Prednisolone (Rheumatology)

Source: UK SPC (eMC) §4.2 for Prednesol 5 mg Tablets / Soluble Prednisolone 5 mg Tablets (https://www.medicines.org.uk/emc/product/14675/smpc). VERBATIM: 'Rheumatoid arthritis: 7.5 to 10mg daily. For maintenance therapy the lowest effective dosage is used.' The SPC states the dose used will depend upon the disease, its severity and the clinical response obtained, and that 'The following regimens are for guidance only'. GENERAL PRINCIPLE: the lowest dosage that will produce an acceptable result should be used; when it is possible to reduce the dosage this must be accomplished by stages. OTHER REGIMENS IN THE SAME SPC — short-term treatment: 20 to 30 mg daily for the first few days, subsequently reducing the daily dosage by 2.5 or 5 mg every two to five days depending on response; most other conditions: 10 to 100 mg daily for one to three weeks, then reducing to the minimum effective dosage. INTERCURRENT ILLNESS: during prolonged therapy any intercurrent illness, trauma or surgical procedure will require a temporary increase in dosage; if corticosteroids have been stopped after prolonged therapy they may need to be temporarily re-introduced. WITHDRAWAL (§4.4): in patients who have received more than physiological doses (approximately 7.5 mg prednisolone or equivalent) for greater than 3 weeks, withdrawal should not be abrupt; once a daily dose equivalent to 7.5 mg prednisolone is reached, dose reduction should be slower to allow HPA-axis recovery. Abrupt withdrawal of up to 40 mg daily for 3 weeks is unlikely to cause clinically relevant HPA-axis suppression in most patients. Gradual withdrawal should still be considered after courses of 3 weeks or less in: repeated courses (especially >3 weeks); a short course prescribed within one year of stopping long-term therapy; other reasons for adrenocortical insufficiency; doses greater than 40 mg daily of prednisolone or equivalent; and patients repeatedly taking doses in the evening. Patients should carry a 'Steroid treatment' card. PAEDIATRIC (from the same §4.2 — reproduced but NOT structured as paedDose because these are not rheumatology doses): 'Fractions of the adult dosage may be used (e.g. 75% at 12 years, 50% at 7 years and 25% at 1 year) but clinical factors must be given due weight.' For ACUTE ASTHMA only, the SPC gives: children over 5 years 30-40 mg prednisolone; children aged 2-5 years 20 mg prednisolone; those already receiving maintenance steroid tablets 2 mg/kg up to a maximum dose of 60 mg; children under 2 years 10 mg for up to three days in the hospital setting for moderate to severe acute asthma. Treatment for up to three days is usually sufficient and there is no need to taper at the end of treatment; the dose may be repeated in children who vomit, but intravenous steroids should be considered in children unable to retain oral medication. These per-kg and fixed paediatric figures are ACUTE-ASTHMA doses in this SPC and must not be transferred to a rheumatological indication — verify any under-18 rheumatology dose against a children's formulary. §4.5 was not retrieved in this bundle (§4.4 truncated at the source-fetch limit), so no interactions list is given. No maximum dose is stated for rheumatoid arthritis. The openFDA cross-check record in this bundle is PRED FORTE (prednisolone acetate OPHTHALMIC suspension, Allergan) — a different route and indication, so it was not used.