Prednisone is a drug often used in IBD. What does one do to get off prednisone?

Usually, prednisone can be tapered rapidly down to 10 mg/day and then more slowly tapered to none in normal people. In patients with IBD, tapering faster than 10 or 5 mg per month can induce a flare. IBD patients also tend to flare when their dose gets down to 10 to 30 mg/day, usually 15 to 20 mg/day. I find it interesting that the dose is very consistent for a given patient, so a patient's previous taper experience is quite helpful. When one gets to the wall, tapering at 2.5 mg/day each 2 to 4 weeks is usually done, and often the dose has to go back a step up during the taper.

Steroid tapering is unpleasant, and the symptoms of the taper can feel just like IBD. Malaise and joint pains are quite common. This is worrysome to both doctor and patient. After a few tries at tapering and failure but no overt signs of IBD relapse, a decision is made that it is steroid withdrawal, courage develops and one pushes through, usually with success.

All the above is for people not under certain stresses. The adrenals put out about 35 mg/day of cortisol, which is about the same as 10 mg/day of prednisone. Under stress, the doses needed are higher. Someone who has been on prednisone for a time who is tapered down to 10 mg/day, then gets pneumonia will need supplememental steroids until the infection is cleared. Even after being tapered off steroids, for a year afterwards patients may need supplemental steroids during times of metabolic stress.

Stephen Holland, M.D.
Section of Clinical Pharmacology
University of Illinois College of Medicine at Peoria
Gastroenterology Ltd, Peoria, IL

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