How the dose is calculated
Prednisolone is dosed in mg/kg/day, given once daily. Asthma exacerbations use a lower dose for a short 3–5 day course; nephrotic syndrome induction uses a higher dose for a longer course, per the specific regimen being followed.
Typical dosing by indication
| Indication | Dose | Frequency | Max |
|---|---|---|---|
| Asthma exacerbation | 1 mg/kg/day | once daily for 3–5 days | 40 mg/day |
| Nephrotic syndrome | 2 mg/kg/day | once daily | 60 mg/day |
Clinical use
- Short courses of oral prednisolone (typically 3–5 days) for acute asthma exacerbations generally don't require tapering, unlike longer courses.
- Nephrotic syndrome induction courses run considerably longer (often 4–6 weeks) at the higher dose before transitioning to an alternate-day tapering regimen — follow the specific protocol being used.
- Morning dosing more closely mimics the body's natural cortisol rhythm and can reduce sleep disturbance compared to evening dosing.
- Longer courses require attention to growth, bone health, blood pressure, blood glucose, and increased infection risk — live vaccines should generally be deferred during significant immunosuppressive dosing.
Frequently asked questions
Does a short course of prednisolone need to be tapered?
Generally no — short courses of around 3–5 days for an acute asthma exacerbation can usually be stopped abruptly without a taper, unlike longer courses which do need gradual dose reduction.
Why is the nephrotic syndrome dose higher and longer than the asthma dose?
Nephrotic syndrome induction requires sustained higher-dose immunosuppression to induce remission, typically over 4–6 weeks, before stepping down to a tapering alternate-day regimen — a fundamentally different treatment goal than a short anti-inflammatory burst for asthma.
Is it better to give prednisolone in the morning?
Yes, when once-daily dosing is used — morning dosing more closely follows the body's natural cortisol rhythm and may cause less sleep disturbance than an evening dose.
Can a child on prednisolone get live vaccines?
Live vaccines are generally deferred during significant immunosuppressive-dose corticosteroid therapy — check current guidance and the specific dose/duration involved with the treating team before scheduling.
References
- British Thoracic Society / SIGN. British Guideline on the Management of Asthma.
- International Pediatric Nephrology Association. Guidelines for the Management of Idiopathic Nephrotic Syndrome.
- British National Formulary for Children (BNFc) — Prednisolone.