What is a sample taper for a patient on high-dose prednisone (corticosteroid) for sudden hearing loss?

From the Guidelines

A typical prednisone taper for sudden hearing loss starts with 60mg daily for 7-14 days, followed by a gradual reduction over 10-14 days, as recommended by the most recent guidelines 1.

Taper Schedule

A common taper schedule would be 60mg daily for 7 days, then 40mg daily for 3 days, 30mg daily for 3 days, 20mg daily for 3 days, and finally 10mg daily for 3 days before stopping.

• This gradual reduction is essential because abrupt discontinuation of high-dose corticosteroids can cause adrenal insufficiency, as the body's natural cortisol production becomes suppressed during treatment 1.
• Patients should take the medication with food to minimize gastrointestinal side effects and should be monitored for potential complications such as elevated blood glucose, mood changes, and sleep disturbances.

Monitoring and Adjustments

• The taper allows the hypothalamic-pituitary-adrenal axis to recover gradually while maintaining some therapeutic effect.
• If symptoms worsen during the taper, the dose may need to be temporarily increased before attempting to taper again.
• Complete audiometric testing should be performed before starting treatment and after completion to assess effectiveness, as suggested by the guidelines 1.

Important Considerations

• The lack of clear evidence supporting systemic steroids for SHL and the existence of potential adverse treatment effects support a large role for shared decision making with patients 1.
• Most serious side effects, however, occur with chronic use, and adverse events are rare and manageable for the short 10- to 14-day course of steroids recommended for SSNHL 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If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly

• The FDA drug label recommends a gradual taper of prednisone after long-term therapy.
• No specific taper schedule is provided in the label for sudden hearing loss or high-dose prednisone.
• However, the label does mention that the dosage should be decreased in small increments at appropriate time intervals until the lowest dosage that maintains an adequate clinical response is reached 2.
• It is essential to consult with a doctor to determine a suitable taper schedule for the patient.

From the Research

Sample Taper for High-Dose Prednisone

A sample taper for a patient on high-dose prednisone for sudden hearing loss can be based on the following evidence:

• The study 3 suggests a 14-day course of 60 mg prednisone with a taper.
• The study 4 mentions a control group that received 5 days of oral prednisolone at 60 mg/d followed by 5 days of tapering doses.
• The study 5 references current ENT-UK guidelines that suggest treatment with a dose of oral prednisolone 1mg/kg/day for 7 days then tapered over a further 5 days.

Taper Regimen

A possible taper regimen could be:

• 60 mg prednisone per day for 7-14 days
• Tapering doses over the next 5-7 days, such as:
  • 40 mg per day for 2-3 days
  • 20 mg per day for 2-3 days
  • 10 mg per day for 1-2 days

Important Considerations

It is essential to note that the effectiveness of high-dose corticosteroids for sudden sensorineural hearing loss is still debated, and the optimal taper regimen may vary depending on individual patient factors and clinical guidelines 4, 5. Additionally, the use of intratympanic corticosteroids has been explored as an alternative treatment option 6, 7.