- Why must prednisone or other oral corticosteroids be tapered gradually and not stopped suddenly?
- What are prednisone withdrawal symptoms?
- What is a good rule of thumb for a tapering schedule?
- Should a patient only attempt tapering under the direction of their doctor so prednisone withdrawal symptoms can be managed? When the patient experiences pain while tapering, should they try to work through the pain and continue tapering or go back on a higher dose temporarily?
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:
- prednisone (Deltasone)
- prednisolone (Prelone)
- methylprednisolone (Medrol)
- betamethasone (Celestone)
- cortisone (Cortone)
- hydrocortisone (Cortef)
- dexamethasone (Decadron)
- triamcinolone (Kenacort)
Tapering Reduces Prednisone Withdrawal Symptoms
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 (prednisone) withdrawal. These symptoms include:
Abrupt discontinuation of treatment in patients who have been on steroids for a prolonged period of time may cause severe symptoms due to the fact the normal production of steroids by the body has been turned off.
Medical Alert Bracelet Can Warn About Prednisone Withdrawal Symptoms
In fact, patients 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. 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 one has been taking steroids, the slower the taper. I will typically taper 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
I may elect to decrease the dose on a daily basis for patients who have not been taking steroids long, to monthly in those who have been on them a while.
It is not uncommon, when patients first decrease the dose to feel some achiness or fatigue. These symptoms often resolve over 2- 7 days. If they do not, one may elect to temporarily increase the dose and taper more slowly. Some patients 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, try 4 mg one day and 2 mg the next and so on until you are on only 4 mg every other day. (e.g. 4 mg one day and 0 the next day) Then, try to go down on that alternate day.
- 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
Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.