Administration is governed by the following general principles: Individualize dosage according to the severity of the disease and the patient's response. The severity, prognosis, expected duration of the disease, and the patient's reaction to medication are primary factors in determining dosage. For infants and children, the recommended dosage should be governed by the same considerations rather than by strict adherence to the ratio indicated by age or body weight.
Dosage should be decreased or discontinued gradually when the drug has been administered for more than 2 weeks to avoid the risk of relative adrenal insufficiency.
Continued supervision of the patient after/cessation of corticosteroids is essential, since there may be a reappearance of severe manifestations of the disease for which the patient was treated.
In acute conditions where prompt relief is imperative, large doses are permissible and may be mandatory for a short period.
In chronic conditions requiring long-term therapy, use the lowest dosage that provides adequate, but not necessarily complete relief. If a high dosage for prolonged periods is considered essential, observe patients closely for signs that might necessitate reduction in dosage or discontinuance of the hormone.
Prednisone may be administered as a single morning dose on alternate days in patients with a normal or moderately responsive pituitary axis on long term corticosteroid therapy. This regimen is designed to minimize hypothalamic-pituitary-adrenal suppression.
Chronic conditions are subject to periods of spontaneous remission.
When such periods occur, discontinue corticosteroids gradually.
The following milligram equivalents facilitate changing to prednisone from other glucocorticoids. (See table.)
Click on icon to see table/diagram/image
Specific dosage recommendations for prednisone - in chronic, usually nonfatal diseases, including endocrine and chronic rheumatic disorders, edematous states, respiratory and gastrointestinal diseases, some dermatologic diseases and hematologic disorders, start with a low dose (5 to 10 mg/day) and gradually increase dosage to the smallest amount that gives the desired degree of symptomatic relief. When adequate suppression of symptoms is achieved maintain dosage at the minimum amount capable of providing sufficient relief without excessive hormonal effects. Divide the daily requirement into 3 or 4 doses.
In congenital adrenal hyperplasia, the usual daily dose is 2.5 to 10 mg.
In acute, nonfatal disease, including allergic states ophthalmic disease, acute and subacute rheumatic disorders dosage ranges between 20 and 30 mg a day. In some patients, higher doses are necessary. Since these conditions are self-limited in their course prolonged maintenance therapy is not usually necessary.
In chronic potentially fatal diseases such as systemic lupus erythematosus, pemphigus, symptomatic sarcoidosis, the initial dosage is 30 mg a day. In some patients higher doses are necessary. As soon as adequate relief is obtained, reduce dosage gradually to the minimum amount that will produce the desired therapeutic effect.
When the disease is acute and life threatening (e.g. acute rheumatic carditis, crisis of systemic lupus erythematosus, severe allergic reactions, pemphigus, neoplastic diseases), the initial dosage is 30 mg a day, administered in 4 divided doses. This dosage is 30 mg a day, administered in 4 divided doses. The dosage may have to be increased in some patients to establish control. As soon as control is attained, reduce dosage gradually to the minimum amount that will maintain relief. When extremely rapid onset of action is desired, one of the soluble adrenocortical hormone preparations may be administered i.v. for the first 2 or 3 doses. In severe allergic reactions, epinephrine is the drug of immediate choice. Prednisone is useful either concurrently or as supplementary therapy.
In certain conditions, such as acute leukemia, and nephrotic syndrome, the recommended dosage is 30 mg a day, or more.
In dental postoperative inflammatory reactions, administer 5 mg 3 times a day, for no more than 2 or 3 days.