Prednisone 40mg Tapering Regimen
For a patient on 40mg of prednisone, the recommended tapering regimen is to reduce the dose by 5mg every week until reaching 10mg/day, then reduce by 2.5mg every week until discontinuation, while monitoring for signs of disease recurrence or adrenal insufficiency. 1
Initial Tapering Phase
- Begin with 40mg daily dose (preferably taken in the morning before 9am to minimize adrenal suppression) 1
- Reduce dose by 5mg every week until reaching 10mg/day 2
- Week 1: 40mg/day
- Week 2: 35mg/day
- Week 3: 30mg/day
- Week 4: 25mg/day
- Week 5: 20mg/day
- Week 6: 15mg/day
- Week 7: 10mg/day
Secondary Tapering Phase
- Once at 10mg/day, slow the taper to 2.5mg reductions every week 2
- Week 8: 7.5mg/day
- Week 9: 5mg/day
- Week 10: 2.5mg/day
- Week 11: Discontinue
Important Considerations
Never stop prednisone abruptly as this can lead to adrenal crisis 1
The tapering schedule must be individualized based on:
For patients with autoimmune conditions, a more gradual taper may be necessary, with longer periods at each dose level 2
For conditions like polymyalgia rheumatica, after reaching 5mg/day, consider maintaining this dose for a longer period (up to a year) before final tapering 2, 3
Monitoring During Tapering
- Monitor for signs of disease relapse at each dose reduction 2
- Watch for symptoms of adrenal insufficiency: fatigue, weakness, dizziness, nausea, hypotension 2
- Follow-up visits every 4-8 weeks during the first year of treatment 2
- Patients should be educated about stress dosing for illness or surgery 2
Special Situations
For severe inflammatory conditions (like autoimmune hepatitis), the taper may need to be slower, with dose reductions every 4 weeks rather than weekly 2
For short-term treatment of acute conditions (like asthma exacerbations), faster tapering or even abrupt discontinuation after 7-10 days may be appropriate 4, 5, 6
For patients at high risk of relapse, consider adding steroid-sparing agents before beginning the taper 2
Stress Dosing During Tapering
- Patients undergoing significant stress (surgery, severe illness) may require temporary return to higher doses 2
- For minor stress, double the current daily dose for the duration of illness 2
- For major stress, consider IV hydrocortisone (starting with 50-100mg every 6-8 hours) 2
Minimizing Steroid Complications
- Consider calcium and vitamin D supplementation to prevent osteoporosis 2
- Monitor for steroid-induced diabetes, hypertension, and weight gain 2
- Morning dosing (before 9am) helps minimize adrenal suppression 1
Remember that successful tapering depends on careful monitoring and adjustment based on both objective measures of disease activity and signs of adrenal insufficiency. The goal is to use the minimum effective dose for the shortest possible time while avoiding disease relapse and withdrawal symptoms.