How many times per day should prednisolone suspension (15 mg/5 ml) be given?

Prednisolone Dosing Frequency

Prednisolone suspension (15 mg/5 mL) is typically administered once daily in the morning as a single dose for most conditions, though divided dosing 2-4 times daily may be used for specific severe conditions requiring higher total daily doses. 1

Standard Dosing Frequency by Clinical Context

Once Daily Dosing (Preferred for Most Conditions)

• Single morning dose is the standard approach for maintenance therapy and most inflammatory conditions, as it causes less adrenal suppression and improves compliance 2, 3
• For proctocolitis, 40 mg prednisolone given as a single morning dose was equally effective as 10 mg four times daily, with no difference in response rates or side effects 2
• In nephrotic syndrome, single daily dosing (2 mg/kg) achieved remission in 77% of children with mean response time of 9.6 days, comparable to divided-dose regimens 3
• For subacute thyroiditis, 15 mg once daily was effective for 51.6% of patients within 6 weeks 4

Divided Dosing (2-4 Times Daily)

• Divided doses are indicated when total daily doses exceed 20-30 mg or for acute severe disease requiring rapid control 1
• The FDA label specifies that pediatric dosing of 0.14-2 mg/kg/day should be given in three or four divided doses 1
• For nephrotic syndrome, the standard regimen uses 60 mg/m²/day given in three divided doses for 4 weeks 1
• Typical adult divided regimens include dosing at 07:00,12:00, and 16:00 hours (±1 hour) 5

Twice Daily Dosing (Alternative Approach)

• Fractionated twice daily dosing may allow lower total daily doses due to prednisolone's 2-3 hour pharmacokinetic half-life 6
• In one study, twice daily dosing of 2 × 1.25 mg (total 2.5 mg/day) was as effective as once daily 4 mg with less diabetogenic effect 6

Critical Decision Points

For your specific 15 mg/5 mL suspension:

• If prescribing ≤20 mg total daily dose: Give as single morning dose 5, 2
• If prescribing >20-30 mg total daily dose: Consider divided dosing (typically 3 times daily) 1
• If prescribing for pediatric nephrotic syndrome: Use three divided doses 1
• If prescribing for asthma exacerbation: Once daily dosing is effective and safe 7

Common Pitfalls to Avoid

• Do not automatically divide doses without clinical indication—single daily dosing reduces adrenal suppression and improves adherence 2, 3
• Avoid evening doses when possible, as they increase insomnia risk and adrenal suppression 5
• Do not use divided dosing for convenience alone—reserve it for higher total daily doses or specific conditions requiring sustained drug levels 1
• For long-term therapy, single morning dosing is strongly preferred to minimize hypothalamic-pituitary-adrenal axis suppression 5, 2