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To prevent steroid-induced osteoporosis, the steroid dose and duration should be as low and as short as possible. All patients on long term glucocorticoids (≥3 months) should be encouraged to do weightbearing exercise, avoid smoking and excess alcohol and take fall prevention measures. Daily calcium and vitamin d intake should be sufficient.
If the literature recommends generally increasing from initial to maximum dose provided it is tolerated, pick the maximum dose. If the literature recommends only increasing from an initial dose if not sufficiently effective, pick the minimum dose. If there is no guidance then pick the mid point between the dose range extremes.
[57] [needs update] Prednisone is usually prescribed at a dose of 60 mg/m 2 of body surface area/day in a first treatment for 4–8 weeks. After this period the dose is reduced to 40 mg/m 2 for a further 4 weeks. People experiencing a relapse or children are treated with prednisolone 2 mg/kg/day until urine becomes negative for protein.
Prednisone is a synthetic glucocorticoid used for its anti-inflammatory and immunosuppressive properties. [36] [37] Prednisone is a prodrug; it is metabolised in the liver by 11-β-HSD to prednisolone, the active drug. Prednisone has no substantial biological effects until converted via hepatic metabolism to prednisolone. [38]
As a first-line treatment for HES patients' symptoms, corticosteroids are recommended. [17] Because high-dose prednisone rapidly lowers eosinophil levels, it is usually started at a dose of 1 mg/kg/day. [6] Upon achieving appropriate control over eosinophilia, the medication can be gradually reduced. [25]
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Patients on high dose sulfasalazine require folic supplementation (1 mg/day) because it inhibits folate absorption. If oral Mesalazine is still not working, prednisone is often given, starting at 40–60 mg/day. Prednisone often takes effect within 10–14 days. The dose should then be tapered by about 5 mg/week until it can be stopped altogether.
Commonly prescribed drugs are prescribed according to guidelines around the world. For instance, for ischemic heart disease, the American College of Cardiology/American Heart Association (ACC/AHA) guideline is used in the United States and the European Society of Cardiology (ESC) guideline is used in Europe.