What is considered a high dose of prednisone?

The starting dose of prednisone may be between 5 mg to 60 mg per day. A dose above 40 mg per day may be considered a high dose. However, everybody responds differently to prednisone, so what might be a high dose depends on the person and the condition.

In general:

• Low dose: less than 7.5 mg per day
• Moderate dose: between 7.5 mg and 40 mg per day
• High dose: 40 mg to 60 mg per day

Sometimes doses much higher than the upper limit of 60 mg are given through an IV for short periods.

Doctors prescribe prednisone at the lowest effective dose for the shortest possible time. If prednisone is not effective, it should be stopped as soon as possible. The dose and time need to be adjusted for each patient based on the condition and response to treatment.

The reason that prednisone is used with care is that prednisone can pose serious side effects and long-term risks. In patients who need longer dosing of prednisone, it may be given every other day. This may reduce side effects and complications.

Side effects

Common side effects from prednisone are due to the effect it has on lowering your immune system’s response to an infection. Prednisone also affects many other parts of your body. These effects may occur at high doses, or even lower doses if the treatment continues for a longer time. Side effects may include:

• Fluid retention that can lead to swelling, high blood pressure or heart failure
• Muscle weakness and loss of muscle
• Weakening of bones that can cause osteoporosis, spinal and long bone fractures or death of bone tissue
• Ulcers of the stomach or esophagus
• Swelling of the belly or inflammation of the pancreas
• Poor wound healing
• Effects on the skin may include thinning, bruising, redness, increased sweating and bleeding under the skin
• Effects on the nervous system may include headaches, dizziness, insomnia, mood swings, personality changes, depression and psychosis
• Effects on glands of the body may include irregular menstrual periods, slowed growth in children and high blood sugar
• Effects on the eyes may include cataracts, increased pressure inside the eyes, bulging eyes and glaucoma

Some people are at higher risk of adverse effects from higher doses or longer use of prednisone. These include people with:

• Hypothyroid disease
• Cirrhosis of the liver
• Herpes infection of the eye
• Mental health conditions
• Aspirin use
• Ulcerative colitis
• Ulcer disease
• Kidney failure
• An infected abscess
• High blood pressure
• Osteoporosis
• Recent intestinal surgery

Use of prednisone at any dose is not considered safe during pregnancy or breastfeeding. Vaccinations may need to be avoided if you are taking prednisone at high doses.

Prednisone is a powerful anti-inflammatory drug used to treat conditions of inflammation. Even a normal dose may be considered high for some people. It is important to always weigh the risks against the benefits when taking this medication.

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