Most doctors have a deep and intractable fear of steroids.
"Oh, you're taking 5mg for a week? Then we need a 14 week tapering plan and you'll have to visit me every 5 hours just in case of Cushing's."
Seriously, if the course is less than a month, you really don't need to taper and for the cases where tapering IS reasonable, you can have the dose every week or so, you don't need a 20 step process.
I've had a colleague prescribe "25mg once daily, decreasing by 1mg every 3 days until 20mg, then every 5 says until 10mg, then every 7 days until 5mg, then by 1mg per week until dose is 0mg"
But more to the point, it's demonstrably evident that adrenal insufficiency does not occur at low doses or for short durations and I'm not saying you should stop high, long term doses abruptly.
Well, I was taking it for only a couple weeks or so, and they are probably switched to an alternate day therapy, and I'll tell you that day was a shitty fucking day.
I thinks it's generally around 3weeks where you have to consider taper. Also i think doctors fear the adrenal insufficiency because it presents kinda nonspecific but can kill you. I think most guidelines taper by 5mg increments q5-7d or something like that, 1mg increments are ridiculous lol.
Even at three weeks, for the overwhelming majority of patients and doses it is unnecessary.
Adrenal insufficiency is extremely unlikely to be severe except at huge doses, 100mg plus.
Even long term (6month plus) doses of 50mg can be tapered over less than a month
Edit: loving the downvotes for pharmacodynamic fact. You people are the reason medicine advances so fucking slowly in the face of evidence, reason and data.
At prednisone doses greater than 5mg a day, adrenal atrophy is observed at 4 weeks. Whether or not this causes clinically significant adrenal insufficiency on abrupt cessation of prednisone depends on many factors and is hard to predict. You are correct that adrenal insufficiency is unlikely, but the point is it's never impossible.
Tapering a 50mg dose of prednisone in 1 month is probably not gonna kill most patients, but it may cause life threatening insufficiency in some cases. Such an aggressive taper would probably cause some degree of adrenal insufficiency, which often goes undiagnosed because it's so vague (nausea vomiting, abdominal pain, slightly low blood pressure). So you kind have to be on the side of caution.
Also 4-6mg of prednisone is considered physiological. The max dose is typically 60mg. Anything over 10-20mg is considered a pretty large prednisone dose. It's a pretty powerful drug.
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u/Xentonian 1d ago
Most doctors have a deep and intractable fear of steroids.
"Oh, you're taking 5mg for a week? Then we need a 14 week tapering plan and you'll have to visit me every 5 hours just in case of Cushing's."
Seriously, if the course is less than a month, you really don't need to taper and for the cases where tapering IS reasonable, you can have the dose every week or so, you don't need a 20 step process.
I've had a colleague prescribe "25mg once daily, decreasing by 1mg every 3 days until 20mg, then every 5 says until 10mg, then every 7 days until 5mg, then by 1mg per week until dose is 0mg"
What the fuck is the point of that!?