Prednisone withdrawal: Symptoms, treatment, and duration

Prednisone is a steroid-type drug. When a person stops taking prednisone or other steroids abruptly, they may notice symptoms similar to adrenal insufficiency. These include lethargy, low appetite, weight loss, and a general feeling of being unwell.

Prednisone is a corticosteroid that doctors prescribe to treat swelling and inflammation. It relieves swelling, itching, and redness by suppressing the immune system.

Doctors should prescribe the lowest possible dose of prednisone to meet a person’s health needs. This is because of the risk of adverse effects.

When a person needs to stop taking prednisone, a doctor will recommend doing so gradually to prevent withdrawal symptoms.

In this article, learn the withdrawal symptoms of prednisone, why they happen, and how to prevent them.

Prednisone is a glucocorticoid, which is a synthetic steroid similar to cortisol, a hormone that the adrenal glands produce. Some people refer to cortisol as the stress hormone.

However, cortisol does much more than manage stress. The body also uses cortisol to regulate the heart rate and blood pressure.

Without medication, the body naturally maintains a consistent level of cortisol.

However, when a person takes prednisone, particularly when the course of treatment lasts for more than a few weeks, the body will reduce the amount of cortisol it makes.

When a person stops taking prednisone, the body cannot immediately produce enough cortisol to make up for the missing drug. It may take several days or weeks before the body’s cortisol production levels return to normal.

While the adrenal glands make most of the body’s cortisol, many different types of cells in the body have cortisol receptors.

As a result, the body uses cortisol for many functions, including:

• mediating the stress response
• regulating metabolism
• managing inflammation
• mediating the immune response
• managing the levels of blood sugar reaching the brain
• reducing insulin and increasing glucagon levels in the pancreas

When the body is not producing enough cortisol to compensate for the missing prednisone, a person can experience a range of symptoms while the body readjusts. This is known as adrenal insufficiency.

People who stop using prednisone after a long time may experience symptoms of corticosteroid withdrawal syndrome, such as:

• body aches
• joint pain
• a general feeling of being unwell
• weight loss
• fatigue
• low blood pressure
• darkening of skin color
• changes in mood

In some older studies, researchers noted the occurrence of:

• headaches
• nausea and vomiting
• inflammation
• fever

Symptoms can vary in intensity and may last anywhere from a few days to several months after discontinuing the drug.

The severity and duration of withdrawal symptoms usually correlate with the length of time a person was taking prednisone and the size of their regular dose.

People who are using prednisone should check with a doctor before stopping or reducing their dose.

Anyone experiencing symptoms of prednisone withdrawal after reducing the dose or stopping the medication should consult a doctor.

The doctor may adjust the taper schedule and recommend ways to manage the withdrawal symptoms.

Treatment for prednisone withdrawal focuses on managing the symptoms and controlling the body’s cortisol production.

Some lifestyle choices that can help manage prednisone withdrawal symptoms include:

• getting enough sleep
• using strategies to manage stress
• avoiding or limiting caffeine and alcohol
• eating a varied and nutritious diet

In some cases, these lifestyle approaches may not be enough to help a person with severe symptoms.

People who have severe symptoms while stopping prednisone should consult a doctor immediately. The doctor may need to readjust the tapering plan or treat any health complications.

To help prevent prednisone withdrawal, a person can take the following precautions while using prednisone and during the taper period afterward:

• sticking to the recommended dosage and not taking more than the doctor prescribes
• tapering the dose according to the doctor’s instructions
• avoiding suddenly stopping prednisone treatment

Doctors prescribe prednisone for numerous conditions, including:

• endocrine disorders that lead to low cortisone levels
• rheumatoid arthritis and other types of arthritis
• diseases that affect collagen, such as systemic lupus erythematosus (SLE) or lupus
• severe allergies and asthma
• some skin conditions, such as severe psoriasis
• eye problems, for example, allergic conjunctivitis
• some respiratory diseases
• some blood disorders, for example, acquired hemolytic anemia
• severe flares of some chronic gastrointestinal diseases
• multiple sclerosis flares
• leukemia
• some types of edema, or fluid retention

When doctors prescribe prednisone, they will generally specify a dosage that gradually decreases over several days to prevent prednisone withdrawal. They will usually not prescribe prednisone or other corticosteroids for long-term use, as the drugs can have severe adverse effects.

In most cases of steroid withdrawal, symptoms are self-limiting and will resolve with time. Most people recover fully from prednisone withdrawal once their body begins producing enough cortisol again.

The duration of symptomatic withdrawal will vary according to the dosage of prednisone the person was taking and the length of treatment.

Generally, those on a lower dose for a shorter period will have less severe symptoms. They may also recover from prednisone withdrawal more quickly, or they may not experience any withdrawal symptoms.

How to Manage Prednisone Withdrawal

Written by Susan Bernstein

Medically Reviewed by Jennifer Robinson, MD on April 18, 2022

• What Are Prednisone Withdrawal Symptoms?
• What Causes Withdrawal?
• Why Taper Steroids?
• How Long Will Withdrawal Symptoms Last?
• How to Manage Withdrawal Symptoms
• Can You Speed Up the Process?
• Can Tapering Cause a Flare?
• More

How and when do you stop taking prednisone, a steroid to treat inflammation? Even if you have side effects from the medication, don’t stop cold turkey or cut back the dose on your own if you’ve been on it more than a few weeks. You could go into steroid withdrawal, which can have severe symptoms.

It’s safer to taper off prednisone. Your doctor will gradually lower your dose. Tapering helps prevent withdrawal and stop your inflammation from coming back.

As you taper, you may notice subtle symptoms. Let your doctor know if you do. They’ll watch you carefully and adjust your prednisone taper dose if needed.

