How to Slowly and Safely Taper Off Prednisone but ... no set rules.

Everyone is different, so you might have to "experiment" with the timing of your pred. My doctor recommended taking pred for PMR in the morning, but that didn't work so well as pain kept waking me up at 5 am or so and it took several hours for the pred to kick in. So then I split my dose in 2 and took half in the morning and half 12 hours later, before bed. I had no trouble sleeping . for me, the pred seems to work for about 12 hours then it tapers off. (for most PMR patients, stiffness is relieved in the afternoon as the day ends anyway.) Some take PRED as late as 2 am once a day and find it helps. Since it varies with individuals, doctors won't always know what schedule relieves your pain best.

The effects of prednisone taken in the morning at 8 a.m. will peak in the afternoon and then start to decline.

You are right about the pattern being the same regardless of the dose. A higher dose of prednisone doesn't stay in your system any longer. Medications typically don't work this way. Medications are cleared from the body depending on the half-life of the medication. The half-life of prednisone is two to three hours, which means it'll stay in your system for 11 to 16.5 hours when the dose is at therapeutic levels.

People often take more of a medication thinking it will work better. That becomes a problem when higher doses of a medication become toxic. That is a problem with Prednisone too ... the body can only use limited amounts prednisone before problems arise.

It is the same problem when the body produces too much or too little cortisol. The body regulates cortisol levels according to what is needed in real time. Too much and too little cortisol both cause health problems. That is why cortisol levels are closely regulated by the body.

My pattern was to take Prednisone in the middle of the night at approximately 3 a.m. so I wouldn't have pain in the morning. I needed to be able to work at 7 a.m.

At some point in time I split my Prednisone dose and took part of my dose in the evening usually between 7-8 pm. When I did that, I could go a full 24 hours with little or no pain. That way my prednisone dose was spread out for an entire 24 hours. I didn't need such a big dose in the morning and overall I needed less Prednisone.

Hello and thank you for your comments. I do see an endocrinologist but I can’t say I really trust her judgment so I am going to try to seek out a second opinion.

Yes that is familiar. Seems like it is okay to live with a small amount of discomfort and keep working on increasing and maintaining range of motion and exercise. No rush on the taper and ok to increase a bit if needed. You can always reduce back down but I do like to let my rheumatologist know what is going on. He keeps saying it is about how I feel and not so much about the inflammation numbers from blood tests. I am having a blood test this week as I anticipate reducing for 4 down to 3mg. I also take an occasional Tylenol and try to avoid inflammatory foods and alcohol and eat prunes and other beneficial stuff like calcium supplements and a bunch of vitamins B E D omega3 C . Just takes a bit of time but at this point I am starting to feel like my old self. Cheers.

This is exactly where I’m at.

Hey @megz
I am currently on 8 mg/day.
Starting April 1st I am going to 7 mg/day and will use your method. At what point do you or anyone else recommend I start with .5 mg reduction per month? I have been on prednisone now for close to two years, and this is my second bout, the first one being in 2014 and lasting 2 years. This time I got down to 2 mg/day as recently as December but then had major flairs that brought me back up to 10 mg/ day. Any suggestions on when to start the .5 mg reduction? Thank you!

I'm hardly one to be giving you advice if you got down to 2mg in December. I'm currently on 5mg and will start a graduated taper to 4.5mg in a few days. I've reduced by .5mg since 10mg, as the rule of thumb is to reduce prednisone by no more than 10% of the dose at a time.

The best teacher of what we should do is our own experience. The pace you've reduced successfully in the past will tell you how to do it this time. My own experience has told me to be extra careful approaching where a flare has occurred in the past and to be prepared to slow the reductions and make them more gradual at that point. Fortunately, this time I cruised past 6.5mg where the previous flare occurred, by using the graduated reduction. My doctor has told me not to hesitate to take an extra week on a particular reduction if I need to. I haven't done that so far, but have it up my sleeve just in case.

I started with pain in october 2024 which got really bad by january 2025. The rheumatologist thinks it is PMR, but is not 100% sure. Late January I started with prednisone 15mg daily for 1 week, 10mg daily for 1 week, 5mg daily for one week. Things were feeling great until I dropped to 2.5mg daily. Within a few days, the pain and stiffness returned. Since I was going on vacation, the doctor suggested I take 5mg daily until I returned.
She thought maybe 2.5mg was too much of a drop. She suggested 4mg daily for 1 month. I decided to try 4.5mg for the first week. I am at 9 days at that dose and the pain and stiffness is creeping back in, worse every day.
Can you tell me if you were able to drop in dose and NOT have pain return, or is this not realistic? The doctor said that I may need to start methotrexate. I need to do some research. I feel very hesitant about that.

I can take away many things from your feedback, so thanks so much for your detailed reply!

"The pace you've reduced successfully in the past will tell you how to do it this time."
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I agree with this statement except that I had more than 20 years of experience with tapering off Prednisone from my usual 60 mg down to zero to achieve remission of uveitis. I taught myself how to taper Prednisone after my ophthalmologist gave me some suggestions. I was able to successfully taper off Prednisone so many times, my ophthalmologist documented in my medical records, "The patient is very skilled with prednisone tapers."

I must have lost my tapering skills after PMR was diagnosed. I never could taper off Prednisone successfully for 12 years after PMR was added to my mix of problems. What I learned from my experience was that there is a huge difference between taking Prednisone on a short term basis compared with taking it long term.

I would modify your statement to include something that says that successful tapering also needs to consider everyone's own personal circumstances. Except for a few general guidelines, there isn't any single best way to taper off Prednisone for treating PMR because everyone has a different set of circumstances.