Stopping the use of prednisone
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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Once the decision has been made to start corticosteroid therapy, the duration of treatment will depend on the individual patient, the disease being treated, the severity of the illness, and co-morbid conditions (other medical conditions).
For self-limited problems such as allergic reactions, brief courses of steroids are generally sufficient.
When treating rheumatic diseases though, the course of therapy is usually long-term.
The rule of thumb is the dose of steroid used should be the lowest dose needed to suppress disease activity.
That being said, what about stopping prednisone?
Tapering should be gradual to avoid the flares of disease that can occur with more rapid discontinuation. Also, because, the adrenal glands are suppressed, sudden discontinuation of prednisone can be associated with significant problems. This is particularly an issue if the patient has been on more than 5.0-7.5 mgs per day for more than thirty days.
The primary consideration here is shock and death. Both may occur particularly in the face of stressors such as infection, injury, or surgery. While alternate dosing or doses lower than 5.0 mgs may lessen the chance for adrenal suppression, the risk is still there.
Reduction of prednisone after long term use should be done under the supervision of a physician who is knowledgeable about hoiw to do it.
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