Methylprednisolone 10mg Tapering Schedule
For a patient on 10mg methylprednisolone daily after long-term use (>3 weeks), reduce the dose by 1mg every 4 weeks until discontinuation. 1, 2, 3
Tapering Schedule Table
| Week | Daily Dose | Duration |
|---|---|---|
| 1-4 | 9 mg | 4 weeks |
| 5-8 | 8 mg | 4 weeks |
| 9-12 | 7 mg | 4 weeks |
| 13-16 | 6 mg | 4 weeks |
| 17-20 | 5 mg | 4 weeks |
| 21-24 | 4 mg | 4 weeks |
| 25-28 | 3 mg | 4 weeks |
| 29-32 | 2 mg | 4 weeks |
| 33-36 | 1 mg | 4 weeks |
| After week 36 | Discontinue | - |
Administration Guidelines
Take as a single morning dose to minimize HPA axis suppression and align with natural cortisol rhythm (peak activity 2am-8am). 4, 3, 5
Split dosing may be considered only if experiencing prominent nighttime pain while on doses <5mg daily, though persistent breakthrough symptoms should prompt reconsideration of the diagnosis. 4, 2
Monitoring Schedule
Follow-up every 4-8 weeks during the first year of tapering to assess disease activity and monitor for adrenal insufficiency. 4, 1, 3
Follow-up every 8-12 weeks in the second year and as clinically indicated thereafter. 4, 1
Monitor specifically for: fatigue, weakness, dizziness, nausea (signs of adrenal insufficiency), blood pressure, blood glucose, and bone density. 1, 3
Managing Relapse During Tapering
If symptoms recur, immediately return to the previous effective (pre-relapse) dose and maintain for 4-8 weeks until disease control is re-established. 4, 2, 3
After stabilization, attempt tapering again at the same 1mg/4-week rate, but consider adding steroid-sparing agents if multiple relapses occur. 2, 3
For patients with repeated relapses, indefinite low-dose maintenance (2.5-7.5mg/day prednisone equivalent) is acceptable rather than risking repeated flares. 2, 3
Critical Stress Dosing Protocol
During acute illness or surgical procedures, temporarily increase the dose to prevent adrenal crisis. 1, 3, 5
For patients on 10mg daily experiencing acute stress (fever, infection, surgery): increase to hydrocortisone 50mg twice daily for 3 days. 2, 3
Patient education is essential: provide clear written instructions about stress dosing and signs of adrenal insufficiency (fatigue, weakness, nausea, dizziness, hypotension). 1, 3
Consider a medical alert bracelet indicating adrenal insufficiency risk for patients on chronic corticosteroid therapy. 2, 3
Supportive Measures Throughout Tapering
Provide calcium and vitamin D supplementation throughout the entire tapering period to protect bone density. 1
Monitor blood pressure and blood glucose regularly, especially in patients with diabetes, hypertension, or cardiovascular disease. 1
HPA axis suppression should be anticipated in any patient receiving >7.5mg daily for >3 weeks, making gradual tapering mandatory. 2, 5