40-Day Prednisone Taper Schedule
For a 40-day prednisone taper, start with 40mg daily for 7 days, then reduce by 5mg every 5 days until reaching 5mg, then reduce by 2.5mg every 5 days until completion.
Recommended 40-Day Taper Schedule
| Days | Daily Dose |
|---|---|
| 1-7 | 40mg |
| 8-12 | 35mg |
| 13-17 | 30mg |
| 18-22 | 25mg |
| 23-27 | 20mg |
| 28-32 | 15mg |
| 33-37 | 10mg |
| 38-40 | 5mg |
Rationale and Key Considerations
Dosing Principles
- Begin with a clinically effective dose (40mg) based on FDA guidelines 1
- Morning administration (before 9am) is recommended to minimize adrenal suppression by aligning with the body's natural cortisol peak 1
- Gradual tapering is essential to prevent adrenal insufficiency, which can occur with abrupt discontinuation 2
Tapering Strategy
- Initial higher dose period (7 days) allows for achieving therapeutic effect
- 5-day intervals for dose reductions balance the need for gradual tapering with practical considerations
- Smaller decrements (2.5mg) in the final stages minimize risk of withdrawal symptoms
Important Precautions
- Never stop prednisone abruptly as this can lead to adrenal insufficiency 2
- Take with food or milk to reduce gastric irritation 1
- Monitor for common side effects including:
- Facial rounding and other cosmetic changes
- Weight gain
- Mood changes
- Hypertension
- Hyperglycemia
Special Considerations
- For patients with severe disease requiring longer treatment, maintenance at 15-20mg daily may be needed before further tapering 3
- For patients at high risk of corticosteroid complications (elderly, diabetic, osteoporotic), consider more rapid tapering if clinically appropriate 3
- If symptoms worsen during tapering, return to the last effective dose before attempting to taper again 3
Alternative Approaches
For specific conditions, the taper schedule may need modification:
- Autoimmune conditions: May require longer initial treatment at higher doses (40-60mg) before tapering 2
- Dermatologic conditions: Taper over 4-8 weeks after achieving disease control 3
- Inflammatory bowel disease: Consider 40mg as single morning dose rather than divided doses to reduce adrenal suppression 4
While some studies suggest that short courses (7-10 days) of prednisone can be stopped without tapering 5, 6, 7, this 40-day schedule represents a more cautious approach appropriate for longer treatment courses where HPA axis suppression is more likely to occur.
Remember that the first 1-2 weeks after completing the taper may still involve some degree of adrenal suppression, so stress doses may be needed if the patient experiences significant physical stress during this period.