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What is the physiological dose of prednisone
What is the physiological dose of prednisone.PDR Search
A Different Look at Corticosteroids | AAFP
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Send the page " " to a friend, relative, colleague or yourself. We do not record any personal information entered above. Commonly-prescribed oral corticosteroid with little mineralocorticoid activity; metabolized to prednisolone; prednisone is roughly 4 times as potent as hydrocortisone as a glucocorticoid Used in many conditions in adult and pediatric patients, including asthma, COPD, SLE, rheumatoid and psoriatic arthritis, prevention of transplant rejection, and many allergic, dermatologic, and inflammatory states If long-term therapy required, the lowest possible effective dose should be used.
For acute conditions, parenteral steroid therapy is recommended initially. NOTE: Hydrocortisone and cortisone are the preferred agents; prednisone has little to no mineralocorticoid properties. NOTE: Hydrocortisone is the preferred glucocorticoid in infants. Titrate to response. The usual range is 5 mg to 30 mg PO once daily. Renal transplant guidelines recommend a calcineurin inhibitor CNI such as tacrolimus and an antiproliferative agent such as mycophenolate plus or minus corticosteroids for initial prophylaxis.
In patients at low immunologic risk who receive induction therapy, corticosteroid discontinuation during first week after transplantation is suggested. Some evidence exists that steroids may be safely stopped in most patients after 3 to 12 months on combination therapy with a CNI and mycophenolate.
Data suggest that the risk of steroid withdrawal depends on the use of concomitant immunosuppressives, immunological risk, ethnicity, and time after transplantation. Once the prednisone taper is completed without a flare, the cyclosporine dose is tapered to alternate day dosing such that the patient is taking prednisone one day and cyclosporine the next day. Once patients reach their maximal response, therapy is continued for another 3 months and then tapered.
Multiple dosage regimens have been studied. Dosage requirements are variable though and should be individualized based on the response of the patient and tolerance to treatment.
The American College of Gastroenterology states that corticosteroids are not effective for maintenance of medically-induced remission in Crohn's disease and should not be used for long-term treatment. Corticosteroids for Crohn's disease are more effective for small-bowel involvement than for colonic involvement. Because of the potential complications of steroid use in this disease, steroids should be used selectively and in the lowest dose possible.
Guidelines recommend oral corticosteroids to induce remission in persons with ulcerative colitis; however, guidelines recommend against systemic corticosteroids for the maintenance of remission.
Total course of treatment may range from 3 to 10 days. Dosing in the afternoon at PM may be helpful for patients prone to nocturnal symptoms, with no increase in adrenal suppression. Consider add-on low dose oral corticosteroids CS 7. Add CS only after exclusion of other contributory factors and consideration of other add-on treatments. In pediatric patients, the use of oral corticosteroids is usually limited to a few weeks until asthma control is improved and the patient can be stabilized on other, preferred treatments.
Increase by 5 mg every 2 to 3 days as needed. For chronic use, may change to every other day therapy. Usual dosage ranges from 5 to 30 mg PO once daily. Use the lowest effective dose usually less than 7. American College of Rheumatology guidelines recommend 0. Taper the dose after a few weeks to the lowest effective dose that maintains control.
Insufficient data exist to recommend a specific steroid taper because nephritis and extrarenal manifestations vary from patient to patient. Some patients may require long-term therapy. If needed, the long-term maintenance dose is 0. In patients with severe skin reactions, higher initial doses e. Adjust until a satisfactory response is noted; taper as clinically indicated. High-dose corticosteroids are controversial; administration has been associated with decreased survival.
Depending on the indication, the initial dose may be gradually tapered after 1 to 2 weeks and discontinued by 4 to 6 weeks, as guided by symptoms. Oral corticosteroids are usually reserved for cases not responding to standard topical treatments. Use lowest effective dose. Corticosteroids are not indicated as initial treatment for anaphylaxis, but can be given as adjunctive therapy after the administration of epinephrine.
