Prednisone Dosing Guidelines

Initial Dosing

For severe disease, the standard approach is 1-2 mg/kg/day (maximum 60 mg/day), according to the American College of Rheumatology and Hepatology guidelines 1, 2
For moderate disease, the recommended dose is 0.5-1 mg/kg/day, as suggested by the American College of Rheumatology 2
For mild disease, the recommended dose is 0.3-0.5 mg/kg/day, as suggested by the American College of Rheumatology 2

After achieving disease control, the goal is to taper to the lowest effective dose, typically 5-10 mg/day or less, as recommended by the Hepatology guidelines 1, 4
For autoimmune hepatitis, the recommended maintenance dose is prednisolone 5-10 mg/day for at least 2 years, as suggested by the American College of Rheumatology 4

Tapering should be gradual to avoid adrenal insufficiency and disease flare, with a reduction of 5 mg weekly until reaching 10 mg/day, as recommended by the Hepatology guidelines 1
Tapering should be gradual to avoid adrenal insufficiency and disease flare, with a reduction of 2.5 mg weekly until reaching 5 mg/day, as recommended by the Hepatology guidelines 1
Below 10 mg/day, taper by 1 mg every 4 weeks, as suggested by the American College of Rheumatology 3

Initial dosing for children is 1-2 mg/kg/day (maximum 60 mg/day) for 2 weeks, as recommended by the Hepatology guidelines 1
Maintenance dosing for children is taper over 6-8 weeks to 0.1-0.2 mg/kg/day or 5 mg/day, as recommended by the Hepatology guidelines 1
For nephrotic syndrome, the recommended dose is 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day), as suggested by the American College of Rheumatology 2, 3

Adrenal suppression risk occurs with any dose >7.5 mg/day for >3 weeks, requiring stress-dose coverage during illness or surgery, as suggested by the American College of Rheumatology 3

Patients on long-term corticosteroid treatment require baseline and annual bone mineral densitometry of lumbar spine and hip, as recommended by the Hepatology guidelines 1
Patients on long-term corticosteroid treatment require calcium and vitamin D supplementation, as suggested by the American College of Rheumatology 3
Patients on long-term corticosteroid treatment require DEXA scanning at 1-2 year intervals, as suggested by the American College of Rheumatology 4