What is considered a high dose of prednisone ?
The starting dose of prednisone may be between 5 mg to 60 mg per day. A dose above 40 mg per day may be considered a high dose. However, everybody responds differently to prednisone, so what might be a high dose depends on the person and the condition.
- Low dose: less than 7.5 mg per day
- Moderate dose: between 7.5 mg and 40 mg per day
- High dose: 40 mg to 60 mg per day
Sometimes doses much higher than the upper limit of 60 mg are given through an IV for short periods.
Doctors prescribe prednisone at the lowest effective dose for the shortest possible time. If prednisone is not effective, it should be stopped as soon as possible. The dose and time need to be adjusted for each patient based on the condition and response to treatment.
The reason that prednisone is used with care is that prednisone can pose serious side effects and long-term risks. In patients who need longer dosing of prednisone, it may be given every other day. This may reduce side effects and complications.
- Immune system effects warning:
- Prednisone may weaken your immune system. A weakened immune system makes you more likely to get infections. Avoid being near people who are sick or have recently been sick, especially with chickenpox or measles. These infections can be serious or deadly in people who have had them before and who have lowered immunity due to this drug.
- Tell your doctor about any recent infections or if you develop any symptoms of an infection, such as fever, chills, or body aches.
- Live vaccines warning: Don’t receive live vaccines while taking prednisone in high doses. If you do, your immune system might not be able to handle the vaccine properly. This may lead to an infection. If you’re not sure if a vaccine is a live vaccine, ask your doctor.
- Weak bones warning: Prednisone can cause bone loss and osteoporosis (weak and brittle bones) with long-term use. This drug can also slow growth in children. Talk with your doctor if you have any questions about this medication.
- Adrenal suppression warning: Prednisone can cause adrenal suppression (when your adrenal glands stop making certain hormones in your body). This can happen if you take this drug for a long time or if you suddenly stop taking this drug. Do not stop taking prednisone without talking to your doctor first.
- Harm to fetus warning: Prednisone can cause harm to a fetus if taken during pregnancy. The risk is greater if you take the drug during the first trimester of pregnancy. If you are pregnant, plan on getting pregnant, or are breastfeeding, talk with your doctor about benefits, risks, and possible treatment options.
|Prednisone dosage chart|
|Indication||Starting dosage||Standard dosage||Maximum dosage|
|Rheumatoid and arthritic conditions*||5–30 mg taken once per day||5–30 mg taken once per day||Not specified|
|Psoriatic arthritis or severe plaque psoriasis||5–30 mg taken once per day||5–30 mg taken once per day||60 mg per day|
|Myasthenia gravis||15–20 mg taken once per day||15–20 mg taken once per day increased by 5 mg every 2-3 days to the lowest effective dose||60 mg per day|
|Multiple sclerosis (acute exacerbation)||1250 mg taken once per day for 3-5 days||1250 mg taken once per day for 3-5 days||Not specified|
|Lupus erythematosus (exacerbation)||20–40 mg taken once per day for mild/moderate cases and 60–300 mg in divided doses for severe cases||Once controlled, the dose is reduced by 10% every 5-7 days until discontinuation||300 mg taken daily in divided doses|
|Lupus erythematosus (maintenance)||10–20 mg taken once per day or 20–40 mg taken every other day||10–20 mg taken once per day or 20–40 mg taken every other day||Not specified|
|Lupus nephritis||Methylprednisolone 500–1000 mg/day given intravenously once per day for 3 days, then oral prednisone 0.5 to 1 mg/kg/day||0.5–1 mg/kg taken once per day (prednisone)||Not specified|