Corticosteroid use in ARDS is controversial. The initial dosage may vary from 5 to 60 mg PO per day. Guidelines use a dose of 0. Taper to 0. Guidelines suggest use of prednisone with cyclophosphamide or azathioprine, and a minimum of 6 months duration. Objective responses may not be noted until at least 3 months of therapy. Exact duration of treatment and need for long-term maintenance should be individualized to clinical response and tolerance of therapy.
Chronic doses of prednisone 15 mg to 20 mg PO once daily may be adequate as maintenance therapy. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Weight-based dosing: 0. Gradually taper after 1 to 2 weeks and discontinue by 4 to 6 weeks, as guided by symptoms. Chemotherapy cycle is repeated every 57 days. Depending on indication, gradually taper the initial dose after 1 to 2 weeks and discontinue by 4 to 6 weeks, guided by symptoms. Guidelines recommend as adjunct therapy for meningitis.
Routine use outside of CNS involvement is not recommended; however, select patients may benefit. The National Institutes of Health NIH COVID treatment guidelines recommend prednisone as an alternative corticosteroid for hospitalized patients who require supplemental oxygen, including those on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation ECMO.
The NIH recommends 40 mg PO once daily or in 2 divided doses for up to 10 days or until hospital discharge whichever comes first. The NIH advises clinicians to review the patient's medical history and assess the potential risks and benefits before starting prednisone.
Treatment cycles may be repeated when the granulocyte and platelet counts returned to normal. Response may be gradual over several months. The optimal dosage of melphalan and prednisone plus thalidomide has not been clearly established and dosages have varied in randomized controlled trials. In one study, previously untreated patients between 65 and 75 years of age received melphalan 0.
Thalidomide was stopped after day 4 of the last cycle. In another study, patients aged 75 years and older received melphalan 0. In cycles 1 through 4, bortezomib 1. In cycles 5 to 9, bortezomib 1. Dosage not established. The progression-free survival time was not significantly improved with carfilzomib, melphalan, and prednisone compared with bortezomib, melphalan, and prednisone in a randomized, phase 3 trial the CLARION trial ; additionally, serious and fatal adverse reactions occurred more often in the carfilzomib-containing arm.
There is not sufficient evidence to support the use of this drug combination for this indication. If side effects e. NOTE: The definitive treatment for median-nerve entrapment is surgery. Corticosteroids are temporary measures; patients who have intermittent pain and paresthesias without any fixed motor sensory deficits may respond to conservative therapy.
Initially, 20 mg to 30 mg PO once daily has been recommended. Some experts give a combination of prednisone and azathioprine. For maintenance, prednisone 5 mg to 15 mg PO once daily has been recommended. Doses for the various manifestations of SLE vary widely. Maintenance doses are usually 10 to 20 mg PO once daily or 20 to 40 mg PO every other day. Initially, large doses e.
Individualize dose and titrate to response. After symptoms controlled, decrease dose slowly every 5 to 7 days. Maintenance doses for chronic conditions are usually 10 to 20 mg PO once daily or 20 mg to 40 mg PO every other day. The treatment combination demonstrated superior results over colchicine alone in the treatment of primary amyloidosis. A multicenter, randomized, controlled trial confirmed that this shorter duration of low dose prednisone is equivalent to using 40 mg of prednisone for a longer duration i.
Data from studies indicate that systemic glucocorticoids shorten recovery time; improve lung function FEV-1improve oxygenation, and reduce the risk of early relapse, treatment failure, and the length of hospitalization. Taper dose over at least 6 weeks. There is variation in the literature with regard to dosage regimens. Prednisone 0. Use of IV methylprednisolone for a few days may precede oral corticosteroid use.
While many case reports suggest a possible net benefit to the use of corticosteroids, some experts advocate for more prospective study of their value. Higher quality data are needed to establish the benefits vs. Experts generally agree that patients who have neurologic deficits should receive a corticosteroid; many patients with MSCC require corticosteroids to help preserve neurologic function, such as ambulation.
