Are There Guidelines for Prednisone Tapers

@kobellava
My doctor has suggested decreasing 1mg per month. Originally I thought that was too slow but after reading all the setbacks from going faster, I will be patient and hope for the best.

There are guidelines. See image for UK NICE guidelines. But Note; these are under review. Here’s a link to EU guidelines. https://ard.eular.org/article/S0003-4967(26)00357-2/fulltext
But there’s also a lot of research around the high %age of people who ‘fail’ during tapering. My experience with GP Nutritionist and Pharmacist is that tapering needs to be personalised. And run in parallel with changes - nutrition, activity, sleep, lifestyle - to eradicate the underlying inflammatory/autoimmune problems that provoked the onset of PMR. Otherwise the chances of tapering failure and/or return of PMR seem quite high. Lots of great online info on Inflammation and PMR, Diet and PMR. Cytokine production and PMR. Healing the HPA Axis and PMR. It’s the endocrine background to PMR.
Happy to share my tapering schedule but it is my personalised schedule.
Good Luck!

Thats a good question. I dont think an answer fits everyone. The Dr, after doing tons of testing to determine what you dont have will start you on prednisone and then tell you to start tapering. Most of the data for PMR suggests it can last for years. The fact your sed rate is normal also doesnt catch everyone. My sed rate and crp were never elevated. Yet the fact that prednisone worked in 4 hours was the diagnosis. I think one other issue is , I had never had a crp or sed rate test. What was my normal? Maybe it was elevated for me. Prednisone is a nasty long term drug. I tried to taper several times and could not get below 10mg. Then on month 5 I tried a taper to 5mg and it worked. Over that 5 month I tapered to zero. My cortisol restarted and I moved on. That is not everyone. The longer you are on prednisone the harder this will get. So I say just pay attention to what your body tells you and be determined to not stay on corticosteroids. good luck

PMR is confounding, painful and so difficult to treat. I was diagnosed in October 2025 and have just tapered off prednisone. I have shoulder, hand and back hip pain, but not as severe. I also gained 15 pounds in a short period of time. My no. 1 complaint (besides the weight gain) is extreme fatigue and depression with uncontrollable crying. My next appt. is in October, so I’m trying to tolerate to see how my body is reacting by the time I go back. My rheumatologist has suggested infusions at a cost to me of $500/month! I choose to live with the pain, but the fatigue is seriously impacting my quality of life. Has anyone out there successfully treated the fatigue? If so, I would be forever grateful for any suggestions. Take care.

@tuckerp I'm interested to know a bit more how you succeeded on month 5 and how long it took you to get to zero. In reference to the original question we're all on our individual taper journeys and I've read a lot of them here on this site and am very grateful for all the info. I've probably learned a lot more here than in reading all the scientific and clinical reports/guidelines (which I have been doing a lot in the past 3 months since my PMR started). My docs (a general internist and a family doc) don't seem to know a lot about PMR and it would probably be a year before I could get an appointment with a rheumatologist knowledgeable about PMR (live in Canada). I'm at high risk for osteoporosis and sarcopenia and want to be off prednisone as quickly as possible (my twin sister snapped her femur head while on bisphonates to treat her osteoporosis several years ago). If anyone is willing to chime in please do. My initial taper was very fast starting at 12.5 mg for a week, to 10 for a week to 7.5 for a week then 5 for a week. Needless to say I only made it to 7.5 for a few days before the pain was getting unbearable, having to start again. However, this next taper was for 2 weeks at each dose. 12.5 mg controls my PMR very well, 10 is not bad with a couple extra hours of discomfort in the morning. My sed rate was not elevated on first testing (has not been tested since) but CRP was 21 pre-prednisone (all my previous CRP tests pre-PMR have been around 1.0). I managed to get it to 15 on the first taper to 7.5 mg. On the 2nd taper, after 2 weeks at 12.5 mg, my CRP was down to 7.5 so I was getting quite happy. Instead of listening to my doc I started tapering 1 mg at a time when I got to 10 and I've been able to get down to 7 mg but CRP has inched up again as has the pain level and length of pain in the morning/early afternoon. I seem to tolerate the pain much better now knowing it's just a fact of life until it eventually "burns out". So should I keep going at 7 mg and hope my CRP goes down eventually or should I go back up for a while to 10 where things were better controlled? I don't see my doc for another 10 days. Sorry for the longwinded story. I know @dadcue had lots of problems getting from 10 to 7 before getting a biologic eventually and others have struggled in this dosing range. I'm especially interested in hearing from people who had a normal ESR but elevated CRP and who had it measured quite often. Thanks everyone!

@tuckerp I'm interested to know a bit more how you succeeded on month 5 and how long it took you to get to zero. In reference to the original question we're all on our individual taper journeys and I've read a lot of them here on this site and am very grateful for all the info. I've probably learned a lot more here than in reading all the scientific and clinical reports/guidelines (which I have been doing a lot in the past 3 months since my PMR started). My docs (a general internist and a family doc) don't seem to know a lot about PMR and it would probably be a year before I could get an appointment with a rheumatologist knowledgeable about PMR (live in Canada). I'm at high risk for osteoporosis and sarcopenia and want to be off prednisone as quickly as possible (my twin sister snapped her femur head while on bisphonates to treat her osteoporosis several years ago). If anyone is willing to chime in please do. My initial taper was very fast starting at 12.5 mg for a week, to 10 for a week to 7.5 for a week then 5 for a week. Needless to say I only made it to 7.5 for a few days before the pain was getting unbearable, having to start again. However, this next taper was for 2 weeks at each dose. 12.5 mg controls my PMR very well, 10 is not bad with a couple extra hours of discomfort in the morning. My sed rate was not elevated on first testing (has not been tested since) but CRP was 21 pre-prednisone (all my previous CRP tests pre-PMR have been around 1.0). I managed to get it to 15 on the first taper to 7.5 mg. On the 2nd taper, after 2 weeks at 12.5 mg, my CRP was down to 7.5 so I was getting quite happy. Instead of listening to my doc I started tapering 1 mg at a time when I got to 10 and I've been able to get down to 7 mg but CRP has inched up again as has the pain level and length of pain in the morning/early afternoon. I seem to tolerate the pain much better now knowing it's just a fact of life until it eventually "burns out". So should I keep going at 7 mg and hope my CRP goes down eventually or should I go back up for a while to 10 where things were better controlled? I don't see my doc for another 10 days. Sorry for the longwinded story. I know @dadcue had lots of problems getting from 10 to 7 before getting a biologic eventually and others have struggled in this dosing range. I'm especially interested in hearing from people who had a normal ESR but elevated CRP and who had it measured quite often. Thanks everyone!

@bettebaldwin would love to see your schedule!

@vanmeerd
Discuss LDN with your doctor. It's off label so you pay for it yourself but I paid $110 for 90 days supply and there are cheaper options online. It requires a compounding pharmacy. Some doctors are adamantly opposed to it but my rheumatologist prescribed it during my prednisone tapering.