Prednisone 60mg Daily Taper Schedule Over 3 Weeks
For a 3-week prednisone taper starting at 60mg daily, reduce the dose by approximately 10mg every 4-7 days, tapering from 60mg to 40mg in week 1, 40mg to 20mg in week 2, and 20mg to 10mg or off by week 3, depending on the underlying condition and clinical response.
Standard 3-Week Taper Protocol
The most commonly recommended approach for a rapid taper from 60mg prednisone involves:
- Week 1 (Days 1-7): 60mg daily for 4 days, then reduce to 40mg daily for 3 days 1
- Week 2 (Days 8-14): 40mg daily for 4 days, then reduce to 20mg daily for 3 days 1
- Week 3 (Days 15-21): 20mg daily for 4 days, then reduce to 10mg daily for 3 days 1
This schedule is derived from alcoholic hepatitis and autoimmune hepatitis treatment protocols where rapid tapers from high-dose steroids are well-established 1.
Alternative Structured Approach
For conditions requiring slightly more gradual reduction:
- Days 1-4: 60mg daily 1
- Days 5-8: 40mg daily 1
- Days 9-12: 30mg daily 1
- Days 13-16: 20mg daily 1
- Days 17-21: 10mg daily 1
Critical Considerations for Tapering
Timing of dose administration: Give prednisone as a single morning dose to minimize hypothalamic-pituitary-adrenal axis suppression and improve adherence 1, 2. Divided doses are unnecessary for most conditions and increase side effect burden 2.
Disease-specific modifications: The taper rate should account for the underlying condition being treated. For autoimmune hepatitis, the initial 60mg dose is typically maintained for only 4 days before beginning reduction 1. For severe alcoholic hepatitis, a 28-day course at 40mg (not 60mg) is more standard, followed by a 2-week taper 1.
Monitoring during taper: Assess clinical response and laboratory markers (transaminases, inflammatory markers) at each dose reduction to detect early relapse 1. If symptoms recur during tapering, return to the previous effective dose rather than continuing the taper 1.
Common Pitfalls to Avoid
Avoid abrupt discontinuation: Even after 3 weeks of high-dose prednisone, stopping abruptly can precipitate adrenal insufficiency. The final week should taper to at least 10mg before considering complete cessation 1.
Do not use this schedule for chronic conditions: This rapid 3-week taper is appropriate only for acute inflammatory conditions. Autoimmune hepatitis, for example, requires months of therapy with much slower tapering (reducing by 5mg weekly from 20mg down to 10mg, then by 2.5mg increments) 1.
Recognize when slower tapering is needed: Patients with cirrhosis, elderly/frail patients, or those with multiple comorbidities may require more conservative dose reductions 1. In these cases, extend the taper to 4-6 weeks rather than 3 weeks.
Monitor for steroid-related complications: Even short courses at 60mg daily carry risk for hyperglycemia, hypertension, psychiatric symptoms, and infection 1. Initiate calcium (1000mg daily) and vitamin D (400-800 units daily) supplementation from day 1 1.
Special Populations
Hemodialysis patients: No dose adjustment is required, as prednisone is hepatically metabolized and not removed by dialysis 3. Use standard tapering schedules without supplemental dosing after dialysis sessions 3.
Patients requiring longer therapy: If clinical response is inadequate after 3 weeks, do not continue high-dose steroids without reassessing the diagnosis and considering steroid-sparing agents 1. Prolonged high-dose monotherapy (>18 months) significantly increases risk of osteoporosis, diabetes, and other serious complications 1.