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prednisone taper; glucocorticoid taper

Management: - not necessary to taper if oral dose < 60 mg/day for 10 days [2] - a taper is unnecessary when glucocorticoid therapy is < 3-4 weeks, regardless of dose [3] - when glucocorticoid therapy is > 3-4 weeks, a taper is necessary to minimize withdrawal & promote recovery of the hypothalamic-pituitary-adrenal axis [3] - taper 5-10 mg weekly if dose > 40 mg predisone equivalent - taper 2.5 mg every 1-4 weeks if dose 10-20 mg predisone equivalent - taper 1 mg every 1-4 weeks if dose < 10 mg predisone equivalent - patients taking long-acting glucocorticoid (dexathasone) should be switched to shorter-acting glucocorticoid (prednisone, hypdrocortisone) before taper - when taper at physiologic dose 5-6 mg prednisone equivalent - obtain 8 AM morning serum cortisol - if 8 AM serum cortisol > 10 ug/dL, taper may be discontinued - otherwise, continue taper & repeat testing weeks to months later [3] - failure to taper below 5 mg/day suggests adrenal insufficiency - after holding prednisone for 1 day, plasma ACTH should increase with primary adrenal insufficiency, but not pituitary insufficiency* [1] * if pituitary insufficiency suspected, obtain gadolinium contrast enhanced MRI neuroimaging of the brain (pituitary protocol) [1]

Related

glucocorticoid prednisone (Deltasone, Orasone, Liquid Pred, Meticortin, Rayos) secondary adrenal insufficiency (SAI)

General

taper

References

  1. NEJM Knowledge+ Complex Medical Care
  2. Prescriber's Letter 10(12):68 2003
  3. Beuschlein F, Else T, Bancos I et a; European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1657-1683. PMID: 38724043 PMCID: PMC11180513 Free PMC article.