Prednisone tapering

Clinical improvement usually begins during corticosteroid treatment. No standard exists for the administration of an oral prednisone taper after the intravenous methylprednisolone treatment. If a taper is given, it is usually completed over 1 to 2 weeks. 

Alternatives to ibuprofen include acetaminophen, prednisone taper, and pentoxifylline... 

Historically, steroids and ACTH have been used in the treatment of MS relapses. While both suppress cell mediated and humoral immune responses, the major effect in MS acute relapse is to suppress inflammation. A meta-analysis of randomized controlled clinical trials (Brusaferri and Candelise, 2000) indicates that any type of steroid or ACTH treatment significantly accelerates short-term recovery from an acute MS relapse. However, there is no evidence that steroids reduce the risk of an MS relapse. A randomized trial of oral versus intravenous (IV) methyl prednisolone for treatment of acute relapses of MS shows no clear advantage of either treatment route (Barnes et al., 1997). Currently methyl precbisolone is considered standard of care for acute MS relapses. Methyl precbisolone (Solu-Medrol) is used with IV treatment for 3-5 days at 500-1000 mg/day. Methyl prednisolone IV therapy may be followed by a oral prednisone taper. The use of low dose oral precbisolone is also effective in conjunction with INFp therapies when flu-like side effects persist. 

Haematologic Thrombocytopenia has been reported in a 61-year-old Caucasian hypertensive man who had his losartan increased from 50 to 100 mg per day [16 ]. Platelet count dropped from the baseline value of 280 x lO cells/L to 15 X lO cells/L. Following prednisone taper, his platelet count returned to >200 x 10 cells/L and losartan was replaced with valsartan. Forty-seven days after commencement of valsartan, the platelet count dropped again to 37 X lO cells/L. Valsartan was withheld and prednisolone taper recommenced and the platelet count improved to 214 X IPP cells/L. The authors suggested the possibility of antibody cross-reactivity between losartan and valsartan due to similarity in their molecules. 

Kidney A 14-year-old boy with ulcerative colitis presented with progressive fatigue, nausea and abdominal pain for the past 2 weeks. His ulcerative colitis had been in remission while on mesalazine (1-5 g/day) for the past 3 years. A condition of renal failure was documented by elevations in serum creatinine, mea, potassium and phosphorus levels. Urine analysis showed 40/hpf leukocytes and proteinuria. Creatinine elevation slightly improved by large volume fluid infusion and correction of electrolyte distmbances. A renal biopsy showed active mononuclear infiltration with scattered eosinophils, consistent with interstitial nephritis. Mesalazine was discontinued and the patient was started on intravenous methylprednisolone (1 mg/kg/day) for 3 days followed by prednisone taper for 2 months. His symptoms improved and creatinine normalised within 8 weeks [87 + ]. 

All Prednisone taper Starting on day of procedure 40 mg daily x 2 days, 20 mg dally X 3 days Minimize edema... 

Oral steroids (prednisone tapers or dose packs) or Intramuscular steroids (kenalog 40 mg IM) or Intralesional triamcinolone, gradually increasing the concentration up from 3 mg/oc, injected monthly until resolved... 

Proctitis Mesalamine suppository 1 g rectally daily If no response to mesalamine Prednisone 40-60 mg/day orally May reduce suppository frequency to 1 g 3 times/week taper prednisone as soon as possible Consider adding azathioprine or 6-MP 1.5-2.5 mg/kg per day orally... 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

Evaluate patients receiving systemic corticosteroid therapy for improvement in symptoms and opportunities to taper or discontinue steroid therapy. For patients using more than 5 mg daily of prednisone for more than 2 months or for steroid-dependent patients consider the following ... 

Gradually taper the dose to approximately 20 mg of prednisone or equivalent per day, given in the morning, then ° Change glucocorticoid to every other day administration, in the morning. 

