From the Guidelines
Prednisone should be tapered down to an individual level sufficient to maintain a remission, starting from 20 mg daily onward, with a reduction of 5 mg every week until 10 mg/day are achieved, and further reduction by 2.5 mg/week can be considered up to 5 mg daily. When considering a prednisone taper, it's crucial to weigh the benefits against potential side effects, especially in patients with conditions like osteoporosis, brittle diabetes, or hypertension 1. The tapering process is critical to prevent adrenal insufficiency, which can occur due to the suppression of the body's natural cortisol production during prolonged corticosteroid use. Key considerations for tapering include:
- Starting dose: Typically begins at 20 mg daily for many conditions
- Reduction schedule: 5 mg every week until 10 mg/day, then 2.5 mg/week up to 5 mg daily
- Monitoring: Regular check-ups to assess the disease's response to the taper and watch for signs of adrenal insufficiency or other side effects
- Patient factors: Individualizing the taper based on the patient's condition, weight, and response to therapy
- Combination therapy: Using prednisone with other medications like azathioprine may reduce corticosteroid-related side effects, as seen in the combination regimen which had a lower occurrence of these side effects (10% versus 44%) 1. It's also important to note that patients on long-term corticosteroid treatment should be monitored for bone disease with baseline and annual bone mineral densitometry of the lumbar spine and hip 1.
From the FDA Drug Label
If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached.
The typical prednisone taper dose is not explicitly stated, but it is recommended to decrease the initial drug dosage in small increments at appropriate time intervals until the lowest dosage that maintains an adequate clinical response is reached.
- The dose should be withdrawn gradually rather than abruptly after long-term therapy.
- Constant monitoring is needed to adjust the dosage based on the patient's response and clinical status. 2
From the Research
Typical Prednisone Taper Dose
- A typical prednisone taper dose is not strictly defined, but studies suggest that doses below 6 mg daily are associated with reduced organ damage 3.
- In patients with systemic lupus erythematosus (SLE), successful tapering of prednisone below 5 mg has increased since the year 2000, which may reflect the greater knowledge of the long-term harm of even low-dose chronic corticosteroid use 3.
- The National Institute for Health and Care Excellence guidance defines high-dose oral corticosteroids as >5 mg oral prednisolone and long-term as duration of treatment >1 month 4.
- In patients with multiple sclerosis relapses, oral prednisolone tapering over 20 days after intravenous methylprednisolone pulse therapy did not show significant differences in terms of activities of daily living (ADL) or disability improvement compared to placebo 5.
- The optimal strategy to ensure early identification and treatment of adrenal insufficiency and safe oral corticosteroid withdrawal in routine clinical practice remains to be defined, particularly in patients with severe asthma 6.
Key Considerations
- Corticosteroid tapering should be individualized based on patient characteristics, disease activity, and clinical response 3, 6, 5.
- Monitoring for adverse effects, such as weight gain, osteoporosis, cataracts, hypertension, diabetes mellitus, and psychiatric complaints, is essential in patients taking long-term oral corticosteroids 4.
- The use of biologic therapies targeting inflammatory mediators may help reduce or eliminate maintenance oral corticosteroid use in patients with severe asthma 6.