How should I taper prednisone 60 mg daily after three weeks of use?

Prednisone 60 mg Taper After Three Weeks

For a 3-week course of prednisone 60 mg daily, taper over 3 weeks using a rapid reduction schedule: 40 mg daily for 7 days, then 20 mg daily for 7 days, then 10 mg daily for 7 days, then stop. 1

Recommended Tapering Protocol

The most appropriate taper for your situation follows a structured 3-week reduction:

Week 1 (Days 1-7)

• 40 mg daily as a single morning dose (before 9 AM) 1, 2
• This represents a 33% reduction from your initial dose

Week 2 (Days 8-14)

• 20 mg daily as a single morning dose 1
• Continue taking before 9 AM to minimize HPA axis suppression 2

Week 3 (Days 15-21)

• 10 mg daily as a single morning dose 1
• After completing this week, you may stop the medication 1

Why This Taper Is Appropriate

Three weeks of prednisone 60 mg requires tapering, but not an extended taper. 1, 2 The duration of your therapy (3 weeks) places you in a zone where:

• HPA axis suppression is present but recovers relatively quickly 3, 4
• A rapid taper is safe and prevents unnecessary prolonged steroid exposure 1
• Research shows HPA function normalizes within 1 week after short courses of high-dose prednisone 3

Alternative Slightly More Gradual Approach

If you experience symptoms during the rapid taper or have concerns about tolerance, use this modified schedule:

• Days 1-4: 60 mg daily
• Days 5-8: 40 mg daily
• Days 9-12: 30 mg daily
• Days 13-16: 20 mg daily
• Days 17-21: 10 mg daily 1

Critical Administration Details

• Take your entire daily dose as a single morning tablet before 9 AM 2, 1
• Taking prednisone in the morning aligns with your body's natural cortisol rhythm and reduces HPA axis suppression 2
• Take with food or milk to reduce gastric irritation 2

Monitoring During Taper

Watch for two distinct problems:

Disease Flare

• If your original symptoms return during tapering, immediately return to the previous dose that controlled symptoms 5
• Maintain that dose for 4-8 weeks before attempting a slower taper 5

Adrenal Insufficiency Symptoms

• Fatigue, weakness, nausea, dizziness, or low blood pressure 5
• These are uncommon with a 3-week course but possible 3, 4

Common Pitfalls to Avoid

Do not stop abruptly after 3 weeks at 60 mg. 2 Even though your course was relatively short, abrupt discontinuation can cause:

• Adrenal insufficiency (though risk is lower than with longer courses) 3, 4
• Disease rebound 5

Do not taper too slowly. 1 Many clinicians inappropriately use the same slow taper (1 mg every 4 weeks) designed for chronic therapy, which unnecessarily prolongs steroid exposure after short courses 5

Do not use divided doses. 2, 1 Taking prednisone multiple times per day increases HPA suppression without improving efficacy 2

Special Circumstances Requiring Modification

If You're on Azathioprine or Another Steroid-Sparing Agent

• You can taper more aggressively: reduce by 5 mg weekly until reaching 10 mg, then by 2.5 mg every 2-4 weeks 5
• This only applies if the steroid-sparing agent has been established for 2-3 months 5

If You Have Cirrhosis, Are Elderly, or Frail

• Consider extending the taper to 4-6 weeks rather than 3 weeks 1
• Use the alternative gradual approach listed above

If You Experience Stress or Illness During/After Taper

• Double your current prednisone dose for 3 days during minor illness 5
• For major stress (surgery, severe infection), contact your physician immediately 5
• This precaution applies for up to 1 week after completing the taper 3

After Completing the Taper

• No additional "stress dosing" is needed after 1 week post-taper for a 3-week course 3
• Your HPA axis should recover to normal function within 1-2 weeks of stopping 3, 4
• No cortisol testing is needed for a 3-week course unless you develop symptoms of adrenal insufficiency 5