Crushing Prednisone Tablets for Pediatric Administration
Yes, you can safely crush a 20 mg prednisone tablet and administer it to an 18-kg child who cannot swallow pills—prednisone tablets are specifically designed to be crushed and mixed with food or liquid for pediatric patients. 1
Evidence Supporting Crushing Prednisone
Prednisone tablets are explicitly crushable: Guidelines from the American Academy of Dermatology and National Psoriasis Foundation confirm that methotrexate (and by extension, similar immunosuppressive tablets like prednisone) can be administered as "scored 2.5-mg tablets that can be split and crushed" for pediatric use. 1
Direct evidence for crushed prednisone in children: A randomized trial specifically compared crushed prednisolone tablets versus oral solution in 78 young children with acute asthma, demonstrating that crushed tablets achieved similar clinical resolution to liquid formulations, though the liquid was better tolerated (less vomiting, better taste). 2 This confirms crushing does not compromise therapeutic efficacy.
Standard practice in pediatric emergency medicine: Multiple national guidelines for acute asthma exacerbations in children recommend prednisone 1-2 mg/kg/day (maximum 60 mg/day) without any restriction against crushing, implicitly supporting this practice when swallowing difficulties exist. 1
Dosing Confirmation for Your Patient
For an 18-kg child, the appropriate dose range is 18-36 mg daily (1-2 mg/kg/day), so a 20 mg dose falls appropriately within guidelines. 1
The maximum pediatric dose is 60 mg/day, so 20 mg is well below safety thresholds. 1
Administration Technique
Mix crushed tablet with small amount of vehicle: Crush the tablet thoroughly and mix with a small amount of soft food (applesauce, pudding) or liquid (juice, water) to facilitate administration. 1, 3
Administer immediately: Give the crushed medication mixture right away to prevent degradation or settling of the powder. 3, 4
No special precautions needed: Prednisone is not a hazardous drug requiring special handling precautions during crushing. 4
Important Clinical Considerations
No need to taper for short courses: For prednisone courses less than 10 days (typical for acute exacerbations), there is no need to taper the dose when discontinuing. 1
Gastrointestinal absorption is reliable: There is no advantage of IV or IM prednisone over oral administration provided gastrointestinal absorption is not impaired, confirming that crushed oral tablets maintain bioavailability. 1
Liquid formulations are preferred but not required: While oral solutions may be better tolerated (less vomiting, better taste), crushed tablets achieve equivalent clinical outcomes when liquid formulations are unavailable or cost-prohibitive. 2