Methylprednisolone Dosage

Drug Detail:Medrol dosepak (Methylprednisolone (oral) [ meth-il-pred-nis-oh-lone ])

Usual Adult Dose for Allergic Rhinitis

Acetate suspension:
80 to 120 mg IM

Comment:

Symptom relief may occur within 6 hours and persist for several days to 3 weeks.

Use: For symptom relief of allergic rhinitis (hay fever).

Usual Adult Dose for Alopecia

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Alternatively, Methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Acetate suspension:
Initial dose: 40 to 120 mg IM once a week for 1 to 4 weeks

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRALESIONAL administration: Acetate suspension is injected into lesion:
Initial dose: 20 to 60 mg injected into lesion; for larger lesions, 1 to 4 injections of 20 to 40 mg should be used to distribute dose.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Uses: For the systemic treatment of dermatologic disorders; intralesional injections maybe used to locally treat alopecia areata, discoid lupus erythematosus, keloids, lichen planus, lichen simplex chronicus (neurodermatitis), psoriatic plaques, necrobiosis lipoidica diabeticorum, and localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Dermatologic Lesion

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Lichen Simplex Chronicus

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Psoriasis

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Dermatological Disorders

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Granuloma Annulare

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Lichen Planus

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Keloids

Dosing should be individualized based on disease and patient response

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

For relief of acute severe dermatitis due to poison ivy: 80 to 120 mg IM; relief may occur within 8 to 12 hours
For relief of chronic contact dermatitis: 80 to 120 mg IM every 5 to 10 days
For relief of seborrheic dermatitis: 80 mg IM weekly to control condition

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

The interval between injections varies with the type of lesion and duration of improvement produced by the initial injection.

Comments:

To minimize the incidence of dermal and subdermal atrophy, multiple injections should be made whenever possible.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Adult Dose for Rheumatoid Arthritis

SYSTEMIC Effect:
Oral:
Initial dose: 4 to 48 mg orally once a day or in divided doses

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral: Acetate suspension: Provides prolonged systemic effect
Maintenance dose: 40 to 120 mg IM once a week

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effect:
INTRA-ARTICULAR INJECTION: Acetate suspension:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

Use: For the treatment of rheumatoid arthritis; short-term intra-articular administration may be used to tide patients over an acute episode or exacerbation

Usual Adult Dose for Adrenogenital Syndrome

Acetate suspension:
Initial dose: 40 mg IM every 2 weeks
Maintenance: Adjust dose as needed for individual patient

Use: For the treatment of adrenogenital syndrome.

Usual Adult Dose for Acute Gout

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

Alternatively, methylprednisolone Dosepak(R):
Day 1: 24 mg orally (8 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 2: 20 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 8 mg at bedtime)
Day 3: 16 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg after dinner; 4 mg at bedtime)
Day 4: 12 mg orally (4 mg before breakfast; 4 mg after lunch; 4 mg at bedtime)
Day 5: 8 mg orally (4 mg before breakfast; 4 mg at bedtime)
Day 6: 4 mg orally (4 mg before breakfast)

Parenteral:
Sodium succinate (IV or IM); in emergency situations, IV is preferred

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

MAINTENANCE DOSING: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Allergic Reaction

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Bursitis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Nephrotic Syndrome

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Osteoarthritis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Rejection Prophylaxis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Rejection Reversal

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Tendonitis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Anti-inflammatory

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Neoplastic Diseases

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Epicondylitis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Synovitis

Dosing should be individualized based on disease and patient response:

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally no more than 48 to 72 hours; after initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension (IM only): For prolonged systemic effect:
Initial dose: 4 to 120 mg IM; may repeat dose depending upon the degree of relief obtained from original injection.

Alternatively, when oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

LOCAL Effects: Acetate suspension only:

INTRA-ARTICULAR Administration:
General guidance: Actual doses may vary with severity of condition

Large joints (knee, angles, shoulders): 20 to 80 mg via intra-articular injection
Medium joints (elbows, wrists): 10 to 40 mg via intra-articular injection
Small joints (metacarpophalangeal, interphalangeal, sternoclavicular, acromioclavicular): 4 to 10 mg via intra-articular injection

Injections may be repeated every 1 to 5 or more weeks, depending upon the degree of relief obtained from the original injection.

SOFT TISSUE Administration:

For conditions of the tendinous or bursal structures: 4 to 30 mg
Repeat injections may be needed for recurrent or chronic conditions.
Product Information may be consulted for specific administration instructions

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.
Intra-articular or soft tissue administration may be used as adjunctive therapy to tide patients over an acute episode or exacerbation of acute gouty arthritis, acute/subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, or synovitis of osteoarthritis.

Usual Adult Dose for Asthma - Acute

Oral:
Burst therapy: 32 to 64 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best

Therapy is usually required for 3 to 10 days but in some cases, may be longer

Comments:

There is no known advantage for using higher doses to treat acute asthma episodes.
Orally administered prednisone is as effective as IV methylprednisolone in treating acute asthma; because oral corticosteroids are less invasive, they are preferred unless gastrointestinal transit time or absorption is impaired.
Tapering the dose of oral corticosteroids following short course or burst therapy of less than 1 week is generally not necessary, especially if patients are concurrently taking inhaled corticosteroids.

Parenteral:
Sodium succinate: IV administration may be used if rapid hormonal effect of maximum intensity is required.

High dose therapy: 30 mg/kg IV over at least 30 minutes every 4 to 6 hours until condition has stabilized, generally 48 to 72 hours; following initial emergency period, a longer-acting injectable or oral preparation should be considered
Alternatively, when oral therapy is not feasible, IM or IV administration may be substituted.

Acetate suspension: For prolonged systemic effect
240 mg IM once (guideline dosing); 80 to 120 mg IM (manufacturer dosing)

Comments:

IM (acetate) administration may result in relief within 6 to 48 hours and persist for several days to 2 weeks.
IM administration is not preferred, but may be used in patients who are vomiting or if there is a concern with adherence.

Use: For the treatment of acute asthma; to prevent progression of exacerbation, reverse inflammation, speed recovery, and reduce rate of relapse.

Usual Adult Dose for Asthma - Maintenance

Initial dose: 6 to 48 mg orally once a day or every other day
Maintenance dose: Gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:

Doses should be given in the morning, either daily or every other day; alternate-day-therapy is recommended when chronic administration is necessary as it may produce less adrenal suppression.
Chronic administration of corticosteroids in patients with asthma is reserved for only the most severe, difficult-to-control asthma.

Use: For patients with the most severe, difficult-to-control asthma.

Usual Adult Dose for Multiple Sclerosis

160 mg orally once a day for 1 week; then 64 mg orally every other day for 1 month

When oral therapy is not feasible, may administer IM (sodium succinate or acetate) or IV (sodium succinate); dosing will be the same as oral.

Comments:

Controlled clinical trials have shown corticosteroids to be effective in speeding the resolution of acute exacerbations of multiple sclerosis, although they have not been shown to affect the natural history of the disease.

Use: For the treatment of acute exacerbations of multiple sclerosis.

Usual Pediatric Dose for Nephrotic Syndrome

Dosing should be individualized based on disease and patient response; in children, dosage may be reduced but this decision should be governed more by the severity of the condition and the response of the patient than by age or size.

Oral:

Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM

When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Rejection Prophylaxis

Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM

When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Rejection Reversal

Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM

When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Anti-inflammatory

Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM

When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Neoplastic Diseases

Initial dose: 4 to 48 mg orally once a day or in divided doses

Parenteral:
Sodium succinate: IV or IM; in emergency situations, IV is preferred

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses (not less than 0.5 mg/kg/24 hours)
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses

Acetate suspension: For prolonged systemic effect; IM only
Initial dose: 0.11 to 1.6 mg/kg/day IM

When oral therapy is not feasible, IM administration may be substituted; a single IM injection during each 24-hour period equal to the total daily oral dose is usually sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Doses exceeding usual doses may be justified in overwhelming, acute, life-threatening situations.
Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses:

As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

Usual Pediatric Dose for Asthma - Acute

0 to 11 years of age:
Initial dose: 0.8 to 1.6 mg/kg oral or IV (succinate) once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best

Therapy is usually required for 3 to 10 days but in some cases, may be longer

Maximum dose: 48 mg

12 years or older:
Initial dose: 32 to 48 mg orally once a day or in 2 divided doses until symptoms resolve and PEF (peak expiratory flow) is at least 80 percent of personal best

Therapy is usually required for 3 to 10 days but in some cases, may be longer

Comments:

There is no known advantage for using higher doses to treat acute asthma episodes.
Orally administered prednisone is as effective as IV methylprednisolone in treating acute asthma; because oral corticosteroids are less invasive, they are preferred unless gastrointestinal transit time or absorption is impaired.
Tapering the dose of oral corticosteroids following short course or burst therapy of less than 1 week is not necessary, especially if patients are concurrently taking inhaled corticosteroids.

