Dosing of Corticosteroids

Dosing of Corticosteroids

General considerations

Consideration of the patient’s weight and age, as well as the severity of the disease being treated, should guide the dosage regimen for systemic corticosteroids. In general, the lowest dose possible to achieve the desired clinical response should be used. Low doses are used to produce an anti-inflammatory effect, while high doses are needed to produce immunosuppression. Prednis(ol)one is generally given as a single daily dose in the morning to mimic the natural cortisol peak. Dosing in the evening often results in sleep disturbances.

A patient taking corticosteroids should have their corticosteroids increased before surgery. Addisonian (adrenal) crisis can present 6 to 12 hours after surgical stress in a patient taking corticosteroids who has not had them increased before the surgery.

Dose reduction (tapering)

The hypothalamic-pituitary axis is suppressed by glucocorticoid therapy. The dose, duration of treatment, and individual patient characteristics affect the onset and extent of this effect. However, treatment with prednis(ol)one at doses greater than 5 mg for longer than 2 weeks can be considered sufficient to cause adrenal suppression. Therefore tapering of the glucocorticoid dose is required to avoid both adrenal insufficiency and the rebound in symptoms that may occur with sudden cessation. The rate of reduction is dependent on the dose level, duration of treatment, and underlying disease state.