What is the protocol for prednisone (corticosteroid) burst dosing?

From the Guidelines

Prednisone burst therapy should be initiated at a dose of 40-60mg daily for 3-5 days, then decreased by 5-10mg every 1-3 days until completion, as this approach allows for rapid symptom relief while minimizing the risk of hypothalamic-pituitary-adrenal axis suppression.

Overview of Prednisone Burst Therapy

Prednisone burst therapy is a short course of high-dose oral corticosteroids that rapidly taper over 5-14 days. This approach is commonly used to treat acute asthma exacerbations, inflammatory conditions, and other diseases that require rapid suppression of inflammation.

Dosage and Administration

The dosage of prednisone for burst therapy can vary depending on the condition being treated and the severity of the disease. A common regimen is 40-60mg daily for 3-5 days, then decreasing by 5-10mg every 1-3 days until completion. For adults with acute asthma exacerbations or inflammatory conditions, a simple approach is 40mg daily for 5 days with no taper needed for short courses. For more severe conditions, consider 60mg daily for 5-7 days followed by a taper.

Side Effects and Monitoring

Short-term side effects of prednisone burst therapy may include increased appetite, mood changes, elevated blood glucose, and fluid retention. Patients with diabetes should monitor blood glucose more frequently during treatment, and those with a history of psychiatric disorders should be monitored for mood changes.

Evidence-Based Recommendations

The most recent and highest quality study on prednisone burst therapy is not explicitly stated in the provided evidence, but based on the available information, the recommended dosage and administration are supported by studies such as 1 and 1, which discuss the use of corticosteroids in various conditions, including pemphigus vulgaris and idiopathic inflammatory myopathies. However, the specific dosage and administration of prednisone burst therapy are not directly addressed in these studies.

Clinical Considerations

When initiating prednisone burst therapy, it is essential to consider the individual patient's needs and medical history. Patients with certain conditions, such as diabetes or psychiatric disorders, may require closer monitoring and adjustments to their treatment plan. Additionally, the dosage and administration of prednisone should be tailored to the specific condition being treated and the severity of the disease.

• Key points to consider when initiating prednisone burst therapy:
  • Start with a dose of 40-60mg daily for 3-5 days
  • Decrease the dose by 5-10mg every 1-3 days until completion
  • Monitor patients with diabetes and psychiatric disorders closely
  • Tailor the dosage and administration to the individual patient's needs and medical history
  • Consider alternative treatments and adjustments to the treatment plan as needed

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. Multiple Sclerosis In the treatment of acute exacerbations of multiple sclerosis daily doses of 200 mg of prednisolone for a week followed by 80 mg every other day for 1 month have been shown to be effective. (Dosage range is the same for prednisone and prednisolone.)

The FDA drug label does provide some information on dosing, but it does not directly support the concept of "burst dosing" for prednisone.

• Key points:
  • The label mentions initial dosages ranging from 5 mg to 60 mg per day.
  • It also provides an example of a high-dose regimen for multiple sclerosis, but this is not explicitly referred to as "burst dosing".
  • The label emphasizes that dosage requirements are variable and must be individualized based on the disease and patient response.
  • No specific guidance is provided on "burst dosing" as a treatment approach 2.

From the Research

Prednisone Burst Dosing

• The practice of prednisone burst dosing is commonly used in the management of acute asthma exacerbations 3.
• A survey of physicians found that there is no predominant dosing regimen, but a fixed single daily dose is the most commonly prescribed regimen, with the majority of physicians prescribing a total burst dose of ≤200 mg for patients ≥12 years of age 3.
• For younger children, approximately one-quarter of physicians prescribed ≤1 mg/kg per day for 3 days, and essentially all prescribed ≤2 mg/kg per day for 10 days 3.
• The use of prednisone burst dosing is also seen in other conditions, such as idiopathic inflammatory myopathy, where it is used as an initial treatment, and methotrexate or azathioprine may be used as steroid-sparing agents 4, 5.
• In patients with generalized myasthenia gravis, methotrexate has been shown to be an effective steroid-sparing agent, with similar efficacy and tolerability to azathioprine 5.
• In rheumatoid arthritis, the combination of methotrexate and azathioprine has been studied, but no enhanced efficacy was seen compared to treatment with single agents 6.