IM (acetate):
0 to 4 years of age: 7.5 mg/kg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)

5 years or older: 240 mg IM once (guideline dosing) OR 80 to 120 mg IM (manufacturer dosing)

Comments:

IM (acetate) administration may result in relief within 6 to 48 hours and persist for several days to 2 weeks.
IM (acetate) administration is not preferred, but may be used in patients who are vomiting or if adherence is a concern.

Use: For the treatment of acute asthma; to prevent progression of exacerbation, reverse inflammation, speed recovery, and reduce rate of relapse.

Usual Pediatric Dose for Asthma - Maintenance

0 to 11 years of age:
Maintenance dose: 0.2 to 1.6 mg/kg orally once a day or every other day as needed for asthma control
Maximum dose: 48 mg

12 years or older:
Maintenance dose: 6 to 48 mg orally once a day or every other day as needed for asthma control

Gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response.

Comments:

The most important determinant of appropriate dosing is response to therapy; once control is achieved and sustained for 3 months, the dose should be carefully titrated down to the minimum dose necessary to maintain control.
Doses should be given in the morning, either daily or every other day; alternate-day-therapy is recommended when chronic administration is necessary as it may produce less adrenal suppression.
Chronic administration of corticosteroids in patients with asthma is reserved for only the most severe, difficult-to-control asthma.

Use: For patients with the most severe, difficult-to-control asthma.

Usual Pediatric Dose for Juvenile Rheumatoid Arthritis

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
SUCCINATE: May administer IM or IV

Initial dose: 0.11 to 1.6 mg/kg/day (3.2 to 4.8 mg/m2/day) IM or IV divided in 3 or 4 doses throughout the day
As a temporary substitute for oral therapy, administer oral daily dose IV or IM divided in 3 or 4 doses throughout the day

ACETATE suspension: IM administration only

Initial dose: 0.11 to 1.6 mg/kg IM once a day
As a substitute for oral therapy: a single IM injection during each 24-hour period equal to the total daily oral dose is generally sufficient; when a prolonged effect is desired a weekly dose may be given as a single IM injection.

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Use: For the treatment of juvenile rheumatoid arthritis; selected cases may require low-dose maintenance therapy.

Usual Pediatric Dose for Allergic Reaction

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Parenteral:
When oral therapy is not feasible IV (succinate) or IM therapy (acetate or succinate) may be used.

Succinate:
Initial dose: 0.11 to 1.6 mg/kg/day IV or IM in 3 or 4 divided doses
Alternatively, 3.2 to 4.8 mg/m2/day

Acetate:
Initial dose: 0.11 to 1.6 mg/kg/day IM once a day

Comments:

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Alopecia

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Dermatologic Lesion

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Lichen Simplex Chronicus

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Psoriasis

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Dermatological Disorders

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Allergic Urticaria

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Granuloma Annulare

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Lichen Planus

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Usual Pediatric Dose for Keloids

Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Intralesional injections may also be useful in treating cystic tumors of an aponeurosis or tendon (ganglia).

Renal Dose Adjustments

Use with caution; no adjustment recommended

Liver Dose Adjustments

Use with caution; no adjustment recommended

Dose Adjustments

Elderly: Dose selection should be cautious generally starting at the low end of the dose range.

Drug Discontinuation:

Abrupt discontinuation after high-dose or long-term therapy should be avoided.
Drug-induced adrenocortical insufficiency may persist for up to 12 months after drug discontinuation.

Recommendations:

Gradual dose reduction is recommended.
In situations of stress, restarting or increasing corticosteroid dose may be needed to account for drug-induced adrenocortical insufficiency.

Alternate Day Therapy:

Alternate day therapy may be considered for long term oral glucocorticoid therapy to help minimize adrenal suppression, and other glucocorticoid-related side effects.
In the event of an acute flare-up, a return to the full suppressive daily dose may be necessary; once stabilized, alternate day therapy may be reinstituted.

Dose adjustments of antidiabetic agents may be necessary while receiving corticosteroids.

