prednisone taper; glucocorticoid taper

Management

• not necessary to taper if oral dose < 60 mg/day for 10 days
• a taper is unnecessary when glucocorticoid therapy is < 3-4 weeks, regardless of dose
• when glucocorticoid therapy is > 3-4 weeks, a taper is necessary to minimize withdrawal & promote recovery of the hypothalamic-pituitary-adrenal axis
  • 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
  • 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*

* if pituitary insufficiency suspected, obtain gadolinium contrast enhanced MRI neuroimaging of the brain (pituitary protocol)

More general terms

• taper

Additional terms

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