Glucocorticosteroids like prednisone, are important components of the treatment regimen for certain inflammatory and autoimmune diseases. The current article gives a brief overview of prednisone dosage in the context of certain crucial conditions and diseases.
Prednisone is a type of glucocorticoid prodrug, and serves as an anti-inflammatory and immunosuppressive agent. It forms a part of the treatment for certain allergic conditions, rheumatoid arthritis, pulmonary tuberculosis, lupus, multiple sclerosis, and adrenal insufficiency diseases like Addison’s disease. Recent research has shown that apart from its ability to reduce fatigue, pain and swelling in the joints, it also slows down the damage of affected joints.
In the past, corticosteroids, simply referred to a ‘steroids,’ were considered to be miracle drugs. This was due to the results of study conducted in 1948, wherein a group of patients suffering from arthritis were given corticosteroid injections daily. The improvement in their condition was so spectacular, that people believed a cure for arthritis had been found. However, as corticosteroid usage became widespread over the years, and its side effects began emerging, it became clear that high doses of corticosteroids taken over prolonged periods of time had many disadvantages. As a result, physicians began prescribing the drug more conservatively, and many people with arthritis were so scared that they often refused to be treated with it.
Prednisone, the brand names of which include, Deltasone, Cortan, Meticorten, Liquid Pred, Panasol-S, Orasone, Sterapred, and Prednicen-M, is a corticosteroid that is most commonly prescribed for treating arthritis. This drug is 4-5 times more potent than cortisol. 5 mg or prednisone is equivalent to the amount of cortisol produced by the body in one day.
The range for prednisone dosage in adults is 5 to 60 mg per day. Generally, prednisone treatment begins with a high dose which is gradually reduced over a period of few weeks. The treatment is then stopped or continued as a low-dose therapy, depending on the individual case. The generally recommended, adult and pediatric doses for certain diseases and conditions have been summarized below.
| Adults | |
| Disease/Condition | Daily Oral Dosage |
| Rheumatoid arthritis | Initial: 10 mg Long-term: 5 mg or less |
| Autoimmune hepatitis | Initial: 20-30 mg Long-term: 5-15 mg |
| Addison’s disease | 7.5 mg |
| Pleural effusion | 20 mg |
| Thyrotoxicosis | 40 mg |
| Pneumocystis jiroveci pneumonia (PCP) | 40-60 mg |
| Acute Asthma | 40-60 mg |
| Tuberculosis meningitis | 60 mg (tapered over six weeks) |
| Tuberculosis pericarditis | 60 mg (tapered over 11 weeks) |
| Nephrotic syndrome | 40-80 mg until urine is protein-free |
| *Multiple sclerosis (moderate relapse) | 60 mg (tapered over 1-2 weeks) |
*In case of severe relapse: 500-1000 mg IV for 3-5 days followed by oral prednisone tapered over 1-2 weeks.
| Children | |
| Disease/Condition | Daily Oral Dosage |
| Acute Asthma | 1-2 mg/kg |
| Juvenile rheumatoid arthritis | 0.05-2 mg/kg |
| Nephrotic syndrome | 2 mg/kg until urine is protein-free |
| Tuberculosis meningitis | 2-4 mg/kg (tapered over four weeks) |
| Tuberculosis pericarditis | 1 mg/kg (tapered over next 11 weeks) |
| Autoimmune hepatitis | 2 mg/kg (tapered over 4-8 weeks) |
Prednisone may also be prescribed to individuals who need to undergo imaging techniques, like CT scan, that involve the use of intravenous dyes. Prednisone is generally prescribed in three doses, with the first dose being prescribed 24 hours before administration of the intravenous dye. The objective behind such a dosage is to prevent the occurrence of any allergic reaction to the dye.
While it is not clear if a daily dose of 3 mg has any clinically significant toxic effects, it is known that a daily intake of more than 5 mg may increase the risk of cataracts, osteoporosis. Higher doses may even lead to decreased wound healing capacity and increased susceptibility to infections due to suppression of immune system.
Corticosteroids are actually drugs that are related to cortisol, which is a hormone synthesized naturally in the body by the adrenal cortex. Cortisol helps to control the balance of salt and water in the body, and regulates the metabolism of proteins, fats, and carbohydrates.
Cortisol is also produced by the body to deal with stress. When a stressful condition occurs, the pituitary gland, which is located at the brain’s base, releases adrenocorticotropic hormone (ACTH) which, in turn stimulates the adrenal glands to secrete cortisol. This extra dose of cortisol helps the body to cope with daily stress, as well as more stressful conditions like emotional problems, surgery, trauma, or infection. When there is an end to the stressful condition, the secretion of the hormone gets back to normal.
The adrenal glands normally secrete about 20 mg of cortisol in a day, usually during the morning hours, but they can secrete five times more if required.
Glucocorticosteroids function by binding to a protein receptor called Glucocorticoid Receptor (GR), which is present in the cytosol of many cells. Through this receptor, glucocorticoids activate the anti-inflammatory genes leading to a suppression of the inflammatory response, and alleviation of the inflammatory symptoms. It also suppresses cell-mediated immunity and other vital processes of the immune system. This renders the patient more susceptible to infections.
Many patients suffering from arthritis and autoimmune hepatitis are prescribed with a long term dose of prednisone. However, it is essential for the concerned medical expert to compare the beneficial effects of this drug along with its side effects. In addition, it is also advisable to evaluate the alternative treatment options, in order to ensure an optimum and safe treatment.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a substitute for professional medical advice.
