Transitioning from IV Methylprednisolone to Oral Prednisone Taper
When transitioning a patient from IV methylprednisolone 20mg every 12 hours (40mg daily) to oral prednisone, use a conversion factor of 1:1.25 and start with oral prednisone 50mg daily, then taper by 5-10mg weekly until reaching 20mg daily, followed by slower tapering of 2.5-5mg weekly until discontinuation.
Conversion from IV Methylprednisolone to Oral Prednisone
- IV methylprednisolone 20mg every 12 hours equals 40mg total daily dose 1
- Use a conversion factor of 1:1.25 when switching from methylprednisolone to prednisone (40mg methylprednisolone = 50mg prednisone) 1, 2
- Start with oral prednisone 50mg daily as a single morning dose to minimize adrenal suppression 3
Tapering Schedule
Initial Tapering Phase (Higher Doses)
Secondary Tapering Phase (Medium Doses)
- Once at 20mg daily, slow the taper to 2.5-5mg weekly until reaching 10mg daily 1, 2
- Example schedule:
Final Tapering Phase (Lower Doses)
Administration Recommendations
- Administer prednisone as a single morning dose (before 9am) to minimize adrenal suppression 3
- Taking prednisone with food or milk can reduce gastric irritation 3
- Consider antacids between meals to help prevent peptic ulcers when using higher doses 3
Monitoring During Tapering
- Monitor for signs of disease relapse or flare during the tapering process 1, 2
- Watch for symptoms of adrenal insufficiency such as fatigue, weakness, dizziness, nausea, or hypotension 1, 2
- If symptoms worsen during tapering, return to the pre-relapse dose and then gradually decrease within 4-8 weeks to the dose at which relapse occurred 1, 2
Special Considerations
- For courses longer than 3 weeks (as in this case), tapering is necessary to prevent adrenal insufficiency 2
- Avoid abrupt withdrawal of therapy as it may precipitate adrenal crisis 3
- For patients on corticosteroids for more than 3 weeks, consider stress-dose steroids during periods of acute illness or stress 1