Prednisone Tapering Guidelines

Introduction to HPA Axis Suppression

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that the critical threshold for hypothalamic-pituary-adrenal (HPA) axis suppression requiring a taper is more than 7.5 mg daily for more than 3 weeks 2, 1

Clinical Practice Guidelines

• The American Academy of Otolaryngology-Head and Neck Surgery suggests that for Bell's Palsy, prednisone 60 mg daily for 5 days followed by a 5-day taper is recommended, but the taper portion is for doses given on days 6-10, not for the initial 5-day high-dose period 3
• The American Academy of Otolaryngology-Head and Neck Surgery recommends full-dose steroids for 7-14 days before tapering begins for Sudden Hearing Loss 4

Patient Monitoring and Education

• The American College of Physicians recommends patient education, informing the patient that no taper is needed but they should contact their physician if they develop symptoms of adrenal insufficiency within 1-2 weeks 1
• The American College of Physicians suggests considering supplemental glucocorticoids as a precautionary measure if the patient experiences major physiologic stress within 1-2 weeks after stopping prednisone 1

Special Considerations

• The American College of Physicians recommends considering a brief taper only if the patient has pre-existing HPA dysfunction, multiple recent courses, or high-risk comorbidities 1