Tapering to Reduce Prednisone Withdrawal Symptoms

Don't stop or taper prednisone without your doctor's advice

Tapering Prednisone
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Prednisone is a potent anti-inflammatory medication used to treat inflammatory types of arthritis and other conditions. Misuse, long-term 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.

Gradual Discontinuation of Steroids

Discontinuation of steroid medications should be done on a gradual basis, called a taper. An exception is if they have been given over a very short period of time. This period of time will vary and will depend on your doctor. A tapering schedule will allow time for your body to adjust as it decreases its own production of cortisol while you are taking prednisone.

Tapering Reduces Prednisone Withdrawal Symptoms

According to rheumatologist Scott J. Zashin, "I typically taper if a patient has taken the medication for more than three 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."

Steroids include:

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

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."

Example Tapering Schedule to Reduce Prednisone Withdrawal

The tapering schedule will differ depending on how long a person has been taking steroids. The longer the period on steroids, the slower the taper. Dr. Zashin often tapers his patients:

  • By 5-milligram increments when they are taking less than 40 milligrams of prednisone
  • By only 2.5-milligram increments when they reach 20 milligrams of prednisone
  • By 1-milligram increments once they reach 10 milligrams

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. The dose is decreased monthly if the patient has been on the medication for a long period.

When people first decrease the dose, it is not uncommon to feel some achiness or fatigue. These symptoms often resolve over two to seven 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 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 for one week (i.e., an alternate day taper). Then, if successful, the doctor may prescribe 4 milligrams one day and 2 milligrams the next and so on until on only 4 milligrams every other day (e.g., 4 milligrams one day and zero the next day). The doctor continues to try to decrease the dose on that alternate day.

Equivalent Doses

According to "The Pill Book," using 5 milligrams of prednisone as the basis for comparison, equivalent doses of the other corticosteroids are:

  • 0.6 milligrams to 0.75 milligrams of betamethasone
  • 25 milligrams of cortisone
  • 0.75 milligrams of dexamethasone
  • 20 milligrams of hydrocortisone
  • 4 milligrams of methylprednisolone
  • 5 milligrams of prednisolone
  • 4 milligrams of triamcinolone
View Article Sources
  • Chang-Miller A. Prednisone Withdrawal: Why Taper Down Slowly? Mayo Clinic. https://www.mayoclinic.org/prednisone-withdrawal/expert-answers/faq-20057923.
  • Silverman HM. The Pill Book. New York: Bantam Books; 2012.
  • Zashin SJ. Interview, January 2006.