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 synthetic steroid with potent anti-inflammatory effects that's used to treat inflammatory types of arthritis and other conditions. 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.

Gradual Discontinuation of Steroids

To avoid prednisone withdrawal when the drug is to be discontinued, it should be stopped on a gradual basis, called tapering, according to a specific schedule prescribed by your doctor. An exception is if prednisone has been given over a very short duration of time; this period will vary, depending on your doctor. Don't try to stop or taper prednisone without your doctor's input.

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. If you take prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal function.

Tapering Reduces Prednisone Withdrawal Symptoms

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

•Joint pain

•Muscle pain

•Fatigue

•Headache

•Fever

•Low blood pressure

•Nausea

•Vomiting

Other corticosteroids 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 advises his patients to wear medical alert bracelets in case an accident or severe medical emergency prevents them from sharing their medical histories, including drug allergies and existing ailments, with health providers.

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 tapers his patients:

  • By 5-milligram increments when they're 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

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.

When people first decrease the dose, it's not uncommon to feel achy or fatigued. 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 (aka 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.

Equivalent Doses

Using equivalent doses of 5 milligrams of prednisone as the basis for comparison, a corticosteroid conversion calculator computed these equivalent doses of the other corticosteroids:

  • 0.6 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

A Word From Verywell

The amount of time it can take you to taper off prednisone depends on a host of factors, including the condition you're being treated for and the dose and duration of use. Eventually your adrenal glands should take over and return to their normal pattern of producing cortisol, but this can take time. In cases where corticosteroids were taken in low doses for long periods of time, tapering can continue for months or years. Keep in mind that there are many options available for discontinuing use of these drugs, so be sure to contact your doctor if you experience withdrawal symptoms, especially if they're beyond what's expected.

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.