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Example of an alternate-day prednisone dose reduction after chronic treatment in an adult or adolescent who has completed linear growth*

Example of an alternate-day 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 30 mg/day
Week 5 20 mg/day
Week 6 15 mg/day
Week 7 10 mg/day
Week 8 7.5 mg/day
Weeks 9 to 10 (2 weeks) 6 mg/day
Weeks 11 to 12 (2 weeks) 5 mg/day
Weeks 13 to 16 (4 weeks) 4 mg/day
Weeks 17 to 20 (4 weeks) 4 mg/day on even days and 3 mg/day on odd days
Weeks 21 to 24 (4 weeks) 3 mg/day
Weeks 25 to 28 (4 weeks) 3 mg/day on even days and 2 mg/day on odd days
Weeks 29 to 32 (4 weeks) 2 mg/day
Weeks 33 to 36 (4 weeks) 2 mg/day on even days and 1 mg/day on odd days
Weeks 37 to 40 (4 weeks) 1 mg/day
Weeks 41 to 44 (4 weeks) 1 mg/day on even days and none on odd days
Week 45 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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