The Best Way to Taper Oral Prednisone (Steroid) Pills
Prednisone is a tricky drug. There are many sight threatening or life threatening disease that will not respond to anything other than prednisone or other drugs that can cause even worse side effects than prednisone.
I and most MDs I know will not prescribe it unless the disease is very dangerous and can cause permanent loss of vision or death.
The side effects can vary per patient but as you can read at the below site, many patients have had terrible side effects.
The best way to taper oral prednisone depends on the following factors:
1. Disease being treated
2. Time patient has been on the steroid
3. Other medical history/illnesses
4. Previous history of reaction to steroid taper
5. Genetics
Here are some examples of how to taper Prednisone. I give my patients my cell phone number when I give Prednisone so they can call me if they start to have a recurrence in their disease or terrible side effects, which indicates the steroid needs to be tapered more slowly. There sometimes is no way to know how fast or slow a patient’s body can taper until the taper starts.
1. There are no randomized, prospective studies saying which taper schedule is the best. This is because there are so many factors that make each patient potentially different in their withdrawl response.
2. General rules of thumb: If patient has been on Prednisone for more than 7-10 days, a taper is needed. Some MDs feel that “If you were on Prednisone for a very short term (i.e. 7 days or less), it is alright to quit cold turkey.” I don’t agree with this and think some sort of taper is safer for patients: but it is patient dependent.
3. See below charts for sample tapers:
a. Option for taper: 10 mg prednisone capsules:
-take 6 capsules each morning with food for 7 days,
-then to take 5 capsules for 2 days,
-4 for 2 days,
-then 3 for 1 day,
-2 for 1 day,
-1 for 1 day then stop. (Reference: Otology & Neurotology
a. Option for taper: 10 mg prednisone capsules:
-take 6 capsules each morning with food for 7 days,
-then to take 5 capsules for 2 days,
-4 for 2 days,
-then 3 for 1 day,
-2 for 1 day,
-1 for 1 day then stop. (Reference: Otology & Neurotology
Issue: Volume 29(4), June 2008, pp 453-460
Copyright: © 2008 Otology & Neurotology, Inc.)
b. Option for taper: 20 mg prednisone capsules: a little faster for patients who have only been on steroid for a few days. But have patient call if any side effects or recurrence of disease.
-take 3 capsules for 7 days
-then 2 capsules for 4 days
-then 1 capsule for 4 days
-then stop
c.
. 
http://www.prescriptionmedications.in/2014/10/09/prednisone-taper.html
d.
http://lup.sagepub.com.ezproxy.welch.jhmi.edu/content/22/7/697.long
As you can see from below chart most MDs and patients would agree that Prednisone has less potential side effects compared with below drugs which are often need for sight and life threatening diseases.
4a. Good review below regarding Prednisone’s side effects.
Just do not agree with: “If you were on Prednisone for a very short term (i.e. 7 days or less), it is alright to quit cold turkey.”
It depends on the patient and factors above about how quickly to stop.
http://mentalhealthdaily.com/2014/06/10/prednisone-withdrawal-symptoms-how-long-do-they-last/
Mental Health Blog
Prednisone Withdrawal Symptoms: How Long Do They Last?
Prednisone is a synthetic corticosteroid drug that is used to treat a variety of conditions including: asthma, adrenal insufficiency, Cron’s disease , inflammatory diseases, some types of cancer, hives, nephrotic syndrome, lupus,Meniere’s disease , and hives. It is also used to help with organ transplants by preventing bodily rejection to the new organ. This is a drug that is also used to help with severe migraine headaches, leukemia, lymphoma, and various types of tumors. It works by replacing steroids that are naturally produced by the body.
Essentially this is a drug that mimics your body’s natural hormones produced from the adrenal glands. When prescribed in significant doses, Prednisone works to help suppress inflammation. In the event that a person’s immune system is attacking its own tissues (as is the case with autoimmune diseases), this drug can help reduce activity by suppressing immune system functioning. It affects the “HPA” or hypothalamus-pituitary-adrenal axis when taken longer than 7 days.
Although Prednisone can be a life saving drug when used to treat certain conditions, others that are on it for a less-significant condition may be extremely unhappy with the drug’s side effects. If you can no longer cope with the side effects as a result of Prednisone use, it may be time to withdraw. Once you have spoken with your doctor about withdrawal and have made up your mind, you will want to educate yourself on the potential symptoms that you may experience upon discontinuation.
Factors that influence Prednisone withdrawal include:
When it comes to any medication, there are factors that influence the severity of withdrawal. Various factors that will play a role in determining how difficult the withdrawal process is include: time span, dosage, individual physiology, and whether you quit cold turkey or tapered. If you experience a very severe withdrawal, it is likely due to one or more of these factors.
1. Time Span
How long have you taken Prednisone? In general the longer you are on this particular steroid, the longer it’s going to take your body to readjust to functioning without it. If you are on it for longer than 2 weeks, it can affect your adrenal glands’ ability to produce cortisol. Therefore your body and brain become dependent on the Prednisone for everyday functioning when taken for an extended period. If you are only on this drug for a couple weeks, you should have a much easier time coping with the withdrawal compared to someone on it for months and/or years.
