40-Day Prednisone Taper Schedule
For a 40-day prednisone taper, start with 40 mg daily for 7 days, then reduce by 5 mg every week until reaching 10 mg/day, followed by 2.5 mg weekly reductions until completion. 1
Detailed Taper Schedule
| Days | Dose | Instructions |
|---|---|---|
| 1-7 | 40 mg | Take 40 mg (8 tablets) once daily in the morning with food |
| 8-14 | 35 mg | Take 35 mg (7 tablets) once daily in the morning with food |
| 15-21 | 30 mg | Take 30 mg (6 tablets) once daily in the morning with food |
| 22-28 | 25 mg | Take 25 mg (5 tablets) once daily in the morning with food |
| 29-35 | 20 mg | Take 20 mg (4 tablets) once daily in the morning with food |
| 36-42 | 15 mg | Take 15 mg (3 tablets) once daily in the morning with food |
| 43-49 | 10 mg | Take 10 mg (2 tablets) once daily in the morning with food |
| 50-56 | 7.5 mg | Take 7.5 mg (1½ tablets) once daily in the morning with food |
| 57-63 | 5 mg | Take 5 mg (1 tablet) once daily in the morning with food |
| 64-70 | 2.5 mg | Take 2.5 mg (½ tablet) once daily in the morning with food |
Prescription Signature
Rx: Prednisone 5 mg tablets Disp: #294 tablets Sig: Take 8 tablets (40 mg) by mouth once daily in the morning with food for 7 days, then 7 tablets (35 mg) daily for 7 days, then 6 tablets (30 mg) daily for 7 days, then 5 tablets (25 mg) daily for 7 days, then 4 tablets (20 mg) daily for 7 days, then 3 tablets (15 mg) daily for 7 days, then 2 tablets (10 mg) daily for 7 days, then 1½ tablets (7.5 mg) daily for 7 days, then 1 tablet (5 mg) daily for 7 days, then ½ tablet (2.5 mg) daily for 7 days, then stop.
Important Considerations
Administration
- Administer in the morning to mimic natural cortisol rhythm and reduce adverse effects 2
- Take with food to minimize gastrointestinal irritation
Monitoring During Treatment
- Blood pressure at each clinic visit
- Glucose levels (consider urine dipstick for glucose)
- Watch for signs of infection, mood changes, and sleep disturbances 2
- For longer-term use (>3 months), consider bone mineral density monitoring 1
Potential Side Effects
- Common side effects include facial rounding, weight gain, acne, and hirsutism (80% of patients after 2 years) 1
- Severe complications (osteopenia, brittle diabetes, psychosis, hypertension) are uncommon but more likely after prolonged therapy (>18 months) 1
- Corticosteroid-related side effects are the most common cause for premature drug withdrawal (13% of patients) 1
Cautions
- Never stop prednisone abruptly due to risk of adrenal insufficiency 2
- Use with caution in patients with diabetes, hypertension, glaucoma, or psychiatric disorders 2
- Live vaccines should be avoided during treatment 2
This taper schedule follows evidence-based guidelines for gradual reduction of prednisone to minimize the risk of adrenal suppression and withdrawal symptoms while maintaining therapeutic effect. The morning dosing schedule helps preserve the natural cortisol rhythm and reduces adverse effects.