|Immune thrombocytopenia (ITC)/ thrombocytopenia purpura||1 mg/kg taken once per day for short-term treatment||5–10 mg taken once per day for long-term treatment||Not specified|
|Erythroblastopenia||5–60 mg taken in 1-4 divided doses daily||5–60 mg taken in 1-4 divided doses daily and gradually reduced until discontinued in 4-6 weeks||Not specified|
|Other autoimmune conditions*||5–30 mg taken once per day||5–30 mg taken once per day||Not specified|
|Allergic skin reactions||5–60 mg taken divided into 1-4 doses per day||5–60 mg taken divided into 1-4 doses per day||Not specified|
|Severe allergic skin reactions||60 mg taken once a day||60–250 mg taken once a day||Not specified|
|Severe allergic reactions||5–60 mg taken divided into 1-4 doses per day||5–60 mg taken divided into 1-4 doses per day||Not specified|
|Asthma (acute exacerbation)||40–80 mg taken per day or divided into 2 doses per day||40–80 mg taken once per day or divided into 2 doses per day until peak expiratory flow hits 70% (usually 3 to 10 days)||Not specified|
|Asthma (short burst)||40–60 mg taken once per day or divided into 2 doses per day||40–60 mg taken once per day or divided into 2 doses per day for 3 to 10 days until peak expiratory flow hits 80%||Not specified|
|Asthma (persistent)||7.5–60 mg taken once per day or once every other day||7.5–60 mg taken once per day or once every other day||Not specified|
|Pneumocystis pneumonia (PCP) infection||40 mg taken twice per day for 5 days||40 mg taken twice per day for 5 days, then 40 mg taken once per day for 5 days, then 20 mg taken once per day for 11 days||Not specified|
|Disseminated pulmonary tuberculosis||60 mg taken once per day||60 mg taken once per day and reduced by 10 mg each week until discontinued in 6-8 weeks||Not specified|
|Allergic or aspiration pneumonitis||5–60 mg taken once per day||5–60 mg taken once per day and gradually reduced until discontinued in 4-6 weeks||Not specified|
|Pulmonary fibrosis||0.5 mg/kg per day taken for 4 weeks||0.5 mg/kg/day taken for 4 weeks followed by 0.25 mg/kg/day taken for 8 weeks then 0.125 mg/kg/day or 0.25 mg/kg/day every other day||Not specified|
|CONNECTIVE TISSUE DISORDERS|
|Osteoarthritis||5–30 mg taken once per day||5–30 mg taken once per day||Not specified|
|Gout||5–30 mg taken once per day||5–30 mg taken once per day||Not specified|
|Bursitis, tenosynovitis, synovitis, epicondylitis||5–30 mg taken once per day||5–30 mg taken once per day||Not specified|
|Dermatomyositis||20 to 40 mg/day for moderate illness, 60 to 100 mg/day for severe illness||10 to 20 mg once daily or 20 to 40 mg every other day||200 to 300 mg per day in divided doses|
|Polychondritis||20 to 40 mg/day for moderate illness, 60 to 100 mg/day for severe illness||10 to 20 mg once daily or 20 to 40 mg every other day||200 to 300 mg per day in divided doses|
|Temporal arteritis, vasculitis||20 to 40 mg/day for moderate illness, 60 to 100 mg/day for severe illness||10 to 20 mg once daily or 20 to 40 mg every other day||200 to 300 mg per day in divided doses|
|INFLAMMATORY BOWEL DISEASE (IBD)|
|Crohn’s disease (acute exacerbations)||40–60 mg per day for 1-2 weeks||Steadily tapering dose (by 5 mg weekly) to 20 mg per day, then steadily tapering dose (by 2.5–5 mg weekly) until discontinuation||Not specified|
|Ulcerative colitis (acute exacerbations)||40–60 mg once per day||40–60 mg once per day until remission of symptoms (usually 5-7 days)||60 mg per day|
|Acute lymphocytic leukemia (palliative treatment)||40–50 mg/square meter of body surface area taken once per day||40–50 mg/square meter of body surface area taken once per day||Not specified|
|Chronic lymphocytic leukemia (palliative treatment)||5–60 mg taken once per day||Individualized according to response||Not specified|
