Oral steroids are prescribed on a taper in order to:
A. Achieve optimal serum levels.
B. Ensure drug reliability.
C. Ensure compliance.
D. Prevent steroid withdrawal syndrome.
Correct Answer: D. Prevent steroid withdrawal syndrome.
Steroids are tapered off in order to prevent a withdrawal syndrome. Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment (more than 1 year). Depending on the dosage, duration of therapy, and risk of systemic disease, decrease dosage by the equivalent of 2.5 to 5 mg prednisone every 3 to 7 days until a dosage of 5 mg of prednisone is reached.
Option A: Optimal serum levels do not require tapering in order to be maintained. Before initiating long-term systemic corticosteroid therapy, a thorough history and physical examination should be performed to assess for risk factors or pre-existing conditions that may potentially be exacerbated by GC therapy, such as diabetes, dyslipidemia, CVD, GI disorders, affective disorders, or osteoporosis.
Option B: Tapering has nothing to do with drug reliability. If the client takes prednisone for more than a few weeks, the adrenal glands will decrease the natural production of cortisol. If the client stops prednisone abruptly before production is restored, the lack of hormones can trigger an array of withdrawal symptoms.
Option C: Compliance is not dependent on tapering. To avoid prednisone withdrawal, the drug should be gradually reduced in stages according to a specific schedule prescribed by the doctor. An exception is if prednisone has been given over a very short period of time. Don’t try to stop or taper prednisone without the doctor’s knowledge or advice.