Prednisone dosing

Oral corticosteroids may be used for patients who are unresponsive to sulfasalazine or mesalamine. Prednisone doses of 40 to 60 mg per day (or equivalent) are recommended.1 Azathioprine or 6-MP is used for patients unresponsive to corticosteroids or those who become steroid-dependent. Over a 12-month period, these agents have been shown to reduce the relapse rate to 36% versus 59% seen with placebo.1 Infliximab 5 mg/kg may also be used for patients who are unresponsive to conventional oral therapies and may reduce the need for colectomy after 3 months of treatment.35... 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

Drug-induced osteoporosis may result from systemic corticosteroids (prednisone doses greater than 7.5 mg/day), thyroid hormone replacement, some antiepileptic drugs (e.g., phenytoin, phenobarbital), depot medroxyprogesterone acetate, and other agents. 

Low-dose, long-term corticosteroid therapy may be used to control symptoms in patients with difficult-to-control disease. Prednisone doses below 7.5 mg/day (or equivalent) are well tolerated but are not devoid of the long-term corticosteroid adverse effects. The lowest dose that controls... 

Stabilize the patient s asthma before treatment is started. Initially, use aerosol concurrently with usual maintenance dose of systemic steroid. After approximately 1 week, start gradual withdrawal of the systemic steroid by reducing the daily or alternate daily dose. Make the next reduction after 1 to 2 weeks, depending on response. Generally, these decrements should not exceed 25% of the prednisone dose or its equivalent. A slow rate of withdrawal cannot be overemphasized. 

In 52 renal transplant recipients (mean age 45 years, 34 men and 18 women) taking prednisone (100 mg/day for 3 days followed by 10 mg/day for as long as needed mean dose 11 mg/day) there was a major reduction in immediate recall but not delayed recall (95). However, there was a significant correlation between mean prednisone dose and delayed recall. In animals, phcnytoin pretreatment blocks the effects of stress on memory and hippocampal histology. 

Rivkees SA, Danon M, Herrin J. Prednisone dose limitation of growth hormone treatment of steroid-induced growth failure. J Pediatr 1994 125(2) 322-5. 

An intravenous corticosteroid, commonly high-dose methylprednisolone, is given during the perioperative period. The dose of methylprednisolone is tapered rapidly and discontinued within days and oral prednisone is initiated. Prednisone doses are tapered progressively over time depending on the type of additional immunosuppression... 

Mitoxantrone plus prednisone is another combination regimen that can palliate hormone-refractory prostate cancer. One hundred and sixty-one patients with hormone-refractory prostate cancer with pain were randomized to receive either 10 mg/day prednisone alone, or this same prednisone dose with mitoxantrone. The primary end point was a palliative ( clinical benefit ) response, as assessed by a pain scale and analgesic requirements. Quality of life was assessed with a series of linear analog health-assessment scales and the Prostate Cancer-Specific Quality of Life Instrument. 

The positive clinical responses in these nonresponders to the most commonly used oral DMARD, methotrexate, are particularly encouraging. It is also noteworthy that 4 of the 5 patients who had an ACR 50 response, and both completers who had ACR 20 responses after 6 months, had previously failed cyclosporin. Note also that the required prednisone dose showed a significant reduction, and analgesic use decreased in 7 patients who completed 6 months of treatment. Dyspepsia, tremor, and headache were seen but all were reported as mild and transient. Laboratory parameters were stable throughout the 6 months of the treatment period [75]. No cases of renal toxicity were reported in any of these patients. 

Seven children treated with daily corticosteroids for at least one year did not show any significant catch-up in growth after introduction of an alternate-day programme with an average prednisone dose of 17 mg q.o.d.(117C). 

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