Canterbury DHB

Context

Prednisone Withdrawal Protocol

In patients with adrenal suppression, please ensure this is recorded in the diagnosis list on letters in Health Connect South.

In This Section

Step 1: Reduce steroids to physiological replacement dosage (5 mg/day)

Step 2: Monitor for recovery of normal steroid secretion

Step 1: Reduce steroids to physiological replacement dosage (5 mg/day)

The patient is gradually weaned from pharmacological steroid dosage (e.g. >5 mg prednisone/day) over a period of weeks or months. Any symptoms at this stage are unlikely to be caused by steroid insufficiency. If the disease for which the steroids are being given flares, steroids must be increased temporarily and the dose then reduced more gradually. Dose reductions will vary depending on the individual physician but suggested dose reductions, made every one to two weeks, are:

When a physiological steroid dose of prednisone 5 mg/day has been reached (equivalent to hydrocortisone 20 mg/day, dexamethasone 0.5 mg/day):

Step 2: Monitor for recovery of normal steroid secretion

Repeat synacthen test at 2–3 monthly intervals (holding off any hydrocortisone or prednisone for 24 hours before the test).

Once the synacthen test is normal (peak cortisol >550 nmol/L), reduce glucocorticoids to zero over the next 2–4 weeks. For hydrocortisone, initially stop the afternoon dose and then withdraw the morning hydrocortisone dose. No further testing is required and the patient no longer needs "stress" steroids or a Medic Alert.

If the synacthen test remains persistently abnormal, then you should lower the maintenance hydrocortisone dose slightly to try and encourage ACTH secretion. For example, from 15/5 to 10/5, and if possible, gradually to only 10 mg mane. During this period the patient may develop symptoms of steroid insufficiency - nausea, fatigue, occasional vomiting, light-headedness, which will guide the tapering of the hydrocortisone. Additional steroids will still be required for "stress".

If you have any queries, please don’t hesitate to contact the Endocrinology Department!

About this Canterbury DHB document (44735):

Document Owner:

Steve Gibbons and Fiona Stone (see Who's Who)

Issue Date:

March 2017

Next Review:

March 2020

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 44735