Prednisone Taper After 60 mg Daily for 2 Weeks
For a 2-week course of prednisone 60 mg daily, you can stop abruptly without tapering—adrenal suppression is not a concern at this duration.
Rationale for No Taper
- Courses shorter than 3 weeks do not require tapering because the hypothalamic-pituitary-adrenal (HPA) axis remains intact and adrenal insufficiency risk is negligible. 1
- The American Academy of Otolaryngology-Head and Neck Surgery confirms that adrenal insufficiency is not a significant concern for short courses like this 14-day regimen. 2
- Research in asthma exacerbations demonstrates no difference in relapse rates or adrenal suppression between patients who tapered versus those who stopped prednisone abruptly after 8 days of therapy. 3, 4
If You Choose to Taper (Optional)
While not medically necessary, some clinicians prefer a brief taper for patient comfort or to minimize steroid withdrawal symptoms (arthralgia, malaise). If you opt to taper:
- Reduce by 10 mg every 2 days until completion, which adds approximately 6 additional days to the course. 2
- This provides a total of approximately 540 mg prednisone over the entire treatment period for a 60 kg adult. 2
Example optional taper schedule:
- Days 1-14: 60 mg daily
- Days 15-16: 50 mg daily
- Days 17-18: 40 mg daily
- Days 19-20: 30 mg daily
- Days 21-22: 20 mg daily
- Days 23-24: 10 mg daily
- Day 25: Stop
Critical Monitoring
- Monitor for hyperglycemia and weight gain, the most frequent adverse events even in short courses. 2
- Ensure the patient understands that steroid withdrawal symptoms (fatigue, joint aches) may occur but do not indicate adrenal insufficiency at this duration. 1
Common Pitfalls to Avoid
- Do not confuse this 2-week course with chronic therapy—the evidence and recommendations for tapering after months of therapy (≥3 weeks at doses >7.5 mg/day) do not apply here. 1, 5
- Avoid underdosing errors by ensuring the full 60 mg daily dose is maintained for the intended 14 days; methylprednisolone dose packs provide inadequate steroid exposure (only 105 mg prednisone equivalent total). 2
- Administer as a single morning dose to align with physiologic cortisol rhythms, though HPA suppression is not a concern at this duration. 1, 5