Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
corticosteroid
Evidence supports the use of oral corticosteroids within 72 hours of symptom onset in all patients with Bell's palsy to shorten the time to complete recovery and to improve long-term outcomes, regardless of the baseline severity of facial palsy.[42][43][44][45][47][48][49][50][51]
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[Evidence A]
Caution should be exercised for the use of high-dose corticosteroids in children (aged <16 years) and in patients with poorly controlled diabetes mellitus, immunodeficiency, poorly controlled hypertension, and prior history of psychosis.
Make sure to exclude Lyme disease-associated facial paralysis when working up Bell’s palsy, as steroids may worsen long-term outcomes in these patients.[53]
The two main trials on which the recommendation is made involved adults. One study used 25 mg twice daily for 10 days and the other used 60 mg once daily for 5 days followed by a tapering dose.[45][48] Evidence from subgroup analysis has demonstrated improved outcomes for prednisolone-equivalent doses totalling 450 mg or higher.[55] One systematic review and meta-analysis comparing standard-dose corticosteroids with higher-dose corticosteroids found that higher-dose corticosteroids reduced incomplete recovery in patients with Bell’s palsy but did not identify a suitable dose.[52]
Primary options
prednisolone: 60 mg orally once daily for 5 days, then 50 mg once daily for 1 day, then 40 mg once daily for 1 day, then 30 mg once daily for 1 day, then 20 mg once daily for 1 day, then 10 mg once daily for 1 day, then stop
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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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