Prednisone withdrawal may cause symptoms like:

• Severe fatigue
• Joint pain
• Fever
• Stiff or tender muscles
• Body aches
• Lightheaded feeling
• No appetite
• Labored breathing
• Vomiting
• Weight loss
• Headaches
• Adrenal crisis, a rare, possibly fatal reaction to a lack of steroid hormone in your body

Withdrawal could also lead to serious psychological symptoms like depression, anxiety, mood swings, mania, or delirium.

Your adrenal glands make a steroid called cortisol that’s similar to prednisone. Your body needs cortisol to function.

When you take prednisone for more than a few weeks, your adrenal glands make way less cortisol. If you stop prednisone or taper too quickly, your body won’t have enough of the steroid it needs. Your withdrawal symptoms are due to that sudden steroid shortage.

When you taper off prednisone, your adrenal glands have time to catch up and make normal levels of cortisol. This could take weeks or even months, depending on how long you took the medication or how high your dose was.

Even a tapered dose of prednisone helps prevent inflammation, which is why you took the steroid in the first place. The doctor will give you a schedule to gradually lower your dose. Follow it carefully. They’ll let you know when it’s safe to stop prednisone altogether.

It’s normal to feel some mild symptoms for about a week or two as you taper off prednisone. Don’t take any OTC pain medicine or prescription drugs without asking your doctor first.

Psychological withdrawal symptoms could last for 2 to 8 weeks. The doctor may give you blood tests to check your cortisol levels as you taper off prednisone. You may need to taper off more slowly or go back to your regular dose if you have severe symptoms.

Take these steps to help control withdrawal symptoms:

• Exercise. If you feel up to it, a slow walk or some stretches may help your aches and pain. Muscles and joints stiffen up if you don’t move them for too long. Gentle yoga or warm-water pool exercise may help, too.
• Physical therapy. The doctor can prescribe physical therapy to treat pain and teach you safe ways to move your body.
• Meditation and counseling. Meditation may help calm anxiety and center your mind. Talk to a therapist, family member, or friend about your feelings to help you feel that you’re not alone.

Wondering if you can get off steroids faster? Maybe. If you’ve only taken prednisone for 3 weeks or less, you might not have to taper. The doctor will let you know. If you’ve been on steroids for more than a year, it may take 2 months to taper off.

Don’t try to speed up the taper on your own. Your adrenal glands need time to ramp up their cortisol production.

Your symptoms may be a return of inflammation, not withdrawal. Tapering too quickly can cause a flare to happen.

If your disease flares, you may need to go back to a higher steroid dose for a short time to get the inflammation under control.

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What will happen if abruptly (that is, immediately take and stop taking) stop prednisolone after a long course – more than a month -? I have “side effects” – question No.

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started and I want to get off as soon as possible.

prednisolone

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Good afternoon Anna. It’s hard for you to say something definite, because you don’t write for what purpose you took this drug. But if you abruptly stop the drug, your disease, which you treated with prednisone, will begin to progress just as abruptly again. 02/27/17

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Prednisolone is an effective drug of a group of synthetic (artificial) glucocorticosteroids.

In the body, these hormones are produced by the adrenal glands and are responsible for the regulation of carbohydrate, mineral and protein metabolism. Prednisolone is prescribed when the internal forces of a person are not enough to suppress the inflammatory and painful process.

Medicines containing prednisolone are taken for many diseases of the joints, bronchial asthma, various allergic reactions, systemic connective tissue diseases, etc. It successfully relieves traumatic, burn and anaphylactic shock. Ophthalmologists use prednisolone to treat inflammation of the eyeball.

The form and dosage of the drug must be chosen by the doctor. It is very dangerous to take prednisolone uncontrollably. Serious side effects can occur with hormonal treatment. That is why doctors prescribe prednisolone only when other drugs have been useless.

Prednisolone withdrawal begins after the main symptoms decrease and the test results normalize. However, the doctor can cancel the drug even in the case when its side effect is very strong. If hormonal therapy was used in an emergency for no more than 3 days, you can stop taking prednisolone immediately, without fear of a withdrawal syndrome.

For patients on long-term treatment, the clinician should select the optimal dosage reduction regimen. The fact is that after 2-3 weeks of treatment, the ability of the adrenal glands to produce a natural hormone decreases. To return it to normal, the intake of synthetic prednisolone is reduced gradually. The rate of decline is influenced by the duration of treatment and the daily dose taken.

With a short course of therapy (from 3 days to 2 weeks), it is acceptable to take 25-50% less medication daily than the day before. For example, a doctor prescribed 1 tablet of prednisolone per day to stop an attack of rheumatoid arthritis. After 5 days of treatment, the patient felt much better. The doctor proceeds to reduce the dose and prescribes a scheme: the sixth day of treatment – 3/4 tablets, the seventh day – 1/2 tablet, the eighth day – 1/4 tablet, the ninth day – do not take.

When reducing prednisolone after three weeks of treatment, the doctor is guided by the value of the initial dose. The general rule is this: the more medication the patient took at the beginning, the sooner it can be canceled. For example, from a daily dosage of 60 mg, the doctor will take 5 mg every week, i.e. whole pill.

Having brought the dosage of prednisolone to the average, the rate of withdrawal should be slowed down and the reaction of the organism should be carefully observed. From the daily allowance of 40 mg, you can subtract 2.5 mg (1/2 tablet) per week. When the patient feels well taking 30 mg of prednisolone per day, they switch to a two-week dose reduction period. First remove 1/2 tablet, and with 10-15 mg – 1/4 tablet.

The withdrawal process is slowest when the daily dose of prednisolone approaches the physiological norm (5-7.5 mg per day). During this period, the doctor may additionally prescribe ascorbic acid and vitamin E. These drugs stimulate the adrenal cortex, helping the body restore the rhythm of hormone production.