What is the recommended tapering schedule for a patient taking 20mg of prednisone (corticosteroid)?

Prednisone 20mg Tapering Schedule

For patients on 20mg of prednisone, the recommended tapering schedule is to reduce to 10mg/day within 4-8 weeks, then taper by 1mg every 4 weeks (or by 1.25mg using alternate-day schedules) until discontinuation. 1

General Tapering Principles

• Tapering should be gradual to prevent adrenal insufficiency and withdrawal symptoms
• Morning administration (before 9am) is recommended to minimize adrenal suppression 2
• Avoid abrupt discontinuation of therapy 2
• Constant monitoring is needed during the tapering process

Specific Tapering Schedule for 20mg Prednisone

Recommended Schedule:

• Weeks 1-2: 20mg daily (starting dose)
• Weeks 3-4: 15mg daily
• Weeks 5-6: 10mg daily
• Then reduce by 1mg every 4 weeks until discontinuation 1

Alternative Schedule (for more rapid tapering):

• Weeks 1-2: 20mg daily (starting dose)
• Weeks 3-4: 10mg daily
• Then reduce by 1mg every 4 weeks until discontinuation 1

Special Considerations

Monitoring During Tapering

• Watch for signs of adrenal insufficiency:

  • Fatigue
  • Weakness
  • Dizziness
  • Nausea
  • Low blood pressure
  • Hypoglycemia 1

• Monitor for disease relapse:

  • If relapse occurs, increase to the previously effective dose
  • Then decrease gradually to the dose at which relapse occurred
  • Continue tapering more slowly 1

Preventive Measures

• For courses exceeding 3 months:
  • Calcium supplementation (800-1000mg daily)
  • Vitamin D supplementation (400-800 IU daily) 1
• For high-dose therapy (>20mg daily for >2 weeks):
  • Influenza vaccination
  • Pneumococcal vaccination 1

Common Pitfalls to Avoid

1. Tapering too quickly: This can lead to adrenal insufficiency or disease relapse
2. Abrupt discontinuation: Can cause adrenal crisis 2
3. Ignoring time of administration: Taking prednisone in the morning (before 9am) helps minimize adrenal suppression 2
4. Failing to monitor: Regular follow-up every 4-8 weeks is recommended during the first year of tapering 1
5. Not considering alternate-day therapy: For long-term treatment, alternate-day therapy (twice the usual daily dose every other morning) may minimize certain undesirable effects 2

Remember that while these guidelines provide a framework, the British Journal of Dermatology notes that "the optimum CS dosing schedule is not known and dosing schedules are largely empirical and based on practical experience" 3. However, following the recommended tapering schedule will help minimize complications while effectively managing the transition off prednisone.