What is the tablet regimen for a 60mg prednisone taper in an adult patient?

Prednisone 60mg Taper: Tablet Regimen

For a 60mg prednisone course, no tapering is required if the treatment duration is 10 days or less—simply stop the medication after completing the course. 1, 2

Standard Dosing Regimen

• Take 60mg daily (typically as a single morning dose) for 5-10 days, then stop abruptly 1
• This translates to twelve 5mg tablets daily if using 5mg prednisone tablets
• Alternatively, three 20mg tablets daily if using 20mg tablets
• The National Asthma Education and Prevention Program explicitly states that for corticosteroid courses of less than 1 week, there is no need to taper the dose 1
• For courses lasting up to 10 days, there is still no need to taper, especially if patients are concurrently taking inhaled corticosteroids 1, 2

Why No Taper is Needed

• Short-term high-dose corticosteroids (5-10 days) do not suppress the hypothalamic-pituitary-adrenal axis sufficiently to require tapering 2, 3
• A landmark double-blind trial demonstrated that abrupt cessation after 10 days of 40mg prednisone showed no difference in peak expiratory flow rate, symptom scores, or treatment failures compared to a tapered course 4
• The concern about "rebound" symptoms after abrupt cessation is not supported by evidence for short courses 4

When Tapering IS Required

Tapering becomes necessary only when:

• Treatment duration exceeds 10 days 1, 2
• Treating chronic conditions requiring prolonged therapy (e.g., autoimmune hepatitis, inflammatory myopathies) 1
• Patient has been on chronic corticosteroids previously (adrenal suppression risk) 2

Common Clinical Scenarios

For Asthma Exacerbations

• Adults: 40-80mg daily in single or divided doses for 5-10 days, then stop 1
• Children: 1-2 mg/kg/day (maximum 60mg/day) for 3-10 days, then stop 1

For Inflammatory Myopathies (Requires Taper)

• Children with juvenile dermatomyositis: Start at 2 mg/kg daily (up to 60mg), then taper over 6-8 weeks 1
• Initial high dose maintained for 2-4 weeks, then reduce by 10-20% of current dose every 2-4 weeks 1

Critical Pitfalls to Avoid

• Do not unnecessarily taper short courses—this adds complexity without benefit and may prolong exposure to corticosteroids 2, 4
• Do not assume all 60mg courses require tapering—the duration of therapy, not the dose itself, determines tapering necessity 2
• Do not confuse weight-based dosing calculations—60mg is already the maximum daily dose for children (1-2 mg/kg up to 60mg) 1
• Ensure adequate gastrointestinal absorption—oral therapy is equivalent to IV therapy when GI function is intact 1

Practical Tablet Count

For a standard 7-day course at 60mg daily:

• Using 5mg tablets: 84 tablets total (12 tablets × 7 days)
• Using 20mg tablets: 21 tablets total (3 tablets × 7 days)

For a 10-day course at 60mg daily:

• Using 5mg tablets: 120 tablets total (12 tablets × 10 days)
• Using 20mg tablets: 30 tablets total (3 tablets × 10 days)