2. Dosage (2 mg to 80 mg)
Since this drug is used to treat a variety of conditions, the dose that you are taking will depend on the condition that you are treating. The maximum recommended dose per day is 80 mg. Most people are taking somewhere between 2 mg and 30 mg per day. In any event, the greater the dosage you take for an extended period of time, the more severe your withdrawal symptoms will likely be. Someone that is on a very low maintenance dose of Prednisone should have a much easier (and quicker) time withdrawing compared to someone who is on the maximum recommended daily dose.
3. Individual Factors
Since this is a powerful corticosteroid, it likely will result in withdrawal symptoms in nearly everyone that took it for an extended period of time. However, the severity of those symptoms can vary depending on the individual. People that were on very high doses for a long term may have a very severe physiological response upon discontinuation, while others may have less of a reaction.
Just know that what you experience may be more or less severe than someone else – as everyone’s situation is different. One person may recover from their withdrawal within a few weeks, while another may experience aches and pains for months following their last dose of Prednisone. The recovery time varies among different individuals.
4. Cold Turkey vs. Tapering
It is never recommended to quit taking Prednisone “cold turkey.” It is thought that if you quit taking this drug cold turkey from a relatively high dose, it could result in potentially dangerous withdrawal symptoms. If you were on Prednisone for an extended period of time, your body likely has become fully dependent on this drug for functioning and providing cortisol.
Since your body has stopped naturally producing cortisol, stopping Prednisone cold turkey can be a recipe for disaster. Why? Because your adrenal glands may not be able to kick back in and produce cortisol. Therefore it is important to gradually “wean” off of this drug to give your adrenal glands some time to pick back up with natural production.
In order to prevent doing damage and or experiencing a nasty cold turkey withdrawal, some have recommended reducing the dosage of your medication by 5 mg every 7 days. If you are unsure about how to taper, be sure to talk with your doctor and voice any concerns you have. If you were on Prednisone for a very short term (i.e. 7 days or less), it is alright to quit cold turkey.
Prednisone Withdrawal Symptoms: List of Possibilities
Below are some common withdrawal symptoms associated with taking Prednisone. Recognize that these are some symptoms that you may experience upon discontinuation from this particular drug. Also understand that you may not experience every symptom listed below and that the intensity of withdrawal will likely differ based on individual circumstances.
- Abdominal pain: Many people notice intense abdominal pain when they first stop taking Prednisone. This may be in the form of intense stomach aches and/or burning sensations throughout the stomach.
- Anxiety: Many people report depression, but a lesser reported symptom is that of anxiety. You may feel somewhat nervous and/or have relatively intense anxiety during withdrawal. It is thought that this is a result of hormonal changes and HPA functioning.
- Body aches: Many people report severe body aches when they stop taking this drug. These aches may last for weeks following your last dose of the drug. If they become too intense, you should consider tapering more gradually.
- Decreased appetite: Since Prednisone is associated with significant increases in appetite, when you stop taking it, you will likely notice a major decrease in appetite. You may have constantly felt hungry while on it, but when you quit taking it, your appetite will significantly drop off.
- Depression: Another common symptom to experience upon discontinuation is that of depression. You may feel very depressed in conjunction with significantly low levels of energy. This is in part due to lack of stimulation. Your adrenal stores need to build themselves back up for you to feel normal. Just know that your brain and body will eventually fully heal as time passes.
- Diarrhea: Some people report diarrhea when they first come off of this drug. If you are experiencing this, be sure to pick up some Imodium (available over the counter) – it should help ease this particular symptom.
- Dizziness: This is a common withdrawal symptom from any drug. If you feel dizzy, just know that it should go away within a few weeks. The most intense dizziness should subside after the drug has been out of your system for a week.
- Fatigue: Most people end up having to deal with extreme levels of fatigue and low energy when they quit this drug. If you feel fatigued, just know that it is a result of your body withdrawing from a drug that it has depended on for functioning for a long period of time. Additionally you no longer have adequate amounts of cortisol to provide the body with energy. It will take some time before these homeostatic levels are reestablished.
- Fever: Some individuals report having a fever when they stop this drug. This is your body’s way of trying to readapt to functioning without Prednisone. The fever should not last more than a week or so after your last dose. If it persists, be sure to consult your doctor and/or another medical professional and consider a more gradual taper.
- Headaches: Since this drug actually helps many people with severe headaches, coming off of it may result in even more extreme headaches than initially experienced. Some individuals report constant headaches, while others report full-blown migraines during withdrawal.
- HPA Changes: Anyone who has taken this drug for an extended period of time will exhibit changes in their HPA (hypothalamus-pituitary-adrenal axis). In other words, the adrenals are no longer producing sufficient levels of cortisol because they have become accustomed to receiving the Prednisone. Therefore even if you gradually taper, it will take your body awhile to get its natural production of cortisol back up.
