Tapering schedule for Glucocorticoids
There are many methods to taper GCs after the disease manifestations are brought under control. In some diseases, GCs can be tapered rapidly. In other chronic inflammatory diseases such as systemic lupus erythematosus (SLE), inflammatory myositis, and systemic vasculitis, the taper must be slower. The following is one possible taper schedule:
- • Prednisone 30 mg twice daily until disease is controlled.
- • 25 mg twice daily × 1 to 2 weeks, then taper to 40 mg daily (single daily dose).
- • Under 40 mg daily taper by 5 mg every week.
- • Under 30 mg daily taper by 5 mg every 1 to 2 weeks.
- • Under 20 mg daily taper by 2.5 mg every 1 to 2 weeks.
- • Under 10 mg daily taper by 1 mg every 2 to 4 weeks.
- • Under 5 mg daily taper by 1 mg daily every month (if at all).
Some patients may develop a steroid withdrawal syndrome (Slocumb’s syndrome) with rapid tapering including arthralgias and myalgias. These symptoms should be controllable with acetaminophen and resolve within 3 to 4 days after the dose has been lowered. If symptoms do not resolve, consider a disease flare may be causing the symptoms.