ASK THE EXPERTS - Tapering prednisone in patients with SLE

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Tapering Prednisone in Patients With SLE

Ask the Experts about New Therapies for Rheumatic Disease

From Medscape Rheumatology

Ayotte, MD

Question

My patient has been taking prednisone 10 mg a day for the past year,

for SLE. Can you advise on the recommended taper procedure?

Response from I. Fox, MD, PhD

Member, Rheumatology and Medicine Department, Scripps Memorial

Hospital, La Jolla, California

The risks of tapering steroids in a patient on a dose of 10 mg per day

for 1 year should be small if the steroids are tapered gradually. At

our clinic, we would initially drop to prednisone 7.5 mg per day for 2

weeks and then further taper by 1 mg per week until patient is off the

medication.

Comment:

The question of steroid dependency is a difficult clinical and

potential medical-legal problem. Consideration of adrenal

insufficiency during stress as well as infection and anesthesia at

surgery need to be considered as the steroids are tapered.

Suppression of the hypothalamic-adrenal axis (HPA) needs to be

considered in a patient who has received a glucocorticoid dose

comparable to more than 20 mg of prednisone a day for more than 3

weeks. Any patient who has a cushingoid appearance must also be

considered at increased risk.

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Read the full article here:

http://www.medscape.com/viewarticle/533265

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