Recommended Prednisone 2-Week Tapering Schedule
For a standard 2-week prednisone taper, start with 40mg daily for 3-4 days, then reduce by 5mg every 2-3 days until completion. 1
General Principles for Prednisone Tapering
- Prednisone should be administered as a single daily dose in the morning (before 9am) to minimize adrenal suppression 2
- For short courses (2 weeks), a structured taper helps prevent rebound symptoms and minimize risk of adrenal insufficiency 1
- Gastric irritation can be reduced by taking prednisone with food or milk 2
Recommended 2-Week Tapering Schedule
Option 1: Standard 2-Week Taper
- Days 1-3: 40mg daily 1
- Days 4-5: 35mg daily 1
- Days 6-7: 30mg daily 1
- Days 8-9: 25mg daily 1
- Days 10-11: 20mg daily 1
- Days 12-13: 15mg daily 1
- Day 14: 10mg daily 1
- Day 15: 5mg daily, then discontinue 1
Option 2: More Gradual Taper (if higher risk of rebound)
- Days 1-3: 40mg daily 1
- Days 4-6: 30mg daily 3
- Days 7-9: 20mg daily 3
- Days 10-12: 10mg daily 3
- Days 13-14: 5mg daily, then discontinue 3
Considerations for Special Populations
For Inflammatory Conditions
- For inflammatory conditions requiring higher initial doses (>30mg), consider starting at 60mg daily for 2-3 days, then follow the taper schedule above 3
- For polymyalgia rheumatica, taper to 10mg/day within 4-8 weeks, then reduce by 1mg every 4 weeks until discontinuation 3
For Immune-Related Adverse Events
- For moderate immune-related adverse events, start at 0.5-1mg/kg/day and taper over 2 weeks once symptoms improve 3
- For severe immune-related adverse events, start at 1-2mg/kg/day and taper over 4-6 weeks 3
Managing Potential Complications
- If symptoms recur during tapering, return to the pre-relapse dose and decrease more gradually (within 4-8 weeks) to the dose at which the relapse occurred 3
- Monitor for signs of adrenal insufficiency during tapering (fatigue, weakness, dizziness, nausea) 1
- For patients with diabetes, more frequent blood glucose monitoring is recommended during the taper 1
Common Pitfalls to Avoid
- Tapering too quickly can lead to disease flare or adrenal insufficiency 1
- Failing to take the medication in the morning can disrupt the natural cortisol rhythm 2
- Abrupt discontinuation after more than 3 weeks of therapy can cause withdrawal symptoms 2
- Not providing patients with clear instructions about the tapering schedule 1
Evidence on Tapering vs. Fixed Dosing
- Some studies suggest that for certain conditions like asthma exacerbations, a fixed-dose regimen without tapering may be as effective as a tapering regimen 4, 5, 6
- However, for most inflammatory conditions and longer courses of therapy, a structured taper is still recommended to minimize risk of symptom recurrence and adrenal suppression 3, 1