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Example of a gradual daily prednisone dose reduction after chronic treatment in an adult or adolescent who has completed linear growth*

Example of a gradual daily prednisone dose reduction after chronic treatment in an adult or adolescent who has completed linear growth*
Week Prednisone dose (oral)
Week 1 60 mg/day
Week 2 50 mg/day
Week 3 40 mg/day
Week 4 35 mg/day
Week 5 30 mg/day
Week 6 25 mg/day
Week 7 20 mg/day
Weeks 8 and 9 17.5 mg/day
Weeks 10 and 11 15 mg/day
Weeks 12 and 13 12.5 mg/day
Weeks 14 and 15 10 mg/day
Weeks 16 and 17 9 mg/day
Weeks 18 and 19 8 mg/day
Weeks 20 and 21 7 mg/day
Weeks 22 and 23 6 mg/day
Weeks 24 and 25 5 mg/day
Weeks 26 and 27 4.5 mg/day
Weeks 28 and 29 4 mg/day
Weeks 30 and 31 3.5 mg/day
Weeks 32 and 33 3 mg/day
Weeks 34 and 35 2.5 mg/day
Weeks 36 and 37 2 mg/day
Weeks 38 and 39 1.5 mg/day
Weeks 40 and 41 1 mg/day
Week 42 Stop
Begin the taper at the patient's current prednisone dose. Daily prednisone is typically administered as a single morning dose. During and after the taper, patients should be considered at high risk of adrenal insufficiency and instructed on the use of stress dose glucocorticoids. For more information, refer to UpToDate content on discontinuing systemic glucocorticoid therapy and treatment of adrenal insufficiency.

* Many factors influence the pace of systemic glucocorticoid withdrawal, including control of the underlying disease, adverse effects of glucocorticoids, patient age, clinical status, and response to prior glucocorticoid tapers. Tapers should be adjusted when there is concern for adrenal insufficiency (based on clinical symptoms and/or laboratory testing). For more information, refer to UpToDate content on glucocorticoid withdrawal and the disease specific treatment topic.

¶ Some experts use laboratory cortisol testing to help guide the taper after reaching a physiologic glucocorticoid dose (approximately 5 to 7.5 mg of prednisone). Testing involves omitting the glucocorticoid dose on the morning of the test and measuring an endogenous cortisol level at approximately 7 to 9 AM. For more information, refer to UpToDate content on the diagnosis of adrenal insufficiency.

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