Corticosteroids withdrawal

Jarad NA, Wedzicha JA, Burge PS, Calverley PM. An observational study of inhaled corticosteroid withdrawal in stable chronic obstructive pulmonary disease. ISOLDE Study Group. Respir Med 1999 93(3) 161-6. 

The treatment of adverse effects of corticosteroids includes symptomatic management and dose tapering on slow withdrawal of drug. Sudden withdrawal of corticosteroids may cause adrenocortical insufficiency and may lead to death. Gradual withdrawal of corticosteroids is advisable, and supplementary corticosteroid therapy should be provided for the patient with a history of corticosteroid withdrawal. 

Intracranial hypertension has been linked to a number of medications (Table 35-14), including corticosteroids (withdrawal), nalidixic acid, nitrofurantoin, danazol, ciprofloxacin, and amiodarone.The main two categories... 

Resurgence of chronic disease which has progressed in severity although its consequences have been wholly or partly suppressed, i.e. a catching-up phenomenon, is an obvious possible consequence of withdrawal of effective therapy, e.g. levodopa in Parkinson s disease in corticosteroid withdrawal in autoimmune disease there may be both resurgence and rebound. 

R. Maintenance of remission in autoimmune chronic active hepatitis with azathioprine after corticosteroid withdrawal. Hepatology 1988 8 781-784... 

Wechsler ME, Garpestad E, Flier SR, Kocher O, Weiland DA, Polito AJ, Khnek MM, Bigby TD, Wong G A, Helmers R A, Drazen JM. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in patients with asthma receiving zafirlukast. JAMA 1998 279(6) 455-7. 

Kroegel C, Reissig A, Hengst U, Petrovic A, Hafner D, Grahmann RP. Ulcerative colitis foUowing introduction of zafirlukast and corticosteroid withdrawal in severe atopic asthma. Eur Respir J 1999 14(1) 243. 

Kinoshita M, Shiraishi T, Koga T, Ayabe M, Rikimaru T, Oizumi K. Churg-Strauss syndrome after corticosteroid withdrawal in an asthmatic patient treated with pranlukast. J Allergy Clin Immunol 1999 103(3 Pt l) 534-5. 

Hayashi S, Furuya S, Imamura H. Fulminant eosinophilic endomyocarditis in an asthmatic patient treated with pranlukast after corticosteroid withdrawal. Heart 2001 86(3) E7. 

The potency and effectiveness of TAC have prompted studies to investigate withdrawal of corticosteroids or other concomitant immunosuppressants. A large randomized, controlled trial compared triple-drug therapy, consisting of TAC, corticosteroids, and mycophe-nolate mofetil, with early withdrawal of corticosteroids or mycophe-nolate in kidney transplant recipients. The results demonstrated equal efficacy in the three arms with no difference in acute rejection rates after 6 months of therapy. Furthermore, TAC has demonstrated equal efficacy to CSA, each in combination with azathioprine, with regard to corticosteroid withdrawal. ... 

Shihab FS, Lee ST, Smith LD, Woodle ES, Pirsch JD, Gaber AO, et al. Effect of corticosteroid withdrawal on tacrolimus and mycopheno-late mofetil exposure in a randomized multicenter study. Am J Transplant February 2013 13(2) 474-84. PubMed PMID 23167508. Epub 2012/11/22. eng. 

If it is necessary to use systemic corticosteroids for long-term control therapy, once-daily or every-other-day therapy should be used and repeated attempts should be made to decrease the dose or discontinue the drug. Withdrawal of chronic therapy may precipitate adrenal failure or unmask underlying inflammatory disorders such as Churg-Strauss syndrome. 

Corticosteroids induce a non-specific immunosuppresion. Owing to their overwhelming incidence of adverse events, many practitioners attempt to use low-dose maintenance therapy or, in some cases, complete steroid withdrawal. Corticosteroids are also effective in reversing acute rejection. 

Treatment Discontinue or minimize immunosuppressants Surgical, radiologic, or antineoplastic therapy Do not abruptly withdraw corticosteroids... 

The recommended dose is prednisone 30 to 60 mg (or an equivalent dose of another corticosteroid) orally once daily for 3 to 5 days. Because rebound attacks may occur upon steroid withdrawal, the dose should be gradually tapered in 5-mg increments over 10 to 14 days and discontinued. 

Metabolic stress, infection, corticosteroids, pancreatitis, diabetes mellitus, peritoneal dialysis, excessive dextrose administration Abrupt dextrose withdrawal, excessive insulin Excess dextrose administration... 

For alcoholic hepatitis is no specific treatment beyond alcohol withdrawal. Corticosteroids have no value. Fatty change in the liver is common, but should not be confused with fatty change associated with non-alcoholic disease, notably diabetes melli-tus. 

IV.a.1.9. Adrenal suppression. It results from inhibition of pituitary ACTH secretion, and some suppression of the normal adrenal response to stress may persist for years after stopping therapy. Rapid withdrawal of corticosteroid therapy can therefore precipitate dangerous acute adrenal insufficiency ( Addisonian crisis , with hypotension, vomiting, coma and ultimately death), and for this reason steroid treatment should always be reduced gradually, sometimes over many months, according to the dose and duration of therapy. 

Abruptly withdrawing the drug after long-term therapy may require supplemental systemic corticosteroids. 

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