What are the risks of stopping Prednisone (corticosteroid) without a taper?

From the Guidelines

Prednisone should always be tapered rather than stopped abruptly when used for more than 5-7 days to avoid adrenal insufficiency and other complications. The risks of stopping prednisone without a taper are significant and can lead to morbidity and mortality. According to the most recent and highest quality study 1, abrupt discontinuation of longer courses of prednisone can lead to adrenal insufficiency, with symptoms including fatigue, weakness, body aches, low blood pressure, and in severe cases, adrenal crisis.

Key Considerations

• The need for tapering depends on the dose, duration of therapy, and individual patient factors, such as comorbidities and other medications 1.
• Short courses of prednisone (typically 5 days or less) at doses of 40mg or less per day can often be stopped without tapering, but this should be done under the guidance of a healthcare provider.
• For longer courses of prednisone, a gradual taper over weeks to months is recommended to allow the body's natural cortisol production to recover, as exogenous steroids suppress the hypothalamic-pituitary-adrenal axis 1.

Tapering Schedule

• The tapering schedule should be individualized based on the patient's response to treatment and their overall health status 1.
• A common tapering schedule is to reduce the oral dose gradually to a dose of 10 mg/day prednisone equivalent within 4–8 weeks, and then taper further by 1 mg/4 weeks (or similar) until discontinuation, as long as remission is maintained 1.

Patient Monitoring

• Patients should be closely monitored during the tapering process for signs of adrenal insufficiency or other complications, and their healthcare provider should be notified immediately if any symptoms occur.
• Regular follow-up appointments with a healthcare provider are essential to ensure that the tapering schedule is working effectively and to make any necessary adjustments 1.

From the FDA Drug Label

Adrenocortical insufficiency may result from too rapid withdrawal of corticosteroids and may be minimized by gradual reduction of dosage If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly Do not stop taking this medicine without first talking to your doctor. Avoid abrupt withdraw of therapy.

The risks of stopping Prednisone without a taper include adrenocortical insufficiency, which may occur due to too rapid withdrawal of corticosteroids. To minimize this risk, it is recommended to withdraw the drug gradually rather than abruptly. Key points to consider:

• Gradual reduction of dosage is necessary to minimize the risk of adrenocortical insufficiency
• Abrupt withdrawal should be avoided
• Patients should not stop taking Prednisone without first talking to their doctor 2 2

From the Research

Risks of Stopping Prednisone Without a Taper

• Stopping prednisone abruptly can lead to a range of adverse effects, including relapse of the underlying condition being treated 3
• The risk of relapse can be minimized by tapering prednisone slowly, with some studies suggesting a tapering regimen of several months or even years 4
• A slow tapering regimen can help to reduce the risk of steroid-induced adverse events, such as hyperglycemia and osteopenia 3, 5
• Individualization and close monitoring are important factors during the steroid-tapering process, as there is significant variability in patient response to prednisone 3

Adverse Effects of Abruptly Stopping Prednisone

• Abruptly stopping prednisone can lead to a range of adverse effects, including:
  • Relapse of the underlying condition being treated 3
  • Hyperglycemia 5
  • Osteopenia 6
  • Other steroid-induced adverse events 5
• The risk of these adverse effects can be minimized by tapering prednisone slowly and under close medical supervision 3, 4

Importance of Tapering Prednisone

• Tapering prednisone is important to minimize the risk of relapse and steroid-induced adverse events 3, 4
• A slow and gradual tapering regimen can help to reduce the risk of these adverse effects and allow for a safer discontinuation of prednisone 4
• The tapering regimen should be individualized and closely monitored, with adjustments made as needed to minimize the risk of adverse effects 3