Systemic Steroids

• The suggested initial daily dosages are intended as guides. The initial recommended therapeutic dosages may vary depending on the condition being treated and is determined individually by the treating team, severity of disease and patient response
• The initial therapeutic dose is continued - as prescribed - until a good clinical response is observed, or discontinuation is decided
• In cases of long-term use (more than 3 weeks), and once a clinical response is observed, dose should be decreased gradually (see tapering below) either to maintenance dose for chronic conditions or for cessation in the case of acute conditions
• For maintenance dose, use the effective and (possibly) the lowest dose for the shortest period of time
• High dosages should be reserved for life-threatening disease, and its duration must be decided by the treating team
• While on corticosteroids, any intercurrent illness, trauma or surgical procedure may require changes in the initial and/or maintenance dosages
• In certain medical conditions, alternate day therapy is preferred in some special populations, for example: children, patients with renal impairment, elderly, breastfeeding, and pregnancy as it minimises suppression of the hypothalamo-pituitary-adrenal axis (HPA)
• Unless recommended, once daily rather than divided dosing preferred as it causes less HPA suppression
• In alternate-day therapy, the minimum daily glucocorticoid requirement can be increased (by 50% to 100%) and administered as a single dose early morning and every other day. Dosage requirements depend on the condition being treated and response of the patient

When discontinuing or decreasing drug, taper dosage if:

• Disease is likely to relapse if corticosteroids abruptly withdrawn (clinical assessment of disease activity may be needed during withdrawal)
• End of therapy in patients receiving high dosages
• Treatment duration of > 3 weeks
• When a short course has been given within one year of cessation of long-term therapy (months or years)
• Non-compliant patients using large dosages at inconsistent times of the day (morning, evening)
• HPA axis suppression for reasons other than systemic corticosteroid use

Steroid withdrawal syndrome may also occur following abrupt discontinuance of glucocorticoids. This syndrome includes symptoms such as: relapse of clinical presentation of treated condition, anorexia, nausea, vomiting, lethargy, headache, fever, joint pain, desquamation, myalgia, weight loss, and/or hypotension. These effects are thought to be due to the sudden change in glucocorticoid concentration rather than to low corticosteroid levels.