Prednisolone Dosing Guidelines

Disease-Specific Dosing

For autoimmune hepatitis, initial treatment is 30 mg/day prednisolone, reducing to 10 mg/day over 4 weeks, plus azathioprine 1 mg/kg/day, with maintenance treatment of prednisolone 5-10 mg/day for at least 2 years, as recommended by the Gut guideline 1
For nephrotic syndrome in children, the initial dose is 60 mg/m² or 2 mg/kg/day (maximum 60 mg/day) as a single daily dose for 4-6 weeks, followed by alternate-day dosing at 40 mg/m² or 1.5 mg/kg (maximum 40 mg on alternate days) for 2-5 months with tapering, according to the American Journal of Kidney Diseases guideline 2
For bullous pemphigoid, severe involvement requires 0.75-1 mg/kg/day, moderate disease requires 0.3 mg/kg/day, and mild/localized disease requires 0.5 mg/kg/day, with tapering by reducing the dose at fortnightly intervals, as recommended by the British Journal of Dermatology guideline 3
For asthma exacerbations in children, a short course of 1-2 mg/kg/day (maximum 60 mg/day) is used until peak expiratory flow rate reaches 80% of personal best or symptoms resolve, typically 3-10 days, as recommended by the Journal of Allergy and Clinical Immunology guideline 4

Prednisolone is typically administered as a single daily dose, and for long-term therapy, alternate-day dosing may help reduce adverse effects, according to the American Journal of Kidney Diseases guideline 2

Patients on long-term steroid therapy should receive calcium and vitamin D supplementation, and bone DEXA scanning should be performed at 1-2 yearly intervals, as recommended by the Gut guideline 1
Patients should be monitored regularly during therapy, with intervals of 1-6 months depending on level of control and treatment required, and consider step-down in therapy once the condition is well-controlled for at least 3 months, as recommended by the Journal of Allergy and Clinical Immunology guideline 4