Changes in thyroid status may require corticosteroid dose adjustment

Immunizations:

Patients receiving immunosuppressive doses of corticosteroids should not receive live or live attenuated vaccines.
Patients on immunosuppressive doses of corticosteroids may receive killed or inactivated vaccines, however their response to vaccination may be diminished and difficult to predict; routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible.
Immunizations may be given in patients receiving corticosteroids as replacement therapy (e.g. for Addison's disease)

Oral Corticosteroid Potency:
Methylprednisolone 4 mg is approximately equivalent to: Betamethasone 0.75 mg; Cortisone 25 mg; Dexamethasone 0.75 mg; Hydrocortisone 20 mg; Prednisolone 5 mg; Prednisone 5 mg; Triamcinolone 4 mg

Precautions

CONTRAINDICATIONS:

Hypersensitivity to any of the ingredients
Intramuscular corticosteroid preparations are contraindicated in idiopathic thrombocytopenic purpura
Benzoyl alcohol containing formulations are contraindicated in premature infants
Systemic fungal infections, except as an intra-articular injection for localized joint conditions
Intrathecal administration (DEPO-MEDROL(R); severe medical events have been associated with intrathecal administration)

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
Oral:

Take with or after food to minimize stomach upset; if prescribed once a day it should be taken in the morning.

Intramuscular (acetate or succinate):

Avoid injection or leakage into dermis in order to minimize dermal and subdermal atrophy; avoid injection into deltoid muscle as there is a high incidence of subcutaneous atrophy.
Acetate suspension: Shake well prior to use

Intravenous (succinate only):

Administer by IV injection over at least 5 minutes or IV infusion; high-doses (greater than 30 mg/kg or 250 mg) should be administered over at least 30 minutes

Intra-articular (acetate only):

Inject into the synovial space; treatment failures are most frequently caused by failure to enter the joint space.
Shake suspension well prior to use

Intralesional and Soft-Tissue (acetate only):

See manufacturer's product labeling for specific administration instructions.
Shake suspension well prior to use.

Storage requirements:

Protect from light
Succinate: Reconstituted solution should be kept at room temperature [20C to 25C (68F to 77F)]; discard after 48 hours
Do not autoclave the exterior of the vials as steroids are sensitive to heat.

Reconstitution/preparation techniques:
Succinate:

Reconstitute with accompanying diluent or bacteriostatic water for injection with benzyl alcohol; discard within 48 hours of mixing.
Reconstituted solution may be added to 5% dextrose (D5); isotonic saline (NS), or D5NS

IV compatibility: Should not be diluted or mixed with other solutions

General:

Current treatment guidelines may be consulted for more specific information on dose ranges.
Corticosteroids confer palliative, symptomatic treatment by virtue of their anti-inflammatory effects; they are not curative.
Undesirable side effects can be minimized by using the lowest effective dose for the minimum period.
Hydrocortisone or cortisone are the first choice for treating primary or secondary adrenocortical insufficiency, however, synthetic corticosteroids may be used in conjunction with mineralocorticoids where applicable.
Initial doses should be maintained or adjusted until a satisfactory response is achieved; if there is a lack of response after a reasonable period of time, discontinue this therapy and consider alternate therapy.
Constant monitoring is necessary as dose adjustments may be needed due to changes in clinical status (e.g., remissions or exacerbations), in response to stressful situations not directly related to the disease being treated, toxicities, and varied individual responses to therapy.

Monitoring:

Monitor growth velocity in pediatric patients
Monitor intraocular pressure if therapy is continued for more than 6 weeks; regular eye exams should be encouraged
Routine laboratory studies (including 2-hour postprandial blood glucose and serum potassium), blood pressure, weight, bone mineral density, and chest x-rays should be performed at regular intervals for patients on long-term therapy
Consider obtaining upper gastrointestinal x-rays in patients with known or suspected peptic ulcer disease
Monitor for hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, and hyperglycemia with chronic use
Consider monitoring renal function in elderly patients

Patient advice:

Patients should understand that this drug is a corticosteroid and that it is important not to stop therapy abruptly.
Patients should understand that during times of stress, such as surgery or infection, additional supplementation may be necessary; they should discuss with their healthcare professional whether they need to carry a medical identification card identifying their corticosteroid use.
Patients on immunosuppressant doses of corticosteroids should understand that a greater risk of infection exists; they should avoid exposure to chickenpox or measles and if exposed, they should consult their healthcare professional promptly.
Patients should check with their healthcare provider before starting any new medications, including herbal supplements and over the counter products, or receiving any vaccinations.
Patients should be advised of common adverse reactions including fluid retention, changes in glucose tolerance, high blood pressure, behavioral/mood changes, increased appetite, and weight gain.

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