What should the patient be told?
Corticosteroids may be withdrawn abruptly provided that the patient has:
Received less than 3 weeks treatment
and not received recent repeated courses of corticosteroids
and received doses less than 4-6mg dexamethasone (or equivalent) total daily dose
and adverse effects are not anticipated by an abrupt withdrawal.
Gradual withdrawal of corticosteroids method
1. Initially reduce rapidly (e.g. halving the dose daily) to physiological doses (dexamethasone 1mg/24h or prednisolone 7.5mg/24h).
2. Subsequently more gradual reduction is advised (e.g. by 1mg–2mg prednisolone per week).
3. Patients should be monitored for any deterioration, in particular for signs of adrenal insufficiency.
If beneficial, corticosteroids should only be continued at a set dose for a maximum of 2–4 weeks, with planned review date to consider withdrawal. Aim to prescribe the lowest dose that controls the symptoms.