Topically applied corticosteroids are as effective as systemic corticosteroids for anterior ocular inflammation. Common regimens from high-quality clinical trials include a prednisone or prednisolone dose of 60 mg PO per day for 5 days, followed by a 5-day taper or 25 mg PO twice daily for 10 daysin combination with appropriate antiviral treatment. A prednisone dose of mg PO administered in descending doses over 10 days has also been used with efficacy. The American Academy of Neurology notes that for new-onset Bell's palsy, steroids are effective in increasing the probability of complete facial functional recovery according to data derived from class I high quality studies.
The optimal dose of prednisone for infantile spasms has not been determined. Based on the evidence currently available, the American Academy of Neurology and the Child Neurology Society's practice parameters for the treatment of infantile spasms state that there is insufficient evidence that oral corticosteroids are effective in the treatment of infantile spasms.
There are limited data available for the treatment of refractory seizure types in pediatric patients.
The steroid therapy group received prednisolone at a physiological dose. Prednisolone was given intravenously at (5 mg) and ( mg) for 10 days. For example, the standard dose of prednisone for the treatment of nephrotic syndrome in children is 2 mg/kg/day. When converted into dose/m2. For prednisone, reduce dose by to 5 mg every 3 to 7 days until a physiologic dose of 5 to mg is achieved in conditions such as. Oral: 10 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses; Low dose: to 10 mg/day; High dose: 1 to mg/kg/day . The standard prednisone dosage for adults is mg per day. Use our prednisone dosage chart to find the recommended and maximum dosage of prednisone. Activation of latent disease or exacerbation of intercurrent infection due to pathogens such as Amoeba, Candida, Cryptococcus, Mycobacterium, Nocardia, Pneumocystis, or Toxoplasma can occur in patients receiving systemic corticosteroids.Corticosteroids were first used in clinical practice in for the treatment of rheumatoid arthritis. Indications since then have spanned multiple specialties and organ systems, including dermatology, rheumatology, immunology and oncology. This review covers practical uses of steroids as well as current and frequently overlooked clinical applications that may be helpful to family physicians. If physicians understand the composition and physiologic effects of corticosteroid agents, appropriate drug selection can be made and inappropriate or problematic uses can be avoided.
Corticosteroid agents mimic the endogenous steroid hormones produced in the adrenal cortex—mineralocorticoid aldosterone and glucocorticoid cortisol.
Mineralocorticoids are primarily regulated by the renin-angiotensin system and possess salt-retaining properties. Glucocorticoids are primarily regulated by corticotropin ACTH and can have anti-inflammatory effects, as well as several metabolic and immunogenic effects, on the body. While several corticosteroid agents possess properties of both hormones, fludrocortisone is most commonly used for its mineralocorticoid activity and hydrocortisone, cortisone, prednisone and prednisolone are used for their glucocorticoid effects.
Table 1 summarizes the relative potencies of the hormonal effects in addition to providing equivalent doses. Therapeutic effects of steroids can often parallel undesirable side effects, especially when high doses and long-term therapy are required.
By anticipating the potential side effects and implementing preventive measures where possible Table 2 , 1 — 4 patients can obtain maximum benefits with minimum adverse effects. The dosage range for steroids is wide, and patient response is variable. A low or maintenance dosage is approximately 0. Short-term, low-dose steroid therapy rarely results in any of the adverse effects listed in Table 2. In long-term therapy, alternate-day administration should be considered.
Some disease states, however, such as temporal arteritis and systemic lupus erythematosus, may not be adequately controlled with alternate-day therapy. Doubling the dosage and administering the drug every other day in the morning more closely mimics the endogenous corticosteroid circadian rhythm. This form of administration enables the patient to experience the therapeutic effects while side effects are minimized. Viral croup is a common childhood disease. In fact, it is the most common form of upper airway obstruction in children six months to six years of age.
Corticosteroids have been studied in the management of croup for the past 30 years, but their use in this condition is controversial. The use of steroids in children with croup is associated with significant clinical improvement at about 12 hours post-treatment and results in less endotracheal intubation. Most current research focuses on outpatient use of corticosteroids in the treatment of moderate and severe croup. Some authors have found that routine use of steroids reduces the need for hospitalization.
