My Experience with Tapering Prednisone
A few years ago I went to the emergency room for an asthma attack. The ER physician gave me a shot of the steroid Solu-Medrol. Then he prescribed for me to take 40 mg of the steroid prednisone daily for 7 days. He did not prescribe a taper. So, this got me thinking: Do you still need to taper off steroids?
Why do we taper off steroids?
In the 1950s corticosteroids were a new and exciting medicine. They were tested on pretty much any disease caused by inflammation, such as arthritis and asthma. On some patients, high doses were given with good results. People with arthritis felt no pain. People with asthma breathed easily.1,2
Some people did not wean off these steroids. And, in some instances, this resulted in severe side effects. As noted by the Mayo Clinic, if you do not wean off steroids you may experience withdrawal symptoms. These include feelings of weakness, body aches, joint pain, nausea, loss of appetite, and lightheadedness.3
The Mayo Clinic notes that corticosteroids mimic cortisol. Cortisol is a hormone secreted by your adrenal gland. After you take prednisone for a week or 2, your adrenal gland will naturally stop making the hormone cortisol.3
Your adrenal glands need time to build up your cortisone supply. So, say you are taking 40 mg of prednisone. Then, 1 day you just stop taking them. The idea here is your body will go through a withdrawal period, thereby making you feel ill.3
Do you still need to taper?
I typically try my hardest to follow any tapering plan that my doctors order. Still, there have been times I have slacked at tapering and just stopped before the tapering was complete. There were a couple of times I did this and worried that I’d feel withdrawal symptoms. But this never happened.
And I never really gave it further thought until my ER doctor ordered 40 mg for 7 days with no taper. When I stopped I did not experience withdrawal.
Since that experience, I was prescribed prednisone 3 or 4 more times. Each of these times the doctor ordered a taper, and each time I asked the doctor if he or she was aware of studies showing you do not need to taper. Each of them gave a response such as, “John, you must taper off steroids.”
So, this inspired me to do some research. Was my emergency room doctor ahead of his time and privy to better wisdom? The answer, according to various studies, appears to be “yes.” In fact, a study published way back in 2002 showed no benefit to tapering with the doses used to treat asthma exacerbations.4
Interestingly, the dose used in the study was 40 mg of prednisone. The experimental group took 40 mg of prednisone for 8 days and then just stopped. The control group started at 40 mg but then gradually tapered for 8 days. The end result was that both groups experienced the same benefit. And neither group experienced withdrawal symptoms, thereby showing there is no need to taper your steroids at low doses.4
The doses used to treat asthma are generally low. As noted, 40 mg is a relatively low dose of prednisone. So, according to the results of this study, this dose is not enough to stop your adrenal gland from making cortisol. This prevents withdrawal when you suddenly stop taking the prednisone.4
What do the experts think?
Interestingly, a 2021 study found that most asthma experts believed even low doses of steroids used for asthma suppress the adrenal gland and you should always taper off steroids. The vote among these doctors, if you want to call it that, was that greater than 70 percent of asthma experts believe tapering is necessary. This means that the minority is less than 30 percent.5
In my humble opinion, a consensus is not science. Science is not up to a vote. You could have 99 percent of experts say the world is flat, but that does not make it so. This is because science either is or is not. And, in the case of the world being flat, it is not.
Here you have more than 70 percent of asthma experts saying adrenal suppression occurs on 40 mg of steroids. That does not make it so. And, of course, that does not make it not so, either. This is why science is so often debated. Of course, this also shows that further studies are needed.
What do you think about tapering prednisone?
My ER doctor falls in the minority. Since I agree with him, that puts me in the minority as well. Personally, I think he is on to something: I think you do not need to taper off the low doses of steroids used to treat asthma. But, that is just me.
Obviously, you should always follow your doctor's directions when taking a prescription. As I have experienced, most doctors believe a taper is necessary. After all, it is best to stay on the safe side. As the old saying goes, do as your doctor prescribes.
Still, as you can see, this topic means more studies are needed. And, perhaps, someday the consensus will change. What do you think? Let us know in the comments below.
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