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Advice for anyone new to Steroid tapering 2 years 7 months ago #67676

  • mrsb04
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  • ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
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As someone who has experienced a badly managed steroid reduction I am posting this as it provides information on steroid withdrawal symptoms and dose tapering to avoid them.

www.medicinenet.com/steroid_withdrawal/article.htm and www.nadf.us/secondary-adrenal-insufficiency.html are essential reads in my opinion. They explain both the reasons for adrenal insufficiency and the symptoms to look out for. Rapid tapers/untreated adrenal insufficiency can be fatal.

GPs (PCPs to you folks across the pond) are much better at managing tapers than hospital 'specialist' docs (ie haematologists) believe me I've been there.

Adrenals need time to cope with dose reductions. Here is an abridged version of the standard UK Guidelines as published by NICE*
Gradual withdrawal for people who have:
Received more than 3 weeks of corticosteroid treatment.
Received more than 40 mg prednisolone daily or equivalent for more than 1 week.
During withdrawal, the dose of oral corticosteroids may be reduced rapidly down to physiological doses (about 7.5 mg of prednisolone or equivalent) and reduced more slowly thereafter.
If the problem has resolved and treatment has been given for only a few weeks.
Reduce by 2.5 mg every 3–4 days, down to 7.5 mg per day, then reduce more slowly, for example by 2.5 mg every week, fortnight, or month.
If there is uncertainty about disease resolution and/or therapy has been given for many weeks.
Reduce by 2.5 mg every fortnight down to 7.5 mg per day, then reduce by 1 mg every month.

These are the latest guidelines from uptodate .com
-5 to 10 mg/day every one to two weeks from an initial dose above 40 mg of prednisone or equivalent per day.
-5 mg/day every one to two weeks at prednisone doses between 40 and 20 mg/day.
-2.5 mg/day every two to three weeks at prednisone doses between 20 and 10 mg/day.
-1 mg/day every two to four weeks at prednisone doses between 10 and 5 mg/day. (personally I would say 7.5mg)
-0.5 mg/day every two to four weeks at prednisone doses from 5 mg/day (personally again I would say 7.5mg) down. This can be achieved by alternating daily doses, eg, 5 mg on day one and 4 mg on day two.

It can take ages to get off them. I can't cope with more than 0.5mg/day /month otherwise I have horrific withdrawal symptoms.

*National Institute for Health and Care Excellence
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Advice for anyone new to Steroid tapering 2 years 7 months ago #67703

  • Hal9000
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  • Give me all your platelets and nobody gets hurt
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Thanks for the info.
The terms 'fast taper' and 'slow taper' are often mentioned by others. What do they mean and how does it relate to the above?

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Advice for anyone new to Steroid tapering 2 years 7 months ago #67722

  • mrsb04
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  • ITP since 2014. Retired nurse. My belief is empower patients to be involved as much as possible in their care. Read, read, read & ALWAYS question medics about the evidence base they use.
  • Posts: 1960
  • Karma: 7
  • Thank you received: 565
See the UK guidelines above

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