- Joint pain: It is extremely common to feel pretty intense joint pain when you stop this steroid. This joint pain is caused by lack of natural cortisol production. In some cases it could be due to inflammation during withdrawal. Avoid excess physical stress and activity until the pain subsides.
- Low blood pressure: Some individuals experience blood pressure drops when they discontinue this drug. Although it increases blood pressure while taking it, many people experience rapid reductions if they discontinue too quickly. In some cases if blood pressure gets too low, it can lead to dizziness and fainting. Be sure to monitor your blood pressure when you quit this drug.
- Low blood sugar: Many people experience low blood sugar when they come off of a corticosteroid like Prednisone. You may want to monitor your blood sugars when you discontinue and keep some sweets around in the event that it dips out of the ordinary.
- Mood swings: People feel fatigued, low energy, and have depression as a result of their withdrawal. It is no wonder that some individuals experience mood swings and/or changes when they quit taking this drug. Just know that these should stabilize when the body heals.
- Muscle soreness: Some people notice muscle soreness and/or pain that does not go away for an extended period of time. The best thing you can do for yourself is to take some sort of over-the-counter pain relief to help yourself cope with this symptom.
- Nausea: You may feel extremely nauseated when you originally stop taking this drug. The intense nausea should only last for a few days and then gradually improve. Assuming your doctor conducted a gradual taper off of Prednisone, the nausea should not be long-lasting.
- Shaking: Many people have reported uncomfortable “shaking” in the limbs including the hands and feet. This is not as common of a symptom, but one that has been reported that can make life uncomfortable for awhile.
- Skin rash: In some cases a person may develop a skin rash when they first quit taking Prednisone. Some hypothesize that burning and/or itching skin could be a result of nerve irritation beneath the skin. If you are experiencing a skin rash or irritation, just know that it’s likely from the withdrawal.
- Suicidal thoughts: When you first quit taking this drug, you may notice that your depression becomes overwhelming to the point of triggering suicidal thoughts. If you feel suicidal at all during withdrawal, make sure you talk to a professional about it. Just know that as your adrenal stores build back up, your depression will gradually subside and your thinking will return to normal.
- Vomiting: Some people report vomiting when they stop Prednisone. This vomiting is usually a result of tapering too quickly and not giving your body a chance to gradually adapt to functioning without the drug. If you are vomiting, it could just be that you are hypersensitive to withdrawal and/or are withdrawing too quickly.
- Weakness: It is common to feel muscle weakness and an overall sense of malaise when you first come off of this drug. It should take your body a few weeks and/or months to fully recover from feeling very week and achy. This is just your body’s way of reacting to functioning without a drug that it has received constantly over an extended term.
- Weight loss: Individuals that are on Prednisone for the long term tend to pack on a pretty good amount of weight. Obviously the amount of weight you gain will be based on your individual circumstances. Most people notice that they begin to lose weight a few weeks after they have fully discontinued this drug.
How long do Prednisone withdrawal symptoms last?
The time it takes you to fully withdraw from Prednisone will depend on individual circumstances. In most cases, the withdrawal symptoms should clear up within 3 to 4 weeks after your last dose. The half life of Prednisone is only 1 hour, but most people report post-acute withdrawal symptoms lasting well after the drug is cleared from the body. A full recovery can take anywhere from a week or two (lower doses) to several months.
If you are experiencing pretty extreme pain as a result of the withdrawal, be sure to take some over-the-counter pain relief. In addition to OTC pain relief, most people recommend increasing the amount of salt and sugar that you eat. This is because when you stop taking Prednisone, your body usually has low blood sugar and low blood pressure. If your withdrawal symptoms persist for an extended period of time and/or are so severe that you cannot function, it is likely that you withdrew too quickly.
Anytime a person is on 5+ mg of Prednisone for 7 to 14 days, sudden discontinuation can result in an adrenal crisis. Work closely with your doctor, follow guidelines, get plenty of rest, and lay low as your body and mind recover. Eventually you will return to normal functioning once your body and brain readjust to functioning without steroids. It should be noted that some people report “Secondary Adrenal Insufficiency” as a result of taking corticosteroids like Prednisone.
In this event, it has taken people 12 to 24 months before they experience full “recovery” back to homeostasis. As was mentioned, the longer you are on the drug, the more gradual the tapering process should be and the longer you should expect withdrawal symptoms to persist following your last dose. As long as you work with your doctor and withdraw VERY gradually, you should be able to experience a full recovery. If you have experienced withdrawal from Prednisone or are currently going through withdrawal, feel free to share your experience in the comments section below.
I was on prednisone for 1 year as a result from a severe allergic reaction to an antibiotic which gave me PMR. I am going through the process now of eliminating this drug from my body. I can relate to what everyone is going through.
I try and do a little exercise every day like walking stretching nothing too strenuous and nap when I feel tired.
For about a week now, she started facing serious joint pains and has been bedridden the whole day today. My mom is a very strong woman, and it breaks my heart to see her like this.
Predictors of corticosteroid tapering in SLE patients: the Hopkins Lupus Cohort.
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Topical tacrolimus 0.1% improves symptoms of hand dermatitis in patients treated with a prednisone taper.
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Oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis.
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