From the Guidelines
A 12-day prednisone taper from 60mg to 10mg is recommended to start with 60mg daily for 2 days, then decrease to 40mg daily for 2 days, followed by 30mg daily for 2 days, then 20mg daily for 2 days, 15mg daily for 2 days, and finally 10mg daily for 2 days, as guided by the most recent evidence from the BSR/BHPR 2021 guideline 1. The goal of this taper is to minimize adrenal suppression and withdrawal symptoms while allowing the body to adjust to decreasing levels of corticosteroids.
- Key considerations for the taper include:
- Taking the medication in the morning with food to reduce gastrointestinal irritation and minimize sleep disturbances.
- Monitoring for significant withdrawal symptoms like fatigue, body aches, or dizziness during the taper, and contacting the healthcare provider if necessary to adjust the taper schedule.
- The potential need for further tapering after completing this initial 12-day taper, especially if the patient has been on long-term steroid therapy, to avoid adrenal crisis. The BSR/BHPR 2021 guideline suggests that glucocorticoids are usually given as daily oral prednisolone, initially at high doses (1 mg/kg up to 60 mg) with the dose rapidly reduced to 15 mg prednisolone at 12 weeks 1, supporting the rationale for a gradual taper.
- The importance of individualizing the taper based on the patient's response and the presence of any underlying conditions that may affect adrenal function or increase the risk of withdrawal symptoms.
- The need for close monitoring by a healthcare provider to ensure a safe and effective taper, especially in patients with complex medical histories or those who have been on long-term steroid therapy.
From the Research
Dosing for Prednisone Taper
- The provided studies do not directly address the specific dosing for a prednisone taper from 60mg to 10mg over 12 days 2, 3, 4, 5, 6.
- However, the studies discuss the importance of tapering corticosteroids to avoid adrenal insufficiency, particularly when discontinuing long-term therapy 2, 3, 4, 5, 6.
- The rate of tapering should be individualized based on the patient's response and the duration of corticosteroid use 2, 6.
- A common approach to tapering is to reduce the dose by small increments every few days, but the exact schedule may vary depending on the patient's condition and the clinician's judgment 2, 6.
Adrenal Insufficiency Considerations
- Adrenal insufficiency is a potential risk when discontinuing corticosteroids, particularly after long-term use 2, 3, 4, 5, 6.
- The risk of adrenal insufficiency increases with higher doses and longer durations of corticosteroid use 2, 6.
- Patients should be monitored for signs of adrenal insufficiency during and after tapering, and the dose should be adjusted accordingly 2, 3, 4, 5, 6.
Tapering Strategies
- There is no one-size-fits-all approach to tapering corticosteroids, and the optimal strategy should be determined on a case-by-case basis 2, 6.
- Clinicians should consider the patient's medical history, the duration and dose of corticosteroid use, and the presence of any underlying conditions that may affect the risk of adrenal insufficiency 2, 6.
- Further research is needed to determine the most effective and safe strategies for tapering corticosteroids and monitoring for adrenal insufficiency 6.