What does one do to get off prednisone?

Often patients are on steroids for some time. What is the protocol for stopping steroids?

Prednisone is a drug often used in IBD. What does one do to get off prednisone?

Usually, prednisone can be tapered rapidly down to 10 mg/day andthen more slowly tapered to none in normal people. In patients withIBD, tapering faster than 10 or 5 mg per month can induce a flare. IBD patients also tend to flare when their dose gets down to 10 to 30mg/day, usually 15 to 20 mg/day. I find it interesting that the doseis very consistent for a given patient, so a patient’s previous taperexperience is quite helpful. When one gets to the wall, tapering at2.5 mg/day each 2 to 4 weeks is usually done, and often the dose hasto go back a step up during the taper.

Steroid tapering is unpleasant, and the symptoms of the taper canfeel just like IBD. Malaise and joint pains are quite common. Thisis worrysome to both doctor and patient. After a few tries attapering and failure but no overt signs of IBD relapse, a decision ismade that it is steroid withdrawal, courage develops and one pushesthrough, usually with success.

All the above is for people not under certain stresses. Theadrenals put out about 35 mg/day of cortisol, which is about the sameas 10 mg/day of prednisone. Under stress, the doses needed arehigher. Someone who has been on prednisone for a time who is tapereddown to 10 mg/day, then gets pneumonia will need supplemementalsteroids until the infection is cleared. Even after being taperedoff steroids, for a year afterwards patients may need supplementalsteroids during times of metabolic stress.

Stephen Holland, M.D.
Section of Clinical Pharmacology
University of Illinois College of Medicine at Peoria

Author: Stephen Holland


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