22-0.80).
Combination Therapy with Antivirals
- A study published in The Cochrane Database of Systematic Reviews 5 found that the combination of antivirals with corticosteroids was associated with a significant benefit in the treatment of Bell's palsy, compared with corticosteroids alone.
- A study published in the Journal of Clinical Medicine 6 found that combined therapy with steroids and antivirals may have potential advantages, especially in patients with more severe disease, but that steroid monotherapy remains effective.