What is the medication regimen consisting of 5 tablets (tabs) on days 1-2, 4 tablets on days 3-4, 3 tablets on days 5-6, 2 tablets on days 7-8, and 1 tablet on days 9-10?

From the Guidelines

The tapering schedule of 5 tabs day 1-2, then 4 tabs day 3-4, then 3 tabs day 5-6, then 2 tabs day 7-8, then 1 tab day 9-10 is a common approach for discontinuing oral corticosteroids, such as prednisone, to minimize potential withdrawal symptoms and rebound effects. This schedule is consistent with guidelines for the management of asthma and other conditions where corticosteroids are used [ 1 ]. The goal of tapering is to allow the body to adjust to decreasing levels of the medication, thereby reducing the risk of adverse effects such as adrenal axis suppression, growth suppression, and other potential complications associated with long-term corticosteroid use [ 1 ].

When following this schedule, it is essential to take the tablets at regular intervals throughout the day as prescribed. The specific medication and dosage are crucial in determining the appropriate tapering schedule, and any modifications should only be made under the guidance of a healthcare provider. The provided evidence highlights the importance of careful management when discontinuing corticosteroids, emphasizing the need for a gradual reduction in dosage to prevent relapse and minimize potential adverse effects [ 1 ].

Key considerations when tapering corticosteroids include:

• Starting with a higher dosage and gradually decreasing it over a set period
• Monitoring for signs of withdrawal or rebound effects, such as increased symptoms or adrenal insufficiency
• Adjusting the tapering schedule as needed based on individual response and medical history
• Maintaining regular follow-up with a healthcare provider to ensure safe and effective discontinuation of the medication.

From the Research

Tapering Regimens

• The provided tapering regimen is 5 tabs day 1-2, then 4 tabs day 3-4, then 3 tabs day 5-6, then 2 tabs day 7-8, then 1 tab day 9-10.
• According to 2, guideline recommendations on tapering regimens have been largely based on expert consensus, and results favor a slow tapering regimen from a low initial steroid dose to minimize risk of relapse.
• However, the study 2 does not provide a specific tapering regimen, and individualization and close monitoring have been identified as important factors during the steroid-tapering process.

Comparison with Existing Studies

• The study 3 evaluated the efficacy and safety of oral prednisolone tapering following intravenous methylprednisolone in patients with multiple sclerosis relapses, and found that the efficacy of an oral prednisolone taper after a corticosteroid pulse is non-superior to IVMP plus placebo.
• The study 4 found that tapering of prednisone treatment for relapses of steroid-sensitive nephrotic syndrome is not necessary in children, and that a short arm of 18 doses of 40 mg/m2 of prednisone on alternate days was comparable to a long arm of the same cumulative dose tapered over double the time.
• The study 5 investigated the long-term effects of early steroid withdrawal after heart transplantation, and found that steroid withdrawal is possible in 57% of patients at 6 months after transplantation, and that the institution of an early steroid taper protocol improves the overall freedom from malignancies.
• The study 6 found that oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis, and that there was no difference between the two groups in the baseline characteristics as well as the mean or categorical EDSS at baseline, at the time of relapse confirmation, and at months 3,6 and 12 after relapse confirmation.

Key Points

• The provided tapering regimen is not directly supported by the existing studies, and individualization and close monitoring are important factors during the steroid-tapering process 2.
• The efficacy and safety of oral prednisolone tapering following intravenous methylprednisolone in patients with multiple sclerosis relapses is non-superior to IVMP plus placebo 3.
• Tapering of prednisone treatment for relapses of steroid-sensitive nephrotic syndrome is not necessary in children 4.
• Early steroid withdrawal after heart transplantation is possible in 57% of patients at 6 months after transplantation, and improves the overall freedom from malignancies 5.
• Oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis 6.