Tapering Prednisolone After 4 Weeks at Low Dose (5 mg Daily)
After 4 weeks of prednisolone 5 mg daily, you can safely discontinue the medication without tapering, because courses under 3 weeks at supraphysiologic doses (>7.5 mg/day) are required to suppress the hypothalamic-pituitary-adrenal (HPA) axis. 1, 2, 3
Why No Taper Is Needed
Physiologic replacement doses (≤7.5 mg prednisolone daily) do not suppress the HPA axis, even when given for several weeks, because they approximate normal daily cortisol production 2, 3.
Your patient received 5 mg daily—below the threshold for adrenal suppression—and the 4-week duration is insufficient to cause clinically significant HPA axis dysfunction 1, 2.
Abrupt discontinuation after short courses (<3 weeks) at supraphysiologic doses or any duration at physiologic doses does not cause adrenal crisis or withdrawal symptoms 2, 3.
When Tapering Would Be Required
Tapering becomes necessary only when prednisolone exceeds 7.5 mg/day for more than 3 weeks, because this combination reliably suppresses endogenous cortisol production 1, 2, 3.
If your patient had been on 10 mg daily (or higher) for 4 weeks, you would taper by reducing 1 mg every 4 weeks after reaching 10 mg/day, or use a faster initial taper (5 mg weekly reductions) down to 10 mg, then slow to 1 mg every 4 weeks 1, 4.
Monitoring After Discontinuation
No routine cortisol testing or follow-up is required for patients stopping 5 mg daily after 4 weeks, because their adrenal function remains intact 1, 2.
Educate the patient that fatigue, weakness, nausea, or hypotension would be unexpected at this dose and duration, but if such symptoms occur, they should contact you to rule out other causes 1.
Common Pitfall to Avoid
Do not reflexively taper all corticosteroid courses—many clinicians unnecessarily prolong low-dose steroids out of unfounded concern for adrenal insufficiency, thereby increasing cumulative steroid exposure and toxicity risk 1, 2.
The critical thresholds are >7.5 mg/day AND >3 weeks duration; your patient meets neither criterion 2, 3.