Prednisone Tapering Schedule for 50 mg Starting Dose
For a prednisone taper starting at 50 mg daily, the recommended approach is to taper by 10 mg every 2 weeks until reaching 30 mg daily, then taper by 5 mg every 2 weeks until reaching 20 mg daily, then by 2.5 mg every 2 weeks until completed, with further slowing to 1 mg every 2-4 weeks once reaching 10 mg daily. 1
General Tapering Principles
- Prednisone courses longer than 3 weeks require tapering to prevent adrenal insufficiency 2, 3
- Single daily morning dosing is preferred over divided doses to minimize adrenal suppression 2, 3
- Tapering schedules should be based on the initial dose, with slower tapering at lower doses 2, 4
- The goal is to minimize withdrawal symptoms while preventing disease flare 3
Specific Tapering Schedule for 50 mg Starting Dose
Phase 1: Initial Reduction (50 mg to 30 mg)
- Reduce by 10 mg every 2 weeks 1
- Week 1-2: 50 mg daily
- Week 3-4: 40 mg daily
- Week 5-6: 30 mg daily
Phase 2: Intermediate Reduction (30 mg to 20 mg)
- Reduce by 5 mg every 2 weeks 1
- Week 7-8: 25 mg daily
- Week 9-10: 20 mg daily
Phase 3: Slow Reduction (20 mg to 10 mg)
- Reduce by 2.5 mg every 2 weeks 1
- Week 11-12: 17.5 mg daily
- Week 13-14: 15 mg daily
- Week 15-16: 12.5 mg daily
- Week 17-18: 10 mg daily
Phase 4: Very Slow Reduction (10 mg to 0 mg)
- Reduce by 1 mg every 2-4 weeks 1, 2
- This phase may take 10-20 weeks depending on disease response and patient tolerance 2
Monitoring During Tapering
- Monitor for signs of disease flare during the tapering process 3
- Watch for symptoms of adrenal insufficiency (fatigue, weakness, nausea, hypotension) 2
- If disease flares during tapering, return to the pre-flare dose and attempt a slower taper after symptoms are controlled 3
Special Considerations
- For inflammatory conditions, consider adding steroid-sparing agents if multiple relapses occur during tapering 2, 3
- Bone protection with calcium (800-1000 mg/day) and vitamin D (400-800 units/day) supplementation is recommended throughout the tapering process 5
- Successful tapering is more likely in patients with well-controlled disease activity 6
Common Pitfalls to Avoid
- Tapering too quickly, which may lead to disease flare or adrenal insufficiency 2
- Not providing patients with clear instructions about the tapering schedule 3
- Failing to monitor for steroid-related side effects during the tapering process 2
- Attempting to taper when disease activity is not adequately controlled 6