Key Takeaways
- Prednisone should be reduced gradually to avoid severe withdrawal symptoms.
- Your healthcare provider will help create a tapering schedule based on your needs.
- Symptoms like achiness or fatigue are common during the tapering process.
A prednisone taper gradually reduces your corticosteroid dose over days, weeks, or months to prevent prednisone withdrawal. Stopping prednisone abruptly can lead to adrenal insufficiency, which causes severe fatigue, body aches, and nausea.
Your healthcare provider will likely recommend a prednisone taper if you have taken it for more than two weeks.
Verywell / Emily Roberts
Why Prednisone Tapering Is Necessary
Prednisone is a synthetic steroid used to treat inflammation. It mimics cortisol, a hormone produced by the adrenal glands, which plays a crucial role in the body’s stress response.
Like cortisol, prednisone helps temper the immune system’s response to stress, reducing inflammation quickly and significantly.
Cortisol also regulates important functions like blood sugar levels, metabolism, and fat breakdown.
While prednisone effectively mimics cortisol’s effects, long-term use can cause the adrenal glands to produce less natural cortisol. When stopping prednisone, the adrenal glands need time to increase cortisol production, which can take longer than expected.
Without this adjustment period, the body may experience a significant cortisol deficit, leading to prednisone withdrawal symptoms.
How to Avoid Prednisone Withdrawal
To prevent withdrawal after prolonged use, prednisone should be gradually reduced according to a schedule created by your healthcare provider. Do not stop or taper prednisone without consulting your healthcare provider.
How to Safely Taper Prednisone
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 prednisone. The schedule will differ based on your dose and how long you used the medication. The decision depends largely on the healthcare provider’s clinical experience.
People who haven’t been taking prednisone 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.
Click Play to Learn How to Taper Off Prednisone
What to Expect
When people first decrease the prednisone dose, it is common to feel achy or fatigued. These symptoms usually get better within two to seven days. If withdrawal symptoms continue beyond a week, talk to your healthcare provider.
Sometimes, your healthcare provider may temporarily increase the dose and taper more slowly. Even so, some people may still experience symptoms.
One way to deal with this is with a technique called alternate-day tapering. For example, instead of lowering the dose from 4 mg to 3 mg, for instance, a healthcare provider may prescribe 4 mg one day and 3 mg the next day, alternating back and forth for one week.
If that’s successful, you may be prescribed 4 mg one day and 2 mg the next, and so on, until you are eventually alternating between 4 mg one day and no dose the next. The healthcare provider would then gradually taper the 4-mg dose.
Prednisone Withdrawal Symptoms
Symptoms of prednisone withdrawal can range from mild to severe. Common symptoms include:
- Extreme fatigue
- Fever
- Headaches
- Joint pain
- Dizziness
- Muscle ache
- Difficulty breathing
- Nausea or vomiting
- Irritability
- Mood swings
- Loss of appetite
People on long-term prednisone therapy have the greatest risk for withdrawal symptoms. However, it can occasionally affect people who have taken the drug for a short time.
Alternatives to Prednisone
Some healthcare providers will opt for a different corticosteroid than prednisone. These medications can have the same benefits but with fewer side effects.
By way of example, a 5-mg dose of prednisone is equal to the following doses of these other corticosteroid drugs:
- Betamethasone: 0.6 mg
- Hydrocortisone: 20 mg
- Cortisone: 25 mg
- Dexamethasone: 0.75 mg
- Triamcinolone: 4 mg
- Methylprednisolone: 4 mg
- Prednisolone: 5 mg
Even so, not all corticosteroids are appropriate for all medical conditions. At the same time, all medications have side effects, which can make some less appropriate for you as an individual.
If you are concerned about prednisone, tell your healthcare provider and ask if there are any reasonable alternatives.
When to Call Your Healthcare Provider
Tapering may not always prevent withdrawal symptoms. There is no way to predict who will experience withdrawal and to what degree.
Reach out to your healthcare provider if:
- Your symptoms are severe or last longer than seven days.
- You have any questions or concerns about your prednisone dose tapering schedule.
Seek emergency medical treatment if you experience symptoms of adrenal crisis, which may include:
- Abdominal pain or flank pain
- Low blood pressure
- Severe weakness
- Headache
- Low blood sugar
- Dehydration
- Dizziness
- Confusion
- Loss of consciousness
Adrenal crisis is a life-threatening condition that can happen when there is not enough cortisol in the body.
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