Prednisone Tapering After a One-Week Course
For a one-week course of prednisone, no taper is necessary—simply stop the medication. 1
Evidence Supporting Abrupt Discontinuation
HPA axis function recovers fully within one week after a short burst of prednisone (even at doses as high as 40 mg three times daily for 3 days, then tapered over 4 days), with normal ACTH and cortisol responses to stimulation testing documented at the one-week mark. 1
No additional stress-dose steroids are required during periods of physiologic stress if at least one week has elapsed since completing a short steroid burst. 1
Eight-day courses of prednisone (40 mg daily) produce no adrenal suppression when tested on day 12, whether given as a flat dose or tapered dose, with zero incidence of adrenal insufficiency in either regimen. 2
Five-day courses of high-dose prednisone (25 mg twice daily) cause transient HPA suppression that resolves by day 5 post-treatment, though mild adrenal blunting may persist briefly. 3
FDA Labeling Guidance
The FDA label states: "If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly." 4 This guidance applies to prolonged courses, not one-week treatments.
Courses of 2–3 weeks or less do not require tapering according to standard clinical practice, as the risk of adrenal crisis is negligible. 5
When Tapering Is Required
Tapering becomes necessary only for courses longer than 3 weeks, because prolonged suppression of the HPA axis develops with extended therapy. 6
The American Society of Hematology strongly recommends against prolonged courses (>6 weeks including taper) of prednisone for newly diagnosed conditions, favoring short courses (≤6 weeks) to minimize adverse effects. 7
Common Clinical Pitfall
Do not confuse disease relapse with adrenal insufficiency. If symptoms recur after stopping a one-week course, this represents inadequate treatment of the underlying condition—not steroid withdrawal—and should prompt reassessment of the diagnosis and consideration of alternative therapy, not reinitiation of steroids. 7
Some older literature suggests caution regarding HPA integrity "for up to one year" after even brief steroid courses, but this is not supported by modern stimulation testing, which demonstrates full recovery within 1–2 weeks. 1, 5
Practical Instructions for the Patient
Take the final dose on day 7 and stop—no taper, no weaning, no gradual reduction. 1
Administer all doses as a single morning dose before 9 AM to align with physiologic cortisol rhythms and minimize any residual HPA suppression. 4
No special precautions are needed for minor illnesses or stress occurring more than one week after discontinuation. 1