The most commonly used corticosteroids are methylpred-nisolone (IV and oral) and prednisone (oral), although prednisolone and dexamethasone also have been shown to be effective for organ transplantation. Corticosteroid doses vary by center-specific protocols, organ type, and patient characteristics. A typical taper would include an IV 100 to 500 mg bolus of methylprednisolone at the time of transplant and then a taper over 5 to 7 days to a maintenance dose of prednisone 20 mg/day or complete cessation.2,7 It is important for practitioners to know that approximately 4 mg methylprednisolone is equivalent to 5 mg prednisone and 0.75 mg dexamethasone.11 At most transplant centers, therapeutic drug monitoring of corticosteroids is not employed. Corticosteroids are associated with a variety of acute and chronic toxicides. The most common adverse events have been summarized in Table 52-5. 

Systemic corticosteroids are a useful option in patients with contraindications to NSAIDs or colchicine (primarily renal impairment) or polyarticular attacks, especially in elderly patients. A single intramuscular injection of a long-acting corticosteroid such as triamcinolone hexacetonide may be used. Oral agents may be needed, especially for severe attacks. Prednisone 40 to 60 mg (or an equivalent dose of another agent) is given daily, with a gradual taper over 2 weeks. 

Prednisone 100 mg/M2 PO QD X 7 days start with ATG taper over 7 days if no serum sickness Cyclosporine 5 mg/kg/d divided BID taper by 1 mg/kg/month as tolerated... 

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. 

Photosensitivity reactions typically resolve with drug discontinuation. Some patients benefit from topical corticosteroids and oral antihistamines, but these are relatively ineffective. Systemic corticosteroids (e.g., oral prednisone 1 mg/kg/day tapered over 3 weeks) is more effective for these patients. 

The use of glucocorticoids for tuberculous meningitis remains controversial. The administration of steroids such as oral prednisone, 60 to 80 mg/ day (1 to 2 mg/kg/day in children), or 0.2 mg/kg/day of IV dexametha-sone, tapered over 4 to 8 weeks, improves neurologic sequelae and survival in adults and decrease mortality, long-term neurologic complications, and permanent sequelae in children. 

Immunosuppressive/anti-inflammatory Adults Older Feds. Hydrocortisone 15-240 mg PO, IM, IV ql2h Methylprednisolone 4—4 mg/d PO, taper to lowest effective dose Methylprednisolone Na succinate 10-80 mg/d IM. Adults. Prednisone or prednisolone 5-60 mg/d PO daily-qid. Infant Younger Children. Hydrocortisone 2.5-10 mg/kg/d PO q6-8h 1-5 mg/kg/d IM/IV bid. 

Corticosteroids are sometimes used in the treatment of severe symptomatic gout, by intra-articular, systemic, or subcutaneous routes, depending on the degree of pain and inflammation. The most commonly used oral corticosteroid is prednisone. The recommended dose is 30-50 mg/d for 1-2 days, tapered over 7-10 days. Intra-articular injection of 10 mg (small joints), 30 mg (wrist, ankle, elbow), and 40 mg (knee) of triamcinolone acetonide can be given if the patient is unable to take oral medications. 

Glucocorticoids are commonly used in the treatment of patients with moderate to severe active inflammatory bowel disease. Active disease is commonly treated with an initial oral dosage of 40-60 mg/d of prednisone or prednisolone. Higher doses have not been shown to be more efficacious but have significantly greater adverse effects. Once a patient responds to initial therapy (usually within 1-2 weeks), the dosage is tapered to minimize development of adverse effects. In severely ill patients, the drugs are usually administered intravenously. 

A 69-year-old man with newly diagnosed giant cell arteritis was given prednisone 30 mg bd, and 2 weeks later developed severe pain along his Achilles tendons bilaterally 1 week later the left tendon ruptured (278). Despite immobilization his pain worsened. The prednisone was gradually tapered and the symptoms abated, with complete recovery. 

B. Oral prednisone therapy, tapered down over 2 weeks... 

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