Posology : מינונים

4.2   Posology and method of administration

Posology
The dosage level depends on the nature and severity of the disease and the patient’s individual response to treatment. In general, relatively high initial doses are used, which need to be considerably higher in acute, severe forms of disease than in chronic disorders.

Unless otherwise prescribed, the following dosage recommendations apply: 
Rheumatology
- Active phases of systemic vasculitis:
Polyarteritis nodosa: 32 - 80 mg/day (in patients with concomitant positive hepatitis B serology, the duration of treatment should be restricted to 2 weeks), polymyalgia rheumatica (PMR): 8 - 32 mg/day,
PMR with giant cell arteritis: 32 - 64 mg/day, temporal arteritis with acute vision loss: initially high-dose intravenous pulse therapy, thereafter 64 - 80 mg/day; 
- Active phases of systemic rheumatic disease: systemic lupus erythematosus, mixed connective tissue disease: 32 - 80 mg/day;

- Active rheumatoid arthritis: depending on the severity of the disease 1 - 80 mg/day. For severe progressive forms, e.g. rapidly destructive forms, 64 - 80 mg/day and/or for extra- articular manifestations 32 - 64 mg/day;

- Spondylarthritis (ankylosing spondylitis with involvement of peripheral joints): 8 - 64 mg/day, psoriatic arthritis: 1.2 - 32 mg/day, enteropathic arthropathy with high inflammatory activity 64 - 80 mg/day;

- Reactive forms of arthritis: 8 - 32 mg/day;

- Arthritis in sarcoidosis: 32 - 64 mg/day;
- Severe systemic form of juvenile idiopathic arthritis (Still’s disease) or with iridocyclitis refractory to topical treatment: 64 - 80 mg/day.


Pulmonary and respiratory tract disorders
- Bronchial asthma:
Oral long-term treatment of adults: initially 32 - 64 mg/day, lower dosages (approximately 16 mg) in milder cases, maintenance dose generally 2 - 8 mg/day. Daily doses exceeding 12 mg should be avoided in long-term therapy. If oral glucocorticoids are used at doses up to about 16 mg/day, inhaled glucocorticoids should always be additionally used.

Oral long-term treatment of severe childhood asthma: initial doses of approximately 1.6 mg/kg body weight/day may be necessary. Inhaled glucocorticoid therapy should be maintained. Systemic therapy takes place intermittently or over the longer term, once minimum requirements have been determined.

- Oral treatment of asthma exacerbation:
Adults: 16 - 32 mg/day until a stable situation (pre-exacerbation level) has been reached for at least 2 days. This is followed by a dose reduction according to the clinical course.
Children: Approximately 0.8 mg/kg body weight/day, until a significant improvement occurs. This is followed by as rapid a dose reduction as possible, according to the clinical course;

- Chronic obstructive pulmonary disease: for exacerbations, 16 - 32 mg/day for a maximum of 2 weeks. Long-term treatment with oral glucocorticoids is not recommended; 
- Allergic rhinitis: 4 mg/day for a maximum of 1 to 3 days.

Dermatology
Adults: initially, 8 - 20 mg/day, for severe pemphigus up to 100 mg/day.
Children: 2 - 12 mg/day; the subsequent dose reduction is guided by the course of the disease.
Nephrology
Adults and children: initially 16 (-48) mg/day until onset of diuresis (generally after 7 - 10 days), maintenance dose 8 - 16 mg/day on 3 days per week.

Method of administration
The tablets may be split if necessary and taken with or after food with sufficient liquid. No information is available about crushing or chewing..
The daily dose should, if possible, be administered as a single dose in the morning (circadian therapy). However, in patients requiring high-dose therapy due to their disease, multiple daily doses are often required to achieve a maximum effect.
The possibility of alternate-day therapy, depending on the clinical picture and the individual response, must be considered. In children and growing adolescents, treatment should preferably be on alternate days or intermittent.

Depending on the underlying disease, clinical symptoms and response to therapy, the dose can be reduced at different rates and terminated or adjusted to the lowest possible maintenance dose, with monitoring of the adrenal axis if necessary. In general, the dose should be kept as high and the duration of treatment as long as necessary, but also as low and as short as possible. Dose reduction should generally be gradual.

In cases of hypothyroidism or liver cirrhosis, relatively low dosages may be sufficient or a dose reduction may be required.