Corticosteroid Therapy Guidelines

Introduction to Corticosteroid Dosage

The American Academy of Otolaryngology-Head and Neck Surgery recommends a prednisone equivalent of 1 mg/kg/day (usual maximum dose of 60 mg/day) for 7-14 days, then tapering over a similar period for sudden hearing loss 6
The equivalent dose in prednisolone would be identical since these medications are bioequivalent 1

For severe/extensive bullous pemphigoid, the dose is 0.75-1 mg/kg/day 1
For moderate bullous pemphigoid, the dose is 0.3 mg/kg/day 1
For mild/localized bullous pemphigoid, the dose is 0.5 mg/kg/day 1
For pemphigus vulgaris, the initial dose is 1-2 mg/kg/day, with the possibility of 0.5-1 mg/kg/day for milder cases 1
Doses above 0.75 mg/kg/day (52.5 mg/day for a 70 kg patient) do not provide additional benefit, and doses above 30 mg/day are associated with significant mortality, particularly in elderly patients 2, 3
For tuberculous pericarditis, the dose is 60 mg/day for 4 weeks, then 30 mg/day for 4 weeks, then 15 mg/day for 2 weeks, then 5 mg/day for the 11th week 4
This dosing regimen significantly reduces mortality (3% vs 14%) and the need for repeated pericardiocenteses 4
For primary adrenal insufficiency, the replacement dose is 4-5 mg/day in a single morning dose, or 3 mg in the morning and 1-2 mg at 2 pm 5
Prednisolone should only be used in selected cases with marked energy fluctuations, with hydrocortisone being preferred 5

For sudden hearing loss in pediatric patients, the dose is equivalent to 1 mg/kg/day (maximum usual dose of 60 mg/day) for 7-14 days, then tapering over a similar period 6

Reduce the daily dose by about one-third to one-quarter until 15 mg/day, then by 2.5 mg steps until 10 mg/day, then by 1 mg/month until the minimum effective dose 7
If no response is observed within 5-7 days, increase the dose by 50-100% increments, considering IV pulsed corticosteroids if the dose exceeds 1 mg/kg/day 1

Single morning dose: Standard for most conditions 1
Divided doses: May be necessary for severe diseases requiring continuous control 1
Every-other-day dosing: Can reduce side effects in long-term therapy 7

For 15 mg of prednisolone, the equivalent doses are: prednisone 15 mg (bioequivalent) 1, methylprednisolone 12 mg, dexamethasone 2.25 mg, hydrocortisone 60 mg 6, and cortisone 75 mg

Prevention of osteoporosis: Mandatory calcium and vitamin D supplementation for all patients on long-term therapy, with regular DEXA scans 1
Signs of overdose: Weight gain, insomnia, peripheral edema 5
Signs of underdose: Lethargy, nausea, loss of appetite, weight loss, increased pigmentation 5
Hyperglycemia and weight gain: Most frequent side effects, even with short courses 6