What's a good prednisone taper schedule?
Key Points
- The best prednisone taper will depend upon how long you have been taking the medicine, your dose, and why you are being treated.
- If you've been treated with a high dose of prednisone, or taken it for more than a few weeks, you will need to slowly stop your medicine, usually over a period of days, weeks or months to help prevent withdrawal side effects.
- Abruptly stopping prednisone or tapering too quickly can lead to withdrawal side effects like fatigue, joint pain, mood swings or may worsen your medical condition. In some cases, adrenal crisis can occur, which is a life-threatening emergency.
- Your healthcare provider will determine your prednisone tapering schedule.
Do not stop or taper prednisone without speaking to your doctor first.
Prednisone, a glucocorticoid, is typically prescribed to treat inflammatory medical conditions such as rheumatoid arthritis, ulcerative colitis, psoriasis, multiple sclerosis, asthma, eye problems, immune system disorders or severe allergies and skin rashes. It may also be used to treat immune-mediated reactions, adrenal insufficiency, or for certain types of cancer.
Prednisone should be tapered slowly over a period of days, weeks, or months to help prevent prednisone withdrawal symptoms due to a lack of the natural steroid cortisol. This is called hypothalamic-pituitary-adrenal (HPA) suppression.
What steroid withdrawal symptoms should I expect?
If prednisone is stopped too quickly, the most common withdrawal symptoms may include:
- Severe fatigue
- Weakness
- Body or muscle aches
- Depression
- Dizziness
- Irritability
- Joint pain
- Loss of appetite
- Lightheadedness
- Mood swings
- Nausea
- Stomach pain
You may also experience a flare-up of symptoms from the medical condition you are being treated for, such as pain due to inflammation (rheumatoid arthritis), trouble breathing (asthma or COPD) or itching or redness (skin allergy), among others.
Contact your healthcare provider if you experience prednisone withdrawal symptoms as you are tapering off the drug. Your dose or tapering schedule may need to be adjusted.
Why do I need to taper prednisone?
You need to taper prednisone slowly so that your body can start producing cortisol, a natural hormone, at levels your body requires. When you take prednisone at high doses or over a longer period of time, your natural production of cortisol is suppressed. Medically, this is called hypothalamic-pituitary-adrenal (HPA) suppression.
Your adrenal glands, found at the top of your kidneys, are responsible for the production of cortisol, your natural stress hormone. Gradually reducing your prednisone dose over time allows your adrenal glands to resume cortisol production to normal levels.
Cortisol is a critical hormone needed by almost every part of your body. It helps to:
- Modulate your response to stress
- Regulate your blood sugar (glucose)
- Control your metabolism (how you utilize nutrients)
- Lower inflammation (swelling, which may be inside your body)
- Control your blood pressure
- Manage your sleep and awake cycle.
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How to taper off prednisone?
Dosing is always individualized for prednisone treatment. Different medical conditions may be treated with different doses or for various lengths of time. Your dose may depend upon your weight, as well.
Although there are many ways for a prednisone taper to be scheduled, the following table depicts one common method in general
Example of tapering schedule for prednisone
A common prednisone tapering schedule with a commercially available dose pack containing 21 tablets of the 5 mg dose is as follows:
| Day of Treatment | Total Daily Dose | Schedule |
| Day 1 | 30 |
Take 10 mg (2 tablets) at breakfast; Take 5 mg (1 tablet) at lunch; Take 5 mg (1 tablet) at dinner; Take 10 mg (2 tablets) at bedtime. |
| Day 2 | 25 |
Take 5 mg (1 tablet) at breakfast; Take 5 mg (1 tablet) at lunch; Take 5 mg (1 tablet) at dinner; Take 10 mg (2 tablets) at bedtime. |
| Day 3 | 20 |
Take 5 mg (1 tablet) at breakfast; Take 5 mg (1 tablet) at lunch; Take 5 mg (1 tablet) at dinner; Take 5 mg (1 tablet) at bedtime. |
| Day 4 | 15 |
Take 5 mg (1 tablet) at breakfast; Take 5 mg (1 tablet) at lunch; Take 5 mg (1 tablet) at bedtime. |
| Day 5 | 10 |
Take 5 mg (1 tablet) at breakfast; Take 5 mg (1 tablet) at bedtime. |
| Day 6 | 5 |
Take 5 mg (1 tablet) at breakfast |
This is not all the information you need to know about prednisone for safe and effective use and does not take the place of your doctor’s directions. Review the full prednisone information and discuss this information and any questions you have with your doctor or other health care provider.
References
- Furst D, Saag K (authors). Glucocorticoid withdrawal. Up to Date. July 28, 2022. Accessed Sept 7, 2022 at https://www.uptodate.com/contents/glucocorticoid-withdrawal
- Prednisone tablet. Daily Med. Updated August 5, 2022. Hikma Pharmaceuticals. Accessed Sept. 6, 2022 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=263ed4fa-3c29-4abb-9cb1-bc016bd34a05&audience=consumer
- Prednisone: Drug Information. LexiComp. Up to Date. Accessed Sept. 6, 2022 at https://www.uptodate.com/contents/prednisone-drug-information#F213081
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