There can be problems with cutting prednisone rapidly, so most of the time we don't do it. However, at doses above 20mg changing is not as much of a problem as below 20mg.
Problems that can occur:

-- MG symptoms may come back rather quickly (likely in a few weeks or less). Prednisone has stopped your body from producing bad antibodies and if you drop it too much, the antibody level may rise causing MG symptoms. Prednisone's effect is quick to initiate (at high doses) and quick to disappear, unlike cellcept or azathioprine some of the alternative drugs.

--Prednisone itself has side effects. Dropping it rapidly can cause these to show up. The symptoms can be found on many websites by searching for prednisone withdrawal myasthenia. They are not MG and not adrenal but likely some physical and some mental.

and if you are dropping below 15mg or maybe 20mg another problem

--Prednisone inhibits our adrenal glands from producing cortisol as prednisone provides it instead. When prednisone is dropped below 20 (or maybe 15 mg per day), then the adrenal glands must start kicking back in to produce cortisol, something they are reluctant to do and without cortisol, we get lots of aches and pains that are related to the low cortisol level (not MG type symptom). But that is pretty much limited to dropping below 15 mg per day and doesn't have any effect at 20mg. When you drop below 20, really go slow!

Most of us have gone through tapering prednisone and like the slow and steady taper. However, I did find changing from 60 to 40 abruptly worked OK and mostly just let me sleep again (high doses seem to make some of us feel "wired.")

A lot of advice is given on alternate day prednisone. So tapering can be 40 one day and 20 the next and gradually going to only a dose every other day. Each person seems to react differently.

Doctors are always trying to get us to taper our prednisone use to the minimum effective dose (which of course varies by person). Since the changes in MG symptoms can take a few weeks to show up, this time delay makes things difficult to figure out for the patient. When we think the prednisone is working, the doctor wants us to try a little less -- prednisone long term is best taken at the lowest level we can get by.

When you get something you are unsure of, like a 20mg drop, you really need to ask your doctor to explain why, and what can you expect might happen with this.

I think you can find a great deal of information about tapering on this discussion group by doing a site search type the following line into the google search box and you will get previous discussions about this.
myasthenia prednisone taper site:www.dailystrength.org

Rhanson , your prednisone response in my opinion is very accurate and it sounds to me as if you've been on and off like myself in varying amounts. You really took the words right out of my mouth for lack of a better analogy .

There is one or two thoughts I'd like to add in regards to high doses and 20 - 30 mg drops. There was a period of time I suffered from cluster headaches aka " suicide headaches " and one of the ways to break out of the cycle was you guessed it high doses of prednisone usually 80 / 60 mg alternating until the clusters were gone , usually in 2-3 days and than I'd go back to whatever at the time was my mg dosage 30/20 or 20/-10 . I had those big drops periodically and sometimes had the insomnia and or emotional highs and lows .

I've always been on the alternating dosages of pred and even now as I'm tapering , down to 1mg every other day and I can tell you my adrenal glands are affected more as I take LESS . Your correct for as long as your on prednisone your adrenal glands essentially stop producing hence the slow taper.

I'm grateful that by mid august I will be prednisone free as we all know what some of the long term effects of this medication that we as mgers often take.

It will be nice one day to conquer myasthenia gravis so all of us would be symptom and medication free.

Cj

Thanks for the detailed info. The plan is to stay at 20mg/day until the middle of August and then 20mg every other day. I can already tell the the brain fog seems to have lessened cutting back to one a day, although that might be as much psychological as physical. Now if I stop losing my hair I'll be an almost happy camper!! WTK

There are lots of ways to taper. Some suggest dropping 1mg a week. It gets harder as your dose is lower. I went from 15 to 5 in six weeks. I will Never go too fast again, it was terrible, body aches, MG symptoms, mood swings. Talk to your doc about any concerns.

That is too large a percentage for a drop. I believe the guideline is 20%. A 50% drop does not seem reasonable.

Hey there..well I cut down VERY slowly over the years....Mg by Mg, usually like down 5 mgs etc....So didnt feel bad affects...From long term use unfortunately have the side affects from it still and always will I assume..But had no bad experiences tapering down..But never did in large doses..But again everyone is different..So hope this works for you..As everyone has said if you feel something not right call dr right away.....As CJ said would be nice if we could all be med and MG free...!!!!! Good luck and keep us posted.....Ps I am on 2.5mgs now.

Best advice I ever got was fron Curt
Only drop 50 percent over a 6 month period of time.
That worked best for. Me.
That would me an you would go slow and be at 20 in 6 months.
I went fast a couple times ans was miserable. When I slowed down I I could function and was better off.
Going too fast just caused me to have Togo back up so I never made headway.
Slower is better.
Alternate days worked best for me too

Hi WT,
I was put on 50 mg Prednisone 18 months ago. I was at that dose for at least three months, then began tapering. I am now taking 5 mg per day and have been for three months, so you can see it has been a very slow taper. I never had more than a 5 mg drop at any time and, in my case, it was the same dose daily. I see my neuro next month and do not know what he will advise next, a 1 mg taper? Every other day? Stop completely?
I too lost a lot of hair, at least 1/2, but when I was down to 15 mg it started growing back, not " good quality " hair, but I'll take it!
Good luck on your taper and please keep us posted.
Claire

When I was diagnosed in February of 2013 I was put on 20mg of prednisone. Two months later the dosage was increased to 60mg. I have since started tapering off the prednisone. My dr is tapering my dose 5mg a month. I'm at 40mg right now and I just started at that dose two days ago. Going from 60mg to 40mg I had no side effects. I am now having some problems I think are from the taper. I have been more tired and feel like I'm getting a cold or something. My body aches and my brain fog is getting worse.
I think with your taper you would have to be having some side effects. I have always been told you need to taper slow. It's side effects are a lot worse when you taper fast. I think I would talk to my neuro and see what he thinks. Good luck with your taper.