From the Guidelines
It's generally safe to stop prednisone abruptly after a short 3-day course of 30 mg daily without tapering. According to the study by Duru N, et al. 1, short courses of prednisone (typically less than 5-7 days) don't usually suppress your body's natural cortisol production enough to cause withdrawal problems. The study notes that hypothalamic–pituitary–adrenal axis suppression may vary greatly from person to person, but it's typically anticipated in patients receiving more than 7.5 mg of prednisone equivalent daily for more than 3 weeks 1. Since the 3-day course is well below this threshold, the risk of adrenal insufficiency is low. However, it's essential to be aware of potential withdrawal symptoms like fatigue, weakness, body aches, joint pain, or low blood pressure, and to contact your healthcare provider if you experience any unusual symptoms after stopping.
Some key points to consider:
- The study recommends tapering for patients on chronic medium/high-dose GC treatment to avoid adrenal insufficiency 1
- However, for short courses like the one described, the risk of adrenal suppression is low, and tapering may not be necessary 1
- Patients should be informed about the risks of adrenal insufficiency and how to prevent it, especially when stopping prednisone after a longer course 1
- In cases where patients are on higher doses or longer courses, a stress scheme with higher dosages may be considered, but evidence supporting this is limited 1
From the FDA Drug Label
Do not stop taking this medicine without first talking to your doctor. Avoid abrupt withdraw of therapy. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
It is not ok to stop prednisone abruptly, even if on a short course of 30 mg x 3 days. Gradual withdrawal is recommended to avoid potential withdrawal symptoms, especially after long-term therapy. However, since 3 days can be considered short-term, it's essential to consult a doctor before stopping the medication to determine the best course of action. 2
From the Research
Stopping Prednisone Abruptly
- Stopping prednisone abruptly after taking 30 mg for 3 days is not recommended due to the risk of adrenal insufficiency (AI) 3.
- Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol, and it can be caused by exogenous corticosteroid therapy, such as prednisone, administered at supraphysiologic dosages for ≥ 1 month 4.
- However, the risk of AI also depends on the dose and duration of treatment, with higher doses and longer treatment durations increasing the risk 3.
- In this case, the treatment duration is only 3 days, which is relatively short, but the dose is 30 mg, which is a moderate to high dose.
- There is no clear consensus on the optimal strategy for stopping prednisone, but it is generally recommended to taper the dose gradually to minimize the risk of AI 4, 5.
Risks of Abruptly Stopping Prednisone
- Abruptly stopping prednisone can lead to adrenal crisis, which is a life-threatening condition characterized by severe hypotension, hypoglycemia, and shock 6, 7.
- The risk of adrenal crisis is higher in patients who have been taking prednisone for a longer period or at higher doses 3.
- However, even short-term treatment with prednisone can cause adrenal insufficiency, especially if the dose is high enough 3.
Recommendations
- It is recommended to consult a healthcare professional before stopping prednisone, especially if you have been taking it for a short period or at a high dose 4, 5.
- A gradual tapering of the dose may be necessary to minimize the risk of AI and adrenal crisis 4, 5.
- Patients who have been taking prednisone should be monitored for signs of adrenal insufficiency, such as hypotension, hypoglycemia, and fatigue 6, 7.