From the Guidelines
The recommended tapering regimen for prednisone after completing one week of 80mg daily is to reduce the dose by 10mg weekly until 20mg, then reduce by 5mg weekly until 5mg, and then give 2.5mg for 2 weeks before stopping, as suggested by the British Society of Gastroenterology consensus guidelines 1.
Tapering Regimen Details
The tapering schedule should be individualized based on the patient's condition, duration of prior steroid use, and risk factors.
- Reduce by 10mg weekly until 20mg: For example, decrease from 80mg to 70mg daily for 7 days, then 60mg daily for 7 days, then 50mg daily for 7 days, then 40mg daily for 7 days, then 30mg daily for 7 days, and then 20mg daily for 7 days.
- Reduce by 5mg weekly until 5mg: After reaching 20mg, decrease by 5mg every 7 days, for example, 20mg to 15mg daily for 7 days, then 10mg daily for 7 days, and then 5mg daily for 7 days.
- Give 2.5mg for 2 weeks before stopping: Finally, reduce the dose to 2.5mg daily for 2 weeks before stopping the medication.
Rationale for Tapering
Tapering is necessary because prolonged corticosteroid use suppresses the hypothalamic-pituitary-adrenal axis, reducing the body's natural cortisol production 1. Abrupt discontinuation can lead to adrenal insufficiency with symptoms including fatigue, weakness, nausea, hypotension, and in severe cases, adrenal crisis.
- Patients should be monitored for signs of disease flare during the taper and advised to take the medication with food to minimize gastrointestinal side effects.
- Morning dosing is preferred to mimic the body's natural cortisol rhythm.
Additional Considerations
Patients on long-term corticosteroid treatment should be monitored for bone disease by baseline and annual bone mineral densitometry of the lumbar spine and hip 1.
- The combination regimen of prednisone and azathioprine is associated with a lower occurrence of corticosteroid-related side effects than the higher dose prednisone regimen, and it is the preferred treatment for some conditions.
From the Research
Prednisone Tapering Regimen
- The recommended tapering regimen for prednisone after completing one week of 80mg daily is not explicitly stated in the provided studies, as they focus on different conditions and tapering regimens.
- However, a study on rheumatoid arthritis suggests that tapering of prednisone should be done slowly using 1 mg decrements every couple of weeks to a month 2.
- In contrast, studies on acute asthma suggest that tapering of prednisone may not be necessary, and a abrupt termination of the treatment may be sufficient 3, 4.
- A study on giant cell arteritis describes a blinded corticosteroid-tapering regimen, which involves tapering prednisone doses in an open-label fashion until 20 mg/day, and then blinding the doses below 20 mg/day 5.
- A study on myasthenia gravis compares a slow-tapering regimen with a rapid-tapering regimen and finds that the rapid-tapering regimen is feasible, well-tolerated, and associated with a good outcome 6.
Key Considerations
- The tapering regimen may vary depending on the condition being treated and the individual patient's response to the treatment.
- It is essential to consider the potential side effects of prednisone and the risk of rebound or relapse when tapering the dose.
- A personalized approach to tapering prednisone, taking into account the patient's specific needs and condition, is crucial.
- The studies suggest that a slow and gradual tapering regimen may be necessary for some conditions, while a more rapid tapering regimen may be suitable for others 2, 6.