Prednisolone withdrawal

Practically-speaking how do I reduce my prednisolone when my vasculitis is in remission?                                                                       Printable version of table pdf.

If your rheumatologist wants to stop your prednisolone, either because you are in remission, or because you have had a newer treatment for your vasculitis, you have a choice. You can either stay on a small replacement dose forever (just over 3mg) or you can deliberately cut the dose so that the adrenal glands slowly awaken but risk feeling a bit tired and under the weather for a while.  Almost all vasculitis patient’s adrenal glands will recover if the dose is cut by 0.5mg every month. This is hard work for patients because for most of that time, you have to run on less glucocorticoid that you need in order to wake up the adrenal. This is the reason that some of you might choose to stay on 3mg daily even if your vasculitis is in remission.

Cutting from 3mg to nothing can take 6 months, and some people can do this more quickly than others. It depends of course on how long you have had prednisolone, but many authors suggest cutting by half a milligram per month. 

Patients with no adrenal glands need approximately 3mg (varies from 2-5mg) prednisolone as there is no hope of the adrenal gland waking up. Details can be found here on http://www.imperialendo.com/prednisolone and http://dx.doi.org/10.1530/EC-17-0257.  

I really want to get my prednisolone dose below 3mg, how do I do this?

The other way to reduce prednisolone below 3mg is to take 3mg on some days and 2mg on others. If you take 2mg for one day and 3mg for 6 days, and then slowly increase the number of days that you take 2mg for. It will in fact take 7 weeks to go from 3mg to 2mg. This should slowly help your adrenal gland to recover. 

Week

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

0

3

3

3

3

3

3

3

1

3

3

3

2

3

3

3

2

3

2

3

3

2

3

3

3

3

2

3

2

3

2

3

4

2

3

2

3

2

3

2

5

2

3

2

2

3

2

2

6

2

2

2

3

2

2

2

7

2

2

2

2

2

2

2

Table 1: Suggested regimen to reduce prednisolone by 1mg over 7 weeks. Doses in mg.

If you look at old textbooks and websites, you will see that in the past, people thought that 7.5mg was the equivalent amount of prednisolone that you need in a day, but we now know that this is too much and is much closer to 3mg. Even doses of 3-7.5 mg therefore have the potential to cause side effects.

Any other tips?

One other tip that some people might benefit from is that the enteric coating in prednisolone make the absorption a bit erratic. When I took it myself (as part of some healthy volunteer research) I did not absorb any at all, but when I took the plain tablets, absorption was absolutely fine. Therefore I tend to avoid the enteric coating.