|Hodgkin lymphoma||40 mg/square meter of body surface area per day on days 1 through 22 then taper, repeat cycle every 57 days||40 mg/square meter of body surface area per day on days 1 through 22 then taper, repeat cycle every 57 days||Not specified|
|Mycosis fungoides||5–60 mg taken divided into 1-4 doses per day||5–60 mg taken divided into 1-4 doses per day||Not specified|
|Hypercalcemia (high blood calcium) due to cancer||50–100 mg taken once per day for 3-5 days||50–100 mg taken once per day for 3-5 days||Not specified|
|ENDOCRINE (HORMONE) DISORDERS|
|Addison’s disease or secondary adrenal insufficiency (maintenance treatment only)||5 mg taken in the morning and 2.5 mg taken in the evening every day||5 mg taken in the morning and 2.5 mg taken in the evening every day||Not specified|
|Congenital adrenal hyperplasia||2.5–5 mg taken at bedtime every day||2.5–5 mg taken at bedtime every day||Not specified|
|TRANSPLANT REJECTION PREVENTION|
|Kidney transplant||5–30 mg taken once per day with other immune-suppressing drugs||5–30 mg taken once per day||Not specified|
|Chronic graft vs. host disease||1 mg/kg taken once per day alternating with cyclosporine||Varies||Not specified|
|Proteinuria||40–80 mg taken once per day||40–80 mg taken once per day until urine is clear of protein, then taper off||Not specified|
|Loeffler’s syndrome, berylliosis, trichinosis||5–60 mg taken in 1-4 divided doses daily||5–60 mg taken in 1-4 divided doses daily and gradually reduced until discontinued in 4-6 weeks||Not specified|
[Table Data Reference From singlecare.com]
Common side effects from prednisone are due to the effect it has on lowering your immune system’s response to an infection. Prednisone also affects many other parts of your body. These effects may occur at high doses, or even lower doses if the treatment continues for a longer time. Side effects may include:
- Fluid retention that can lead to swelling, high blood pressure or heart failure
- Muscle weakness and loss of muscle
- Weakening of bones that can cause osteoporosis, spinal and long bone fractures or death of bone tissue
- Ulcers of the stomach or esophagus
- Swelling of the belly or inflammation of the pancreas
- Poor wound healing
- Effects on the skin may include thinning, bruising, redness, increased sweating and bleeding under the skin
- Effects on the nervous system may include headaches, dizziness, insomnia, mood swings, personality changes, depression and psychosis
- Effects on glands of the body may include irregular menstrual periods, slowed growth in children and high blood sugar
- Effects on the eyes may include cataracts, increased pressure inside the eyes, bulging eyes and glaucoma
Some people are at higher risk of adverse effects from higher doses or longer use of prednisone. These include people with:
- Hypothyroid disease
- Cirrhosis of the liver
- Herpes infection of the eye
- Mental health conditions
- Aspirin use
- Ulcerative colitis
- Ulcer disease
- Kidney failure
- An infected abscess
- High blood pressure
- Recent intestinal surgery
Use of prednisone at any dose is not considered safe during pregnancy or breastfeeding. Vaccinations may need to be avoided if you are taking prednisone at high doses.
Prednisone is a powerful anti-inflammatory drug used to treat conditions of inflammation. Even a normal dose may be considered high for some people. It is important to always weigh the risks against the benefits when taking this medication.
U.S. National Library of Medicine DailyMed. Prednisone. December 2020. Available at: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=263ed4fa-3c29-4abb-9cb1-bc016bd34a05&version=3#. [Accessed August 9, 2021].
American Osteopathic College of Dermatology (AOCD). Steroids (Oral). Available at: https://www.aocd.org/page/SteroidsOral. [Accessed August 13, 2021].
Drugs.com. Prednisone. December 2020. Available at: https://www.drugs.com/pro/prednisone.html. [Accessed August 9, 2021]
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