Prednisone

General

• Type: Corticosteroids, systemic
• Dosage Forms:1, 2, 5, 10, 20, 50, 5/5ml
• Common Trade Names: Sterapred, Sterapred DS, Rayos

Adult Dosing

For all doses of prednisone, it is best given with food. Also, ideally best when given in AM to coincide with natural cortisol release. No need to taper if short course less than 1 week, otherwise consider taper.

• Corticosteroid-responsive conditions
  • 5-60mg PO QD
  • Dose varies based on condition
• Asthma, acute
  • 40-80mg/day PO divided QD-bid
    • Most practitioners give 60mg PO x 1, followed by 40mg PO QD x 4 days (for a 80-100kg adult)
  • If patient can tolerate PO, no need to give steroids IV, but if asthma is severe, and bipap / intubation likely, best to keep patient NPO and give methylprednisolone IV
• Adrenal Insufficiency
  • 4-5mg/ m^2 PO QD
  • Taper dose gradually to discharge when appropriate
• Multiple Sclerosis, acute exacerbation
  • 200mg PO QD x1 week, then 80mg po qod x1 mo
  • Give with food, also prescribe PPI for gastric protection. Taper dose gradually to discharge
• Alcoholic Hepatitis, acute
  • 40mg PO QD
• PCP, Adjunct treatment
  • 40mg PO BID x5 days, then 40mg PO QD x5 days, then 20mg PO QD x11 days
  • Start within 72hrs of antimicrobial treatment
  • Always consider discussion with HIV consultants prior to given steroids, as they will be managing patient in hospital

Pediatric Dosing

For all doses of prednisone, it is best tolerated with food. Ideally best when given in AM to coincide with natural cortisol release. No need to taper if short course less than 1 week, otherwise consider taper.

• Corticosteroid-responsive conditions
  • 0.05-2mg/kg/day PO divided QD-QID
  • Dose varies based on condition
• Asthma, acute
  • 1-2mg/day PO divided QD-bid Max 60mg/day
  • If patient can tolerate PO, no need to give steroids IV, but if asthma is severe, and Bipap / intubation likely, best to keep patient NPO and give methylprednisolone IV
• Adrenal Insufficiency
  • 4-5mg/ m^2 PO QD Taper dose gradually to discharge when appropriate
• Nephrotic Syndrome
  • 2mg / kg PO QD
  • Max 80mg / day. Use for 1st 3 episodes
  • PCP, adjunct treatment (children <40kg)
  • 1mg/kg PO BID x5days, then 0.5mg/kg PO BID x5days, then 0.5mg PO QD x 11 days. Start within 72 hrs of antimicrobial treatment (Children >40kg)
  • 40mg PO BID x5 days, then 20mg PO BID x5 days, then 20mg PO QD x 11 days. Start within 72 hrs of antimicrobial treatment (Adolescents)
  • 40mg PO BID x5 days, then 40mg PO QD x5 days, then 20mg PO QD x 11 days. Start within 72 hrs of antimicrobial treatment

Special Populations

• Pregnancy Rating: Category C
• Lactation: Probably safe "Limited information in animals and/or humans demonstrates no risk/minimal risk of adverse effects to infant/breast milk production; caution advised" -Epocrates
• Renal Dosing
  • Adult - No adjustment
  • Pediatric - No adjustment
• Hepatic Dosing
  • Adult - Not defined
  • Pediatric - Not defined

Contraindications

• Allergy to class/drug
• Systemic fungal infection
• Recent varicella or measles infection
• Caution in TB, immunosuppressed, hypertension, CHF, DM, PUD, seizure disorder, psychiatric disorder, osteoporosis,

Adverse Reactions

Serious

• Adrenal insufficiency
• Cushing syndrome
• Immunosuppression
• Infection, fractures, thromboembolism
• hypertension
• CHF
• Diabetes mellitus
• GI perf / ulcer
• Osteopenia / osteoporosis
• tendon rupture
• pseudotumor cerebri
• Increased ICP
• Seizures
• Glaucoma

Common

• Sodium and fluid retention
• diaphoresis
• headache
• Vertigo
• Insomnia
• Nervousness, mood swings
• Muscle weakness
• BP elevation
• glucose intolerance
• Menstrual irregularities

Pharmacology

• Half-life: 18-36h (biological) 3.4-3.8h (chemical)
• Metabolism: Liver CYP450; 3A4 substrate. Prodrug is converted to prenisolone
• Excretion: Urine
• Mechanism of Action: Exact mechanism unknown, inhibits inflammatory cytokines, produces multiple glucocorticoid and mineralcorticoid effects

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Acute allergic reaction	60mg initially, then 40mg PO daily x 5 days	Corticosteroid (outpatient)	PO	Adult
Acute asthma exacerbation	40-60 mg PO daily x5 days	Corticosteroid	PO	Adult
Acute asthma exacerbation	1-2 mg/kg/day (max 60 mg) x3-10 days	Corticosteroid (pediatric)	PO	Pediatric
Acute asthma exacerbation (peds)	1-2mg/kg/day (max 60mg) in 1-2 divided doses x 3-5 days	Systemic corticosteroid alternative to dexamethasone	PO	Pediatric
Acute rheumatic fever	1-2mg/kg/day PO	Moderate-to-severe carditis	PO	Pediatric
COPD exacerbation	60 mg PO x1, then 40 mg PO daily x5 days	Corticosteroid (preferred, oral)	PO	Adult
Crohn's disease	40-60mg daily with taper once remission induced	Moderate flare	PO	Adult
Giant cell arteritis	1mg/kg/day (max 80mg)	Initial treatment; alternative to IV pulse dose	PO	Adult
Gout and pseudogout	30-50mg initially, taper over 10 days	Alternative when NSAIDs and colchicine contraindicated	PO	Adult
Henoch-Schonlein purpura	1mg/kg/day	Severe arthralgias, abdominal or scrotal disease	PO	Pediatric
Hypercalcemia	60mg daily	Steroid-sensitive tumors (lymphoma, multiple myeloma)	PO	Adult
Nephrotic syndrome	2mg/kg/day PO (max 60mg) x 4-6 weeks, then taper	Initial treatment, minimal change disease	PO	Pediatric
Pericarditis	0.2-0.5 mg/kg/day x2 weeks, then taper	Steroid (if NSAID contraindicated or refractory)	PO	Adult
Polymyalgia rheumatica	15mg daily x 2-4 weeks	Initial treatment; dramatic response expected within days	PO	Adult
Sudden sensorineural hearing loss	1mg/kg/day PO (max 60mg) x 10-14 days	First-line, oral glucocorticoid	PO	Adult
Ulcerative colitis	40mg daily x 2 weeks, then taper by 5mg/week	Moderate-severe flare	PO	Adult

References

Epocrates