Although budenoside is well tolerated with minimal side effects because of limited systemic availability, it is not yet available for use in the United States except in a nasal form. A single intramuscular injection of 0. Therefore, intramuscular corticosteroid treatment should be considered in patients with moderate croup before discharge from the emergency department when outpatient therapy is entertained. Pneumocystis carinii pneumonia PCP is a leading cause of morbidity and mortality in patients infected with human immunodeficiency virus HIV.
This clinically significant complication of HIV infection occurs in 60 to 80 percent of patients with acquired immunodeficiency syndrome not receiving prophylaxis 14 and causes death in approximately 25 percent of its victims.
Since the late s, adjunctive treatment with corticosteroids has been documented in case reports and research studies with favorable clinical results, and it is currently endorsed by the National Institutes of Health as a standard therapy.
Documented benefits of corticosteroid therapy in patients with PCP include reduced morbidity and mortality, decreased need for mechanical ventilation assistance and a reduced long-term decline in pulmonary function or exercise tolerance.
Progression of other opportunistic infections associated with HIV infection as a result of the immunosuppressive effects of corticosteroids is a risk that must be considered. While some studies report only minor complications associated with steroid therapy, such as reactivation of localized herpetic lesions, 18 others have reported an increased incidence of infection and cancer. Based on the benefits and risks of adjunctive corticosteroid therapy, the current recommendations are not intended for all patients but only for those with confirmed or suspected HIV and PCP infection who are at high risk of respiratory failure and death.
Patients at risk include those with an arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar gradient of more than 35 mm Hg. The recommended dosing regimen is oral prednisone, 40 mg twice daily for five days, then 40 mg once daily for five days, then 20 mg daily for the duration of the anti-pneumocystis therapy.
Methylprednisolone, given at 75 percent of the oral prednisone dosage, can be substituted if parenteral therapy is necessary. A confirmatory diagnosis of PCP and HIV infection should be obtained, and other diseases, such as tuberculosis and cryptococcosis, should be ruled out before steroid therapy is begun. Further investigation is required to determine the appropriate use and benefits of steroid therapy when the patient has concomitant life-threatening infections and when the patient has already received more than three days of anti-pneumocystis therapy and has developed significant hypoxia.
Hyperthyroidism is a common disease affecting around 2 percent of women and 0. The amount of benefit and the effect on patient outcome in this circumstance is not yet known. Graves' eye disease is treated by first normalizing the thyroid function and then administering diuretics and systemic glucocorticoids. Other causes of hyperthyroidism that may be treated with corticosteroids are subacute thyroiditis and thyroid storm. Hyperthyroid disease related to thyroiditis is usually mild and self-limited.
Beta blockers may be used to treat symptoms. In subacute thyroiditis, non-steroidal anti-inflammatory drugs or corticosteroids can be used to relieve thyroid pain and tenderness. Thyroid storm is a life-threatening condition of the hyperthyroid state.
Corticosteroids are used as adjuvant analgesics for pain in cancer patients and patients with neuropathic pain such as herpes zoster—related neuropathy, spinal cord compression and pain following oral surgery. Prednisone, at a dosage of 7. Patients with nerve compression pain or pain resulting from increased intracranial pressure showed a better response when compared with patients with other pain syndromes.
Perioperative use of corticosteroids has been advocated to reduce pain and decrease edema and trismus following oral surgical procedures.
The most significant improvement occurs in the treatment of postoperative edema. Dosages of prednisone between 40 and 80 mg per day can be used.
Maximal benefit has been achieved after third-molar extraction, although some benefit has been reported after other surgeries. Some evidence indicates that combining corticosteroids with acyclovir Zovirax will decrease the duration of zoster-associated pain.
Systemic treatment with corticosteroids such as prednisone, at 40 mg per day for three weeks, decreases the proportion of patients affected by postherpetic neuralgia, especially pain occurring six to 12 weeks after onset. Alcoholic hepatitis is a chronic, progressive and often fatal disease.
Treatment has generally been supportive. Meta-analysis of studies from to supports the finding that patients with acute severe alcoholic hepatitis and hepatic encephalopathy, without gastrointestinal bleeding, benefit from a trial of corticosteroid therapy.
