Prednisone tapering side effects
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Adrenal glands manufacture glucocorticoids (steroids). THese are called endogenous glucocorticoids since they are produced by the body.
Taking glucocorticoids orally or intravenously can reduce the ability of the person’s own adrenal glands to continue to manufacture glucocorticoids.
Without the ability to increase steroid production in the face of stressors such as injury, infection, and surgery, a patient can go into shock.
The chances of the adrenal glands being suppressed increase as the dose of “outside” steroid exceeds the average daily output of the adrenal glands which is about 5.0-7.5 mg prednisone, therapy continues for more than a few weeks or months, doses are given late in the day or in split doses, or long-acting corticosteroid preparations are used.
Taking steroids on an alternate day (every other day) schedule decreases the chance of adrenal insufficiency but does not eliminate it.
Tapering should be gradual to avoid major flares of disease. If a patient flares, then the steroid dose must be increased and then tapered again- making the length of steroid therapy
required much longer.
Abrupt decreases or withdrawal of steroids can lead to major flares as well as other complications.
At the upper level of steroid therapy (about 40 mgs of prednisone or higher), dose reductions should be no greater than 10 mgs every few weeks. At 40 mgs down to about 20 mgs, the rate of taper should be no faster than 5 mgs every few weeks. When a patient gets to 20 mg, then tapering should be no more rapid than 2.5 mgs every 4 weeks or so.. At doses of less than 10 mgs per day then tapering should be at a rate of 1-2 mgs every 4 weeks. The longer a patient has been on therapy, the slower the rate of reduction should be.
Alternate day therapy is best done when the patient has gotten to a relatively low dose. Alternate therapy is not working if the patient reports a flare of their symptoms on the off day.
Patients with co-morbid conditions such as diabetes or hypertension need to be managed with extreme caution depending on the severity of the co-morbid condition.
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