From the Research
A 5-day prednisolone taper for adults should start with 40-60mg on day 1, then decrease by 10mg daily (e.g., 50mg, 40mg, 30mg, 20mg, 10mg) to minimize the risk of adrenal insufficiency and other side effects, as supported by the most recent study on prednisolone replacement in adrenal insufficiency 1. This tapering schedule allows for a gradual reduction in prednisolone dosage, reducing the risk of adrenal crisis and other side effects. The patient should take the full daily dose in the morning with food to minimize gastrointestinal irritation and reduce interference with the body's natural cortisol production. Common side effects may include increased appetite, mood changes, insomnia, and elevated blood sugar, and patients with diabetes should monitor their blood glucose more frequently during the taper. Those with a history of stomach ulcers should consider taking a proton pump inhibitor for protection. Never stop prednisolone abruptly as this can cause adrenal crisis, and if severe side effects occur, the patient should contact their healthcare provider immediately. It is essential to note that the risk of adrenal insufficiency is higher in patients taking prednisolone, especially at low doses, as shown in studies 2, 3, 4. However, the most recent study on optimizing prednisolone replacement in adrenal insufficiency 1 provides the best guidance for tapering prednisolone. Additionally, a study on mortality risk in patients with adrenal insufficiency using prednisolone or hydrocortisone 5 highlights the importance of careful management of prednisolone tapering to minimize the risk of adverse outcomes. Overall, a gradual tapering schedule, such as the one described, is recommended to minimize the risk of adrenal insufficiency and other side effects.