Prednisone Tapering Schedule

Prednisone is a synthetic corticosteroid drug that mimics the effect of human cortisol. Cortisol has gotten some bad press in the popular media for it’s ability to “pack on the pounds” and has been labeled with negative connotations as a “stress hormone.” However, cortisol is a crucial hormone in our body and without it our body could not adapt to changing conditions within the body.

Cortisol Function

Cortisol is produced by the adrenal glands that are located right atop your kidneys. Cortisol is produced and sent into the blood stream as a response to stress and nutrition demands. It suppresses the immune system, creates glucose when you have low blood sugar and aids in metabolism of fat, protein and glucose. It also decreases bone formation, which is why long term therapy increases the risk of osteoporosis and bone fracture.

Prednisone Uses

Prednisone can treat inflammation from short term infections or allergic reactions but is also used to manage chronic conditions like lupus, Crohn’s, rheumatoid arthritis and severe asthma.

In the outpatient retail pharmacy setting you see a lot of generic Medrol Dosepaks and corticosteroids like prednisone being prescribed for acute respiratory infections like bronchitis. They are being used as an anti-inflammatory. Corticosteroids suppress the immune system, which is responsible for the inflammatory response in infections. If a patient has bacterial bronchitis they will routinely be prescribed an antibiotic to wipe out the source of the infection and prednisone to bring down the swelling and inflammation in the lungs in order to provide some quick relief. Patients using a short course of therapy experience much less prednisone side effects compared to those who require long-term therapy.

The Debate of Tapers in “Burst” Therapy

Continuing with the acute bronchitis case, this patient would usually be given a short term steroid “burst” of high dose prednisone. Those high daily dose is usually tapered off over the course of a few days to avoid adrenal exhaustion and withdrawal effects. You see, when you introduce prednisone (which the body recognizes as cortisol) to the body, the adrenals stop making their own supply. The theory behind tapering off of steroids like prednisone is that by slowly removing the external steroid source, the body can adapt and begin making its own again with less stress placed on the system. The practice of tapering in short term therapy, even in higher doses is debated by many clinicians. Some doctors and clinicians claim that not only is a taper not necessary in short term therapy (14 days or less) but it is better to stop this therapy earlier, the adrenals and body adjust just fine. Using a taper just introduces more of the artificial source for a longer period of time, which is best to be avoided to minimize side effects and more quickly restore natural body hormone levels.

Prednisone Tapering Schedules

A prednisone tapering schedule will depend on the unique medical condition of the patient and how long they have been taking prednisone before attempting to taper off. Here is a 12-day taper schedule for high dose prednisone from a dermatologists office:

(With 10 mg tablets)

Day 1 take 6 tablets
Day 2 take 6 tablets
Day 3 take 5 tablets
Day 4 take 5 tablets
Day 5 take 4 tablets
Day 6 take 4 tablets
Day 7 take 3 tablets
Day 8 take 3 tablets
Day 9 take 2 tablets
Day 10 take 2 tablets
Day 11 take 1 tablet
Day 12 take 1 tablet

A decrease in dose is usually made every 2-3 days. The above example decreases by 10 mg every 2 days but some tapering schedules will decrease the dose by half every 3 days. Example:

Day 1 – 40 mg
Day 2 – 40 mg
Day 3 – 40 mg
Day 4 – 20 mg
Day 5 – 20 mg
Day 6 – 20 mg
Day 7 – 10 mg
Day 8 – 10 mg
Day 9 – 1o mg
Day 10 – OFF

Small dose, short course Methylprednisolone (comparable to prednisone) drug therapy is often dispensed with the taper schedule laid out in a pre-arranged blister-package. These use 2 mg tablets, start with 6 tablets on day 1 and decrease by a tablet every day until gone.

Consult Your Doctor for Prednisone Tapering

Your doctor has the most complete medical information and drug history to be able to formulate the best prednisone tapering schedule. It is even more critical in high dose, long-term prednisone therapy to be tapered under the discretion and advice of a competent physician.