Tapering to Reduce Prednisone Withdrawal Symptoms

Don't Stop or Taper Prednisone Without Your Doctor's Advice

Tapering Prednisone. Astronaut Images/Caiaimages/Getty Images

Prednisone is a potent anti-inflammatory medication used to treat inflammatory types of arthritis and other conditions. Misuse, longterm use, or high doses can lead to undesirable side effects. Prednisone must be taken according to directions. To avoid prednisone withdrawal when the drug is to be discontinued, it should be tapered according to a specific schedule prescribed by your doctor. Do not try to stop or taper prednisone without your doctor's input.

  • Why must prednisone or other oral corticosteroids be tapered gradually and not stopped suddenly?
  • What are withdrawal symptoms associated with prednisone?
  • Why should a patient only attempt tapering under the direction of their doctor?

Gradual Discontinuation of Steroids

Discontinuation of steroid medications should be done on a gradual basis (i.e., tapered), except if they have been given over a very short period of time. The time of use necessitating taper may vary per prescribing doctor. Steroids include:

  • prednisolone (Prelone)
  • prednisone (Deltasone)
  • methylprednisolone (Medrol)
  • betamethasone (Celestone)
  • cortisone (Cortone)
  • hydrocortisone (Cortef)
  • dexamethasone (Decadron)
  • triamcinolone (Kenacort)

Tapering Reduces Prednisone Withdrawal Symptoms

According to rheumatologist Scott J. Zashin, MD, "I typically taper if a patient has taken the medication for more than 3 days. The main reason for a gradual taper is that patients may develop symptoms of steroid or prednisone withdrawal.

The symptoms include joint pain, muscle pain, fatigue, headache, fever, low blood pressure, nausea, and vomiting. Abrupt discontinuation of treatment in people who have been on steroids for a prolonged period of time may cause severe symptoms due to the fact that the normal production of steroids by the body has been turned off."

Medical Alert Bracelet Can Warn About Prednisone Withdrawal Symptoms

People who are taking steroids regularly for their condition may need a boost of medication during periods of stress, such as surgery or severe medical illness. Dr. Zashin advised, "I recommend my patients purchase a ​medical alert bracelet from their pharmacy in case they are in an accident and are unable to provide a medical history."

Dr. Zashin's Tapering Schedule to Reduce Prednisone Withdrawal

In terms of a taper regimen, the longer a person has been taking steroids, the slower the taper. Dr. Zashin typically tapers his patients:

  • by 5 mg increments when they are taking less than 40 mg of prednisone
  • by only 2.5 mg when they reach 20 mg of prednisone
  • by 1 mg increments once they reach 10 mg

Dr. Zashin elects to decrease the dose on a daily basis for patients who have not been taking steroids for a long period of time to monthly if the patient has been on the medication for a long period.

It is not uncommon, when people first decrease the dose, to feel some achiness or fatigue. These symptoms often resolve over 2 to 7 days. If symptoms do not 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 mg.

Occasionally, tapering on an every other day basis may be useful. For example, instead of tapering from 4 mg to 3 mg of prednisone, one might try taking 4 mg one day and 3 mg the next day for one week (i.e., an alternate day taper). Then, if successful, a patient could try 4 mg one day and 2 mg the next and so on until on only 4 mg every other day (e.g., 4 mg one day and 0 the next day). The patient continues to try to decrease the dose on that alternate day.

Equivalent Doses

According to The Pill Book (Bantam Books), using 5 mg of prednisone as the basis for comparison, equivalent doses of the other corticosteroids are:

  • 0.6 mg-0.75 mg of betamethasone
  • 25 mg of cortisone
  • 0.75 mg of dexamethasone
  • 20 mg of hydrocortisone
  • 4 mg of methylprednisolone
  • 5 mg of prednisolone
  • 4 mg of triamcinolone

Corticosteroid Converter: Calculate equivalent dosages of various corticosteroids. Easy-to-use conversion tool, from GlobalRPh.com

Answer provided by Scott J. Zashin, MD, clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano.