What Is Considered A High Dose Of Prednisone ?

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.

In general:

  • 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.

Important warnings
  • 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
AUTOIMMUNE DISORDERS
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 REACTIONS
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
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
LUNG DISORDERS
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
CANCER
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
OTHER DISORDERS
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]

 

Side effects of Prednisone

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
  • Osteoporosis
  • 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.

References

 

  1. 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].
  2. American Osteopathic College of Dermatology (AOCD). Steroids (Oral).
    Available at: https://www.aocd.org/page/SteroidsOral. [Accessed August 13, 2021].
  3. Drugs.com. Prednisone. December 2020.
    Available at: https://www.drugs.com/pro/prednisone.html. [Accessed August 9, 2021]

 

Related Prednisone Medical Questions :
  • Can you drink alcohol with prednisone?
  • What is considered a high dose of prednisone ?
  • How long can you take prednisone safely?
  • How long does it take for prednisone to work?
  • Prednisone Side Effects
  • Do i take all 6 prednisone pills at once on the first day?
  • Methylprednisolone vs Prednisone – What’s the difference between them?
  • How long does prednisone stay in your system?
  • Prednisone vs Prednisolone – What’s the difference?
  • Does prednisone cause a rapid heart rate?
  • I just took 800 mg ibuprofen and 30 mg of prednisone. Is that going to be ok?
  • Why does prednisone cause weight gain?
  • How long does it take prednisone to get out of your system?
  • What are the side effects of steroids?
  • Does prednisone make you sleepy?
  • Can prednisone raise blood pressure?
  • Is it safe to take ibuprofen right after taking prednisone?
Click Here For More Info

www.genepredni.com

2 thoughts on “What Is Considered A High Dose Of Prednisone ?”

Leave a Comment