Prednsione Notes English - Professor Richard Kirk 2023

Professor Richard Kirk
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Steroid Treatment Notes
Steroid Potency
Methylprednisolone is about 1.25 times (20%) more potent than prednisolone and 5 times more potent than hydrocortisone. So 8 mg methylprednisolone is equivalent to 10 mg prednisolone and 40 mg hydrocortisone.(1)
Steroid Dosage
In adults 1-1.5 mg/kg methylprednisolone is considered a high dose and ≤ 0.1mg/kg a low dose.(2) A physiological dose of hydrocortisone is 8 mg/m2/day (approximately 0.2 mg/kg/day) or prednisolone 0.05 mg/kg/day).(3) The dose should be given in the morning to reduce adrenal suppression
Steroid Taper
A gradual steroid taper does not necessarily prevent adrenal suppression. Despite this common practice is to taper. The length of time of steroid exposure is used to decide the tapering time. A reasonable guide is: no taper for an exposure of <1 month; a 1-2 week taper for an exposure of 1-3 months; a 2-3 week taper for an exposure of 3-6 months; and a 3-4 week taper for >6 months of exposure.(3)
Adrenal Suppression
Children with adrenal suppression may be asymptomatic until a crisis is precipitated by a physiological stress, such as illness, surgery, or injury. The period of risk develops one month after steroid exposure and when steroids are tapered below a physiological dose or stopped. Typically adrenal suppression lasts weeks or months. If steroids have been given for longer than one month, before discontinuing or tapering steroids below the physiological dose, consider screening for adrenal suppression with a first morning cortisol level.(3)
Adrenal Crisis
Patients who have or are receiving low dose steroids may be asymptomatic but still at risk of an adrenal crisis, unless it is proven the hypothalamic–pituitary–adrenal axis is intact. During at risk times an adrenal crisis can be prevented by receiving stress dosing for moderate to severe illness or injury and surgery. Prophylaxis hydrocortisone dose schedules vary, depending on the stress level between 30 and 100 mg/m2/day.(3)
An actual crisis is aborted with hydrocortisone 100 mg/m2 (maximum 100 mg) intravenously (or intramuscularly) stat, then 100 mg/m2/24 h (maximum 200 mg) divided every 6 h or by continuous infusion.(3)
  1. Corticosteroid Dose Equivalents. Abimbola Farinde, PharmD, PhD Faculty, Columbia Southern University. 2019
  2. Prednisone: Drug information. Accessed 2023.
  3. Adrenal suppression from exogenous glucocorticoids: Recognizing risk factors and preventing morbidity. Ahmet et al. Paediatr Child Health 2021;26: 242–247
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