How Steroid Tapering Can Help You Avoid Withdrawal Symptoms

Steroids — or corticosteroids and glucocorticoids — are medications prescribed for different types of inflammation. They can treat rashes, allergic reactions, asthma, autoimmune disorders, and more. Steroids come in different forms: pills, creams, injections, inhalants, and IV (intravenous) infusions.

Steroids work quickly to shut down inflammation. But they come with many potential side effects. The risk of side effects increases with higher doses and longer time of use. So the lowest dose for the shortest amount of time possible is ideal. But steroids can’t always be stopped suddenly because that can also cause unwanted effects. The dose needs to be slowly lowered over time (tapered) to stop them safely. 

Here’s what you need to know about steroid tapers and symptoms of steroid withdrawal. It’s important to note that steroids for inflammation are different from anabolic steroids. Those substances help increase muscle mass. 

What is steroid tapering?

Steroid tapering is the process of slowly decreasing a steroid dosage over time. 

For example, your provider may give you a prescription for a steroid taper that looks something like this: “Prednisone 10 mg tabs. Take 40 mg by mouth daily for 7 days, then taper by 10 mg every 7 days.”

These shortened instructions can often sound confusing. Since space on pill bottles is limited, healthcare providers may be forced to shorten instructions. But they can explain that those instructions mean:

• Take a total of 40 mg (4 of the 10 mg pills) by mouth for 7 days.

• Then, take a total of 30 mg (3 of the 10 mg pills) by mouth for the next 7 days.

• Then, take a total of 20 mg (2 of the 10 mg pills) by mouth for the next 7 days.

• Finally, take a total of 10 mg (1 of the 10 mg pills) by mouth for the final 7 days.

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Your provider should prescribe the exact amount of pills you need to complete the taper. Sometimes that might require a combination of pill sizes (10 mg and 5 mg tabs) or cutting pills in half. 

If you aren’t sure about how to take your medicines, you can ask questions to the following people:

• Your healthcare provider

• Their care team (Nurses and medical assistants)

• Pharmacists and pharmacy techs

Why are steroids prescribed in tapered doses?

To understand why steroid tapers are needed, it helps to know a bit about cortisol — a natural steroid produced by the adrenal glands. The adrenal glands make about 6 mg to 10 mg of cortisol each day to keep you alive. Cortisol supports a lot of different bodily functions, like metabolism and blood pressure. 

So what happens when you take steroid medications? When the body picks up on steroids from outside sources like pills, it won’t waste energy making cortisol every day. The adrenal glands take a little “nap” and stop producing cortisol. This effect is more pronounced with higher doses of steroids and longer periods of use. The form of steroid also matters — steroid pills have stronger full-body effects than other forms like creams or inhalants.

Steroids need to be tapered because of this adrenal gland “nap.” When steroid doses are slowly decreased over time, the adrenal glands have time to wake up and start making cortisol again. 

Why should you not abruptly stop taking steroids?

Steroids shouldn’t be stopped abruptly because of the risk of steroid withdrawal (adrenal insufficiency). Adrenal insufficiency means that the adrenal glands aren’t producing enough cortisol to keep the body running properly. 

What are the symptoms of steroid withdrawal?

The most common symptoms of steroid withdrawal include:

• Fatigue

• Body aches

• Weakness

• Dizziness

• Stomach cramps, nausea, or vomiting

• Joint pain

• A feeling of being run down (like you’re sick with cold or flu)

Steroid withdrawal may feel uncomfortable. If you’re feeling poorly during a steroid taper, talk to your provider. They might coach you through your symptoms. Or they can slow down the taper to help your symptoms.

When do you need a steroid taper?

There’s no one-size-fits all approach. But some factors that increase the need for steroid taper include:

• Taking higher doses of steroids

• Taking steroids more than once daily

• Taking steroid pills daily for more than 2 weeks 

• Taking inhaled steroids for more than 6 months

Remember that no specific dosage is “too high.” And withdrawal symptoms usually don’t happen when you use steroids for shorter periods of time. Since it’s not always straightforward, don't hesitate to talk with your provider about whether you need to taper your medication. Together you’ll come up with a plan to safely lower your steroid dose.

Should all types of steroids be taken in tapered doses?

It depends on how much you take and for how long. When in doubt, ask your healthcare provider. But first, it helps to be familiar with the names and types of steroids. 

Since there are so many different types, steroids go by many different names. Examples of common steroids include:

• Pills: Prednisone, prednisolone, dexamethasone, medrol dose pack

• Creams: Triamcinolone, hydrocortisone, clobetasol, betamethasone

• Inhalants: Fluticasone, mometasone

But this is not a complete list. If you’re ever unsure about a medication you’re taking, you can always ask the person who prescribed it. 

What should you do if you forget to taper a steroid dosage?

First, don’t panic. Call your healthcare provider as soon as possible to discuss the next best steps. All providers’ offices have some kind of after-hours service for urgent situations. 

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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