How to Reduce Prednisone Withdrawal Symptoms

Determining the Appropriate Tapering Strategy

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Prednisone is a synthetic (artificial) steroid that reduces inflammation. It is used to treat inflammatory types of arthritis, asthma, severe allergies, and other conditions. Like other corticosteroids, prednisone works by lowering the activity of the immune system.

Prednisone must be taken according to your healthcare provider's directions. If you are prescribed prednisone for more than a few weeks, you will need to taper off the medication. This means you reduce the dosage slowly until you can stop the medication completely. Stopping prednisone all at once can lead to side effects and withdrawal symptoms.

This article explains how prednisone works and why it is important to follow your healthcare provider's instructions for tapering off prednisone.

Prednisone Withdrawal Symptoms
Verywell / Emily Roberts

Why Tapering Is Necessary

Prednisone is similar to cortisol, a hormone made by the adrenal glands. Cortisol is a steroid involved in regulating many of the body's systems, including metabolism and immunity. It plays a key role in our body's response to stress.

Prednisone works by mimicking the effects of cortisol. However, when prednisone is taken for more than a few weeks, the adrenal glands make less natural cortisol. As a result, stopping prednisone quickly can cause a number of problems.

To avoid withdrawal after long-term use, prednisone should be reduced gradually according to a schedule set by your healthcare provider. Don't try to stop or taper prednisone without your healthcare provider's knowledge or advice.

Withdrawal Symptoms

Symptoms of prednisone withdrawal can range from mild to severe. Typical prednisone withdrawal symptoms include:

How Prednisone Is Tapered

The risk of prednisone withdrawal is so high that some healthcare providers will pre-plan a tapering schedule if high doses are used for more than three days.

In most cases, however, tapering is only needed if you take prednisone by mouth for more than three weeks.

There are no set rules for tapering off of prednisone. The schedule will differ based on the dose you were taking and how long you used the medication. The decision depends largely on the healthcare provider's clinical experience.

Example of Prednisone Tapering Strategy

  • Decrease dose by 5-milligrams (mg) at a time if the dosage is less than 40 mg per day.
  • Decrease in 2.5-mg increments once a 20-mg dose is reached.
  • Decrease in 1-mg increments once a 10-mg dose is reached.

People who haven't been taking steroids for very long may have their dose decreased by a little each day. People who have been taking prednisone for a very long time may need a much slower taper. In some cases, the dose may be decreased monthly.

What to Expect

When people first decrease the dose, it's common to feel achy or fatigued. These symptoms often get better over two to seven days. If withdrawal symptoms continue to bother you beyond a week, talk to your healthcare provider.

In some cases, your healthcare provider may temporarily increase the dose and taper more slowly. Some people may still have difficulty tapering off steroids despite reducing the dose by only 1 mg at a time.

Another technique is known as an alternate-day taper. For example, instead of simply lowering the dose from 4 mg to 3 mg of prednisone, a healthcare provider may prescribe taking 4 mg one day and 3 mg the next day, then alternating back and forth for one week.

Then, if that's successful, the healthcare provider may prescribe 4 mg one day and 2 mg the next, and so on until the patient is taking only 4 mg every other day (for example, 4 mg one day and zero the next day). The healthcare provider then continues to try to decrease that 4-mg dose.

Tapering may not always prevent withdrawal symptoms. There are no tests to accurately predict who will experience withdrawal and to what degree. If your withdrawal symptoms are severe or last longer than seven days, call your healthcare provider, who can adjust the dose and slow the taper. 

People on long-term prednisone therapy have the greatest risk for withdrawal. However, it can also occur in people who are only taking the steroid for a short period of time. In some cases, the tapering process may take weeks or several months.

Alternatives to Prednisone

Some healthcare providers will opt for a different corticosteroid than prednisone. These medications can have the same benefits with fewer side effects.

A 5 mg dose of prednisone is equal to the following doses of other corticosteroids (based on a corticosteroid conversion calculator):

  • Celestone (betamethasone): 0.6 mg
  • Cortef (hydrocortisone): 20 mg
  • Cortone (cortisone): 25 mg
  • Decadron (dexamethasone): 0.75 mg
  • Kenacort (triamcinolone): 4 mg
  • Medrol (methylprednisolone): 4 mg
  • Omnipred (prednisolone): 5 mg

Summary

Prednisone is a corticosteroid used to treat inflammation. It mimics the stress hormone cortisol. When taken for extended periods, prednisone interferes with the body's natural production of cortisol. 

As a result, it is not recommended to stop prednisone abruptly. Doing so can cause body aches, fatigue, fever, and other uncomfortable withdrawal symptoms. 

To minimize or prevent these withdrawal symptoms, your healthcare provider will instruct you how to taper off the steroid slowly. Be sure to follow your healthcare provider’s directions. You may still experience uncomfortable symptoms for a few days when you taper.

A Word From Verywell

The amount of time it takes to taper off prednisone depends on many factors. These include the condition you're being treated for, the dose, and the duration of use. Eventually, your adrenal glands should return to their normal cortisol production levels, but this can take time.

There are many options available for discontinuing prednisone use. When low doses of corticosteroids are used for long periods, tapering can continue for months or years. Work closely with your healthcare provider to find the right taper for you.

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Margolin L, Cope DK, Bakst-Sisser R, Greenspan J. The steroid withdrawal syndrome: a review of the implications, etiology, and treatments. J Pain Symptom Manage. 2007;33(2):224-8. doi:10.1016/j.jpainsymman.2006.08.013

Additional Reading
  • Silverman HM. The Pill Book. New York: Bantam Books; 2012.