Prednisone – Standard Dosage Amount/Schedule?

Question:

My pulmonologist has told me that new guidelines do not call for such a taper when prednisone is given in bursts of 7-10 days, since adrenal suppression is not as significant as once thought. Perhaps some of the doctors with whom you’ve talked aren’t familiar with this, or just don’t subscribe to the notion?

My pulmonologist put me on 40mg of prednisone for six days, one a day and quit.No tapering.

Response:

I still have yet to find out why one might prescribe a descending dosage over a short period and that remains my question. From what I can find to read, it seems that tapering is important when the dosage is long-term and that tapering is inconsequential when the dosage is short term – but doctors seem to prescribe a tapering dosage over a short term just because “it couldn’t hurt” or for some other reason I cannot yet fathom. If you or anyone can answer that question, I could rest more easily. Thanks for your time.

My pulmonologist has told me that new guidelines do not call for such a taper when prednisone is given in bursts of 7-10 days, since adrenal suppression is not as significant as once thought. Perhaps some of the doctors with whom you’ve talked aren’t familiar with this, or just don’t subscribe to the notion.

Response:

IMHO, it’s based on the doctor, more than an exact science. I have had the following used on me (for asthma/bronchitis that “won’t-go-away”):

• 60 mg x 5 days, then stop, no taper
• 60 x5, 40 x 5, 20 x 5, 10 x 5, taper (most have been a form like this, with either 60 or 40 as starting)
• 120 x 3, 60 x 5, etc. (doctor went with 1 mg/kilo and I weigh 300 lbs–only had this once, and, doubt he was right)

I’ve been all over MicroMedex and other references, and, have found support for a short dose, no taper (60×5), and, of course, the taper. Don’t know if there is an EASY test to see how much you’re affected by the dosage and type of taper (or not). It’d be some kind of adrenal sensitivity (something like that) one?

I get, every year or two, some sort of ear infection and/or fluid in my ears. No antibiotic every makes it go away, only waiting it out, cooperative weather (dry and warm), or prednisone makes it go away. I’ve been fortunate not to need prednisone for the last two or three years but am considering it for the problem that started a few days ago. The last time I took this medication for this condition, doctors seemed to be switching away from a steady xxx mg/day and moving towards some sort of descending treatment, e.g., you take 6 5mg pills throughout the day on day #1, 5 pills on day 2, and so on until you take a single pill on day #6.

What’s the wisdom on this these days? I never had any trouble getting off prednisone when I took a steady dosage, and I received no additional benefit or lack thereof I’m aware of from the one time I took the descending course – sometimes I required a second course of the medicine, including the one time we tried the descending dosage. I’m asking all this both for my own info and, to be honest, because I’m considering self-medicating this go-round – I’ve got the leftover pills from a previous time, a full prescription’s worth that was 60 5mg pills, and don’t see much point in visiting the doctor now.

Response:

I was hoping you would tell us how many days each treatment course involved but, oh well.

Response:

This is important with all meds. Also you need to ween down on pred and very slowlyto boot.

This is certainly not always true, and is the reason I asked the relatively simple question I did regarding duration of each course of prednisone.

Response:

Part of what I’m trying to ascertain here is how much guessing is involved in dosing prednisone for a condition like mine. I get the feeling it’s just a shot in the dark in terms of both quantity and duration. I decided to do some homework and found, amongst others, this at http://www.rxlist.com/cgi/generic/pred_ids.htm

DOSAGE AND ADMINISTRATION: The initial dosage of prednisone tablets may vary from 5 mg to 60 mg of prednisone per day depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice while in selected patients higher initial doses may be required. The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, prednisone should be discontinued and the patient transferred to other appropriate therapy.

IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT.

After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. It should be kept in mind that constant monitoring is needed in regard to drug dosage. Included in the situations which may make dosage adjustments necessary are changes in clinical status secondary to remissions or exacerbations in the disease process, the patient’s individual drug responsiveness, and the effect of patient exposure to stressful > situations not directly related to the disease entity under treatment; in this latter situation it may be necessary to increase the dosage of prednisone for a period of time consistent with the patient’s condition. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly.

This isn’t how I’ve been treated – the above appears to suggest treating with prednisone until a satisfactory result has been achieved, but I was given a specific dosage and duration each time and told to take it completely. Each time that first course was finished, I was asked to wait a few days before trying a second course. I did not receive “constant monitoring”. This is an interesting (to me, anyway) web page I found by doing a google.com search on prednisone. Any other references anyone else has found would be greatly appreciated.

Response:

Another interesting bit of web-found wisdom, from http://www.druginfonet.com/faq/faqpredn.htm

Doctors’ Answers to “Frequently Asked Questions” – Prednisone These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician. Abrupt Stop of Prednisone

Question: I have been prescribed prednisone (60 mg a day for 12 days and then to stop with out tapering), but every thing I read says abrupt stopping of prednisone can have serious side effects, including death. I would like to know if the 12 days at 60 mg is short term > enough so as not to be concerned about all the emphatic warnings about abrupt stopping the prednisone.

Answer: Anything less than 3 months or so can tolerate abrupt stoppage > without problems. Over three months would depend on your age and the > steroid dosage, but most would have some sort of taper at that point.

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