Determining the Appropriate Tapering Strategy
By Carol Eustice Medically reviewed by Grant Hughes, MD on July 21, 2019
Table of Contents
Table of Contents
How to Taper
What to Expect
Prednisone is a synthetic steroid with potent anti-inflammatory effects that is used to treat inflammatory types of arthritis and other conditions.1 Like other corticosteroids, prednisone works by lowering the activity of the immune system.
The drug must be taken according to directions, since misuse, long-term use, or high doses can lead to undesirable side effects. Similarly, discontinuation of the drug in the proper way can help prevent symptoms of prednisone withdrawal.
Verywell / Emily Roberts
Why Tapering Is Necessary
Prednisone is similar to cortisol, a hormone naturally made by your adrenal glands. It works by mimicking the effects of the hormones your body produces naturally in your adrenal glands.
Cortisol is a steroid hormone that regulates a wide range of processes throughout the body, including metabolism and the immune response. It also plays a very important role in helping the body respond to stress.
If you take prednisone for more than a few weeks, your adrenal glands will decrease the natural production of cortisol. If you stop prednisone abruptly before production is restored, the lack of hormone can trigger an array of withdrawal symptoms.
To avoid prednisone withdrawal, the drug should be gradually reduced in stage according to a specific schedule prescribed by your doctor. An exception is if prednisone has been given over a very short period of time. Don’t try to stop or taper prednisone without your doctor’s knowledge or advice.
Symptoms of prednisone withdrawal can range from mild to debilitating and typically include:2
Low blood pressure
How Prednisone Is Tapered
So profound are the risks of prednisone withdrawal that some doctors will pre-plan a tapering schedule if high doses are used for more than three days.1 In most cases, tapering is needed if you have been taking prednisone orally for more than three weeks.
The tapering schedule will differ depending on how long a person has been taking steroids. There are no set rules to direct the tapering process; the decision depends largely on clinical experience.
Example of Prednisone Tapering Strategy
Decrease dose in 5-milligram (mg) increments if less than 40 mg of prednisone is taken per day.
Decrease in 2.5-mg increments once 20 mg dose is reached.
Decrease in 1-mg increments once 10 mg dose is reached.
For patients who haven’t been taking steroids for a long period of time, the doctor may decrease the dose on a daily basis. The dose may be decreased monthly for patients who’ve been on the medication for a long period.
What to Expect
When people first decrease the dose, it’s not uncommon to feel achy or fatigued.2 These symptoms often resolve over two to seven days. If symptoms don’t resolve, a doctor may elect to temporarily increase the dose and taper more slowly. Some people may have difficulty tapering off steroids despite incremental tapers of only 1 milligram.
Occasionally, tapering on an every-other-day basis may be useful. For example, instead of tapering from 4 milligrams to 3 milligrams of prednisone, a doctor may prescribe taking 4 milligrams one day and 3 milligrams the next day, and alternating back and forth for one week (also known as an alternate-day taper).
Then, if successful, the doctor may prescribe 4 milligrams one day and 2 milligrams the next and so on until the patient is taking only 4 milligrams every other day (for example, 4 milligrams one day and zero the next day). The doctor then continues to try to decrease the dose on that alternate day.