Prednisolone/prednisone
Corticosteroid
For more detailed drug information, see Prednisolone/prednisone in the AMH.
Seek specialist advice.
Dosage – Prednisolone/prednisone
Doses are expressed as mg/kg and mg/m2 – read carefully.
Autoimmune or inflammatory disease
Dose depends on the disease and its severity. It has been used for diseases that include JIA, Crohn’s disease, multiple sclerosis, juvenile dermatomyositis, Kawasaki disease and systemic lupus erythematosus.
1 month – 18 years, oral, initially 1–2 mg/kg (usual maximum 60 mg) once daily. Once condition has stabilised, reduce to the minimum dose required to maintain control of disease.
Corticosteroid-sensitive nephrotic syndrome
First episode
3 months – 18 years, oral, initially 60 mg/m2 or 2 mg/kg (maximum 60 mg) once daily for 4–6 weeks, then 40 mg/m2 or 1.5 mg/kg (maximum 40 mg) on alternate days for 4–6 weeks.
Relapses
3 months – 18 years, oral 60 mg/m2 or 2 mg/kg (maximum 60 mg) once daily until proteinuria stops for 3 consecutive days, then 40 mg/m2 or 1.5 mg/kg (maximum 40 mg) on alternate days for 4 weeks.
For frequent relapses, prophylaxis with up to 0.5 mg/kg (maximum 20 mg) on alternate days may be considered.
Acute asthma
Seek specialist advice before treating children aged <1 year for asthma.
1 month – 18 years, oral 1 mg/kg (maximum 50 mg) once daily for 3–5 days.
Croup
>1 month, oral 1 mg/kg; repeat dose after 12–24 hours if necessary.
Prevention of transplant rejection
Dosage depends on the type of transplant and immunosuppressive regimen (see specialist protocols). The following doses have been used.
1 month – 18 years, oral, initially 60 mg/m2 or 2 mg/kg (maximum 80 mg) once daily 1 or 2 days post-transplant, reducing gradually over 6–12 months.
Infantile spasms (West syndrome)
>1 month, oral, initially 10 mg 4 times daily for 2 weeks (if spasms continue after 1 week, increase to 20 mg 3 times daily for 7 days). Taper dose over 15 days:
From 40 mg daily, reduce dose by 10 mg every 5 days, then stop.
From 60 mg daily, reduce dose to 40 mg daily for 5 days, then 20 mg daily for 5 days, then 10 mg daily for 5 days, then stop.
Inflammatory eye conditions
Do not use without close supervision by, or discussion with, an ophthalmologist (serious adverse effects can threaten vision).
1 month – 18 years, 1 eye drop every 4–8 hours, adjusted according to response. For severe inflammation, 1 drop every 1–2 hours may be used initially.
Administration advice
Oral: take with food to help reduce stomach upset.
Practice points
Chronic use
adjust dose according to response; higher doses are required for active disease than for maintenance treatment; once condition has stabilised, reduce to lowest effective dose
minimise the risk of adrenal suppression by giving in the morning
immunosuppression increases the risk of infection; before starting treatment, consider vaccination requirements and infection risk, see Immunomodulators in AMH
ensure adequate monitoring for adverse reactions, eg obesity, hypertension, osteoporosis, adrenal suppression, psychiatric effects, cataracts
chronic use may retard growth; alternate-day dosing may minimise this; follow growth and development carefully (catch-up growth may occur after corticosteroid withdrawal)
due to risk of adrenal suppression, consider need for withdrawing treatment gradually as abrupt withdrawal can result in adrenal crisis
Ophthalmological use
monitor intraocular pressure if used >10 days or in high doses, and for cataract formation if used long term
when stopping treatment, the dosage may need to be reduced gradually (over several days to weeks) to avoid rebound inflammation
Products
Search for Prednisolone/prednisone on the PBS
Prednisolone
tab, 1 mg (scored), 100, Panafcortelone, Predsolone, PBS
tab, 5 mg (scored), 60, Panafcortelone, Solone, PBS
tab, 25 mg (scored), 30, Panafcortelone, Solone, PBS
oral liquid, 5 mg/mL, 30 mL, Predmix, Redipred, PBS
eye drop, 0.5%, 0.5 mL (single use), 20, Minims Prednisolone
supp, 5 mg, 10, Predsol, PBS‑R[30]1
enema, 0.2 mg/mL, 100 mL, 7, Predsol Retention Enema, PBS‑R[28]2
Prednisone
tab, 1 mg (scored), 100, Panafcort, Predsone, PBS
tab, 5 mg (scored), 60, Panafcort, Sone, PBS
tab, 25 mg (scored), 30, Panafcort, Sone, PBS
1 proctitis; ulcerative colitis
2 for prescribing by certain health practitioners, see PBS