Further clinical trials were recommended to clarify the role of steroids in the treatment of alcoholic hepatitis. Bacterial meningitis is a serious disease that may result in death or permanent neurologic complications such as seizures, paralysis or sensorineural hearing loss.
These produce inflammatory components such as cytokines, which lead to meningeal inflammation and increased intracranial pressure. Studies show that potent corticosteroids, such as dexamethasone, combined with appropriate antibiotics reduce the risk of acquired sensorineural deafness and the incidence of other neurologic sequelae in meningitis caused by Haemophilus influenzae.
The drug was administered in a dosage of 0. Corticosteroids may also be used in the treatment of tuberculous meningitis. In one randomized, controlled study 55 involving 47 patients in India, dexamethasone was found to be useful as an adjunct treatment in cases of tuberculous meningitis, especially in patients with severe disease. A more recent randomized trial 56 using prednisone in children with tuberculous meningitis showed that prednisone in a dosage of 2 to 4 mg per kg per day for one month improved survival rate and intellectual outcome.
Table 4 57 lists other unlabeled uses of corticosteroids. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Actions and Side Effects. Edema Decreased salt intake Increased potassium excretion Potassium supplements may be necessary.
Increased calcium excretion Use with caution in patients at increased risk of developing osteoporosis; calcium supplements may be necessary, especially in postmenopausal women. Gastrointestinal Gastric irritation Take with meals to prevent gastric upset.
Endocrine Hypercortisolism Cushingoid state , secondary adrenal insufficiency Associated with long-term use even at lower dosages Menstrual difficulties, including amenorrhea and postmenopausal bleeding Precipitation of diabetes mellitus Glucose intolerance, hyperglycemia In patients with diabetes, increased dosages of insulin or oral hypoglycemic agent and changes in diet should be expected. Cardiovascular Hypertension Use with extreme caution in patients with recent myocardial infarction because of an apparent association with left ventricular free-wall rupture.
Thromboembolism Use with caution in patients with thromboembolic disorders because of reports of rare increased blood coagulability. Thrombophlebitis CHF exacerbation Ocular Posterior subcapsular cataracts Prolonged use may result in increased intraocular pressure or damaged ocular nerve.
Use in patients with ocular herpes simplex may cause corneal perforation. Glaucoma May enhance secondary fungal or viral infections of the eye Musculoskeletal Muscle pain or weakness, muscle wasting, pathologic long bone or vertebral compression fractures, atrophy of protein matrix of bone, aseptic necrosis of femoral or humeral heads Use with caution in patients prone to development of osteoporosis; risk versus benefit should be reassessed if osteoporosis develops; elderly, debilitated or poorly nourished patients may be more prone to these effects.
Supplementation with calcium, 1, mg per day, and vitamin D, IU per day, is recommended. Neuropsychiatric Headache, vertigo, seizures, increased motor activity, insomnia, mood changes, psychosis Use with caution in patients with convulsive or psychiatric disorders.
Use may aggravate preexisting psychiatric conditions. Steroid-induced psychosis is dose-related, occurs within 15 to 30 days of therapy and is treatable if steroid therapy must be continued. Pseudotumor cerebri reported during withdrawal. Other Increased susceptibility to infections, masked symptoms of infections Contraindicated in patients with systemic fungal infections except to control drug reactions associated with amphotericin B [Fungizone] therapy.
Do not use live virus vaccinations during therapy. Reactions to skin tests may be suppressed. In most patients, endogenous corticosteroid secretions are equivalent to 5 to 7. Recommended tapering schedules Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment more than 1 year. Depending on dosage, duration of therapy and risk of systemic disease, decrease dosage by the equivalent of 2. Then perform a challenge to determine the extent of HPA axis recovery.
Depending on the results and patient's symptoms, therapy may be discontinued or a slower taper considered. If symptoms do not subside when steroid dosage is adjusted, other causes must be considered. In certain severe illnesses or during acute flare ups, daily dosing may be re-initiated. Pneumocystis carinii Pneumonia. Pain Management. Alcoholic Hepatitis.
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