From the Guidelines
You should taper prednisone after 1 week of treatment to minimize the risk of withdrawal symptoms and adrenal crisis. When considering tapering prednisone, it's essential to prioritize the patient's morbidity, mortality, and quality of life. According to the study published in Hepatology 1, prednisone can be tapered down to an individual level sufficient to maintain a remission from 20 mg daily onward, with a reduction of 5 mg every week until 10 mg/day are achieved.
Key Considerations for Tapering Prednisone
- The tapering schedule should be individualized based on the patient's initial dose and response to treatment.
- Reductions of 5 mg every week are recommended until 10 mg/day are achieved, and further reduction by 2.5 mg/week can be considered up to 5 mg daily.
- 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.
- The combination regimen of prednisone and azathioprine is associated with a lower occurrence of corticosteroid-related side effects than the higher dose prednisone regimen.
Potential Risks of Abrupt Discontinuation
- Withdrawal symptoms, including fatigue, weakness, body aches, joint pain, and in severe cases, adrenal crisis.
- Suppression of natural cortisol production, which can take time to resume after abrupt discontinuation of prednisone. It's crucial to follow a healthcare provider's specific instructions for tapering prednisone, as needs vary based on dose, duration of treatment, and individual health factors, as noted in the study 1.
From the FDA Drug Label
Do not stop taking this medicine without first talking to your doctor. Avoid abrupt withdraw of therapy. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
Tapering is recommended when stopping prednisone after long-term therapy. Although the label does not explicitly state the duration of treatment that constitutes "long-term therapy", it advises against abrupt withdrawal and recommends gradual tapering when stopping the drug.
- The label does not provide a specific tapering schedule for a 1-week treatment course.
- However, given the potential for adrenal suppression and corticoid withdrawal symptoms, it is prudent to consult a doctor before stopping prednisone, even after a short treatment course. 2
From the Research
Tapering Prednisone
- The need to taper prednisone after 1 week of treatment is supported by several studies 3, 4, 5.
- According to a study published in 2001, tapering of prednisone should be done slowly using 1 mg decrements every couple of weeks to a month 3.
- Another study from 2004 found that adrenal function is impaired in patients receiving long-term steroid medication, leading to symptomatic complications when steroids are withdrawn 4.
- A more recent study protocol from 2023 aims to test the clinical noninferiority of abrupt glucocorticoid stop compared to tapering after ≥28 treatment days 5.
- However, the study from 2001 suggests that tapering should be done slowly, whereas the 2023 study protocol explores the possibility of abrupt stop.
Risks of Not Tapering
- Not tapering prednisone can lead to adrenal insufficiency, as the body may not be able to produce enough cortisol on its own after prolonged use of the medication 4, 5.
- A study from 2004 found that about a third of patients experienced symptoms such as fatigue, arthralgias, and muscular weakness after steroid withdrawal 4.
- Another study from 2005 found that even low doses of prednisone can suppress bone formation and may have adverse effects on bone mass and/or bone strength 6.