From the Guidelines
The protocol for ordering a prednisone taper typically starts with a dosage of 0.5 to 1 mg/kg per day, which is then tapered by 10 mg every 2 weeks to a dosage of 30 mg/d, followed by a slower taper of 5 mg every 2 weeks until the dosage reaches 20 mg/d, and finally 2.5 mg every 2 weeks until completion, as recommended by the Mayo Clinic Proceedings study 1. When initiating prednisone treatment, the dosage is usually 60 to 80 mg/d as a single daily dose, with a taper after 2 to 4 weeks depending on patient response.
- The tapering process is crucial to avoid adrenal insufficiency and other side effects.
- It is essential to monitor patients for side effects, including mood changes, increased blood glucose, fluid retention, and increased infection risk.
- The specific regimen should be tailored to the patient's condition, weight, and medical history, and patients should be educated on the importance of taking prednisone in the morning with food to minimize insomnia and gastric irritation.
- For longer courses, calcium and vitamin D supplementation may be necessary to prevent bone loss, and alternate-day dosing or the lowest effective dose should be considered to minimize adverse effects, as noted in the study 1. Key considerations for the tapering process include:
- Tapering by 10 mg every 2 weeks to a dosage of 30 mg/d
- Slowing the taper to 5 mg every 2 weeks until the dosage reaches 20 mg/d
- Further slowing the taper to 2.5 mg every 2 weeks until completion
- Occasionally, slowing the taper to 1 mg every 2 to 4 weeks at 10 mg/d until completed, as outlined in the study 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If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly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 protocol for ordering a prednisone taper involves gradually withdrawing the drug rather than stopping it abruptly.
- The exact tapering schedule is not specified, 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 2.
- It is also important to monitor the patient's clinical status and adjust the dosage as needed to minimize the risk of adrenal insufficiency or other withdrawal symptoms.
From the Research
Protocol for Ordering a Prednisone Taper
The protocol for ordering a prednisone taper can vary depending on the condition being treated and the patient's response to the medication.
- In patients with polymyalgia rheumatica (PMR), a common protocol is to start with a high dose of prednisone (15 mg/day or more) for at least 1 month, followed by a gradual taper until the patient stops taking the medication 3.
- In acute asthma, some studies suggest that a tapering course of oral prednisolone may not be necessary, and a personal asthma management plan with a reserve course of prednisolone may be more appropriate 4, 5.
- In systemic lupus erythematosus (SLE) patients, doses of prednisone below 6 mg daily are associated with reduced organ damage, and successful tapering of prednisone below 5 mg has increased since the year 2000 6.
- In myasthenia gravis, a rapid-tapering regimen of prednisone therapy may be feasible, well tolerated, and associated with a good outcome, allowing for sparing of a mean of 1898 mg of prednisone over 1 year 7.
Factors Influencing Tapering
Several factors can influence the tapering of prednisone, including:
- Disease activity: Lower disease activity is associated with successful tapering in SLE patients 6 and myasthenia gravis patients 7.
- Patient characteristics: Caucasians, younger patients, and patients with a higher level of education may be more likely to have a prednisone taper in SLE patients 6.
- Concomitant medications: The use of azathioprine may be prescribed for all participants in myasthenia gravis patients 7.