Prednisone 20 mg for 1 Week: No Taper Required
For a short course of prednisone 20 mg taken for only 1 week, no taper is necessary—stop abruptly. 1, 2, 3
Rationale for No Taper After 1 Week
- Hypothalamic-pituitary-adrenal (HPA) axis suppression requires >3 weeks of therapy at doses >7.5 mg daily to become clinically significant 4
- A 1-week course at 20 mg daily is insufficient duration to cause meaningful adrenal suppression that would necessitate tapering 1
- Multiple randomized controlled trials in acute conditions (asthma exacerbations) demonstrate that abrupt discontinuation after 7-14 days is as safe and effective as tapering, with no increased risk of relapse or rebound 2, 3
Evidence Supporting Abrupt Discontinuation
- A double-blind trial comparing tapered versus non-tapered prednisone after 10 days of treatment found no difference in relapse rates or rebound symptoms between groups 3
- Another pilot study of 28 patients treated with non-tapering courses showed no significant difference in relapse rates within 21 days compared to historical controls who tapered 2
- Expert consensus states that tapering is unnecessary for courses <2-3 weeks duration in acute, steroid-responsive conditions 1
When Tapering IS Required
You must taper if any of the following apply:
- Duration >3 weeks at any suppressive dose 4, 1
- Chronic disease requiring ongoing control (e.g., rheumatoid arthritis, polymyalgia rheumatica) 5, 4
- Doses >30 mg daily for >1 week, where rapid HPA suppression may occur 4
- Patient has received multiple courses of steroids in recent months 1
Common Pitfall to Avoid
- Do not reflexively taper all prednisone courses—this unnecessarily prolongs steroid exposure and increases cumulative adverse effects without clinical benefit for short courses 2, 3
- The widespread practice of tapering all prednisone prescriptions is not evidence-based for courses <2 weeks 1, 2