14-Day Prednisone Treatment with Taper
For a 14-day prednisone course, administer full-dose prednisone (typically 1 mg/kg/day or 60 mg/day maximum) for 7-14 days as a single morning dose, then taper by 10 mg every 2 days until completion. 1
Recommended Dosing Schedule
Initial Dosing Phase
- Start with prednisone 1 mg/kg/day as a single morning dose (usual maximum 60 mg/day) 1, 2
- Administer before 9 am to align with natural cortisol rhythm and minimize adrenal suppression 3
- Continue full dose for 4-7 days depending on clinical response 1
Tapering Phase
- After 4 days at maximum dose, reduce by 10 mg every 2 days 1
- Example 14-day regimen: 60 mg daily for 4 days, then 50 mg for 2 days, 40 mg for 2 days, 30 mg for 2 days, 20 mg for 2 days, 10 mg for 2 days 1
- This provides approximately 540 mg total prednisone over 14 days for a 60 kg adult 1
Key Administration Principles
Timing and Dosing Strategy
- Single daily dosing is strongly preferred over divided doses 2, 3
- Take with food or milk to reduce gastric irritation 3
- Administer antacids between meals if using high doses 3
Important Considerations for Short Courses
- Tapering is NOT required for courses under 3 weeks in duration 2
- For acute conditions like asthma exacerbations, abrupt discontinuation after 10-14 days is safe and effective without tapering 4, 5
- However, the traditional taper approach remains standard practice for most conditions to provide psychological reassurance and gradual dose reduction 1
Disease-Specific Context
When This Regimen Applies
- Sudden sensorineural hearing loss: Full dose 7-14 days, then taper over similar period 1
- Acute inflammatory conditions requiring short-term high-dose therapy 1, 2
- The 14-day course with taper is specifically validated for conditions requiring immediate high-dose intervention 1
Dosing Equivalents
- Prednisone 60 mg = Methylprednisolone 48 mg = Dexamethasone 10 mg 1
- Avoid underdosing: A standard methylprednisolone dose pack (84 mg over 6 days) provides only 105 mg prednisone equivalent, far below the recommended 540 mg over 14 days 1
Common Pitfalls to Avoid
Underdosing Errors
- Do not use methylprednisolone dose packs as equivalent therapy—they provide inadequate total steroid exposure (only 105 mg prednisone equivalent vs. 540 mg needed) 1
- Ensure initial dose reaches 1 mg/kg/day, not lower "conservative" doses that compromise efficacy 1
Monitoring Considerations
- Most serious adverse effects occur with chronic use; short 10-14 day courses have acceptable and manageable side effects 1
- Hyperglycemia and weight gain are most frequent adverse events even in short courses 1
- For courses this short, adrenal insufficiency is not a significant concern 2, 4
When to Modify the Standard Taper
- If treating acute asthma or similar self-limited conditions, consider abrupt discontinuation after 10 days rather than tapering—evidence shows no increased relapse or rebound 4, 5
- Early treatment initiation is critical; ensure patient starts therapy immediately rather than delaying for a "perfect" taper schedule 1