Hello madhu1951,
Corticosteroids, as you know, are similar to cortisol, a hormone
produced naturally in the body. During times of stress, emotional or
physical, extra amounts of cortisol are released by the adrenal
glands. Since our brains are unable to discern whether the blood level
of cortisol is naturally made or ingested, natural cortisol production
is suppressed when the level is high. After a time, naturally produced
cortisol may be halted altogether. Typically, when a doctor prescribes
steroids, the dosage is gradually decreased, allowing the adrenals
time to recover and begin normal cortisol production. One should never
abruptly stop taking steroids. Up to seven days may be needed for the
residual steroid to be excreted from the body. Some doctors recommend
taking up to a year, very gradually decreasing the dosage each month.
According to Medicine Net ?How quickly steroids can be tapered depends
on continued control of the underlying disease with decreasing doses,
and on how quickly our body adjusts to the need to produce its own
hormones. If things go well, four to six weeks (or longer) is a
reasonable period.? Symptoms of steroid withdrawal can include
fatigue, loss of appetite, weight loss, diarrhea, abdominal pain, and
fainting.
http://www.thione.com/4step.php
http://www.medicinenet.com/steroid_withdrawal/page1.htm
This University of Miami School of Medicine site states? Over the
years, researchers began to learn why some patients develop symptoms
of decreased adrenal function, while others never do. The production
of corticosteroids is controlled by a "feedback mechanism," involving
the adrenal glands, the pituitary gland and brain-the
Hypothalamic-Pituitary-Adrenal Axis" (HPAA). The continuous
administration of corticosteroids inhibits this mechanism, causing the
HPAA to "hibernate."? This site also concurs with the tapering, and
alternate day dosing regimen.
http://www.med.miami.edu/patients/glossary/art.asp?articlekey=484
Using corticosteroids such as prednisolone or prednisone long term
can cause bone density loss and osteoporosis by decreasing the
absorption of dietary calcium. Supplementing your diet with Vitamin D
and 1000 mg. of calcium daily if premenopausal, 1500 mg daily if
postmenopausal, can help, but will not stop bone loss completely.
http://www.medicinenet.com/Ulcerative_Colitis/page5.htm
This University of Washington site says ? This "steroid withdrawal
syndrome" may involve aching in the muscles, bones, and joints;
nausea; weight loss; headache; and/or fever. Fortunately, the symptoms
usually are not very severe, and they don't last more than a couple of
weeks at the most. If your corticosteroids are being tapered and you
develop symptoms, check with your doctor to make sure it is not the
disease flaring up.?
http://www.orthop.washington.edu/arthritis/medications/corticosteroids/06
http://www.medicinenet.com/steroid_withdrawal/page1.htm
http://www.medsafe.govt.nz/profs/Datasheet/c/Cortisonetab.htm
?Taking steroids every other morning gives the body a better chance to
recover function. The day without the hormone allows natural
stimulation of the hypothalamus and pituitary glands. Thus,
alternate-day therapy is ideal, if possible, once the disease is under
control. It is still not clear whether new steroids being developed
will available to decrease the risks of side effects and HPAA
suppression.? According to MedicineNet
http://www.medicinenet.com/steroid_withdrawal/page1.htm
This article by John Walsh, and Colin Dayan, University Department of
Medicine, Bristol Royal Infirmary describes ways of withdrawing from
steroids, making it clear that not every method works equally well for
all patients. Every-other day dosing, to monitoring blood cortisol
levels is discussed. One method commonly used for long term steroid
users, is to reduce the dosage by a one or one and a half milligram
each month, over 7-12 months. See the bottom of Page 6, continuing
onto Page 7
http://www.leeds.ac.uk/acb/annals/annals_pdf/May00/ACB279.PDF
From the Colorado Health Site, ?Some guidelines for tapering
corticosteroids suggest that patients on high doses of steroids, or
patients receiving long-term treatment, should be tapered over 9 to 12
months to limit the symptoms associated with steroid withdrawal. Your
body naturally makes steroids, but after taking medication such as
prednisone at high doses or for long periods of time, your body will
eventually stop making its own. When you begin to taper your
prednisone dose, your body will once again start producing its own
steroids. However, it may take your body weeks to months to return to
its normal production level. One side effect of taking prednisone in
doses greater than 5mg/day, for a long period of time, may be adrenal
suppression. This suppression may last as long as 9 to 12 months after
discontinuing corticosteroids at doses similar to what you have been
taking (15-30mg). Withdrawal symptoms may include headache, fever,
joint pain, muscle pain, nausea, vomiting, weight loss, lethargy, and
low blood pressure. If you experience any of these symptoms while
tapering your prednisone, you should contact your doctor immediately.
By gradually tapering your prednisone dose, these symptoms may be
minimized. One regimen suggests dosage reductions of prednisone 2.5mg
every 3 to 7 days until a dose of 5 to 10mg/day is reached. Remember,
if you experience any form of stress (infection, surgery, trauma) up
to one year after stopping prednisone, steroid replacement therapy may
be indicated. Your body may not yet be capable of producing enough
steroids to help you cope with the added stress.?
http://www.coloradohealthsite.org/chnqna.html?Drug%20Information%20Center?Lupus?801
According to Stephen Holland, M.D., University of Illinois College of
Medicine, Peoria, IL ?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.?
http://homepage.mac.com/sholland/Papers/Steroid.html
?Tapering practices vary considerably between prescribers and
depending on the length of, the clinical condition being treated, and
the patient's clinical status.?
http://www.ascp.com/public/pubs/tcp/1996/may/subacutecareforum.htmltherapy
http://www.uveitis.org/_disc1/00000050.htm
and the reply
http://www.uveitis.org/_disc1/00000053.htm
?One should be cautious about abruptly stopping corticosteroids
completely. We often gradually reduce the dosage over a period of a
few days, and sometimes the tapering process can be very slow, lasting
months, depending upon symptoms. One should always check with their
physician before making any major change in corticosteroid dosage.?
Meditation project website
http://meditationproject.com/VanDyke.html
Your doctor can prescribe additional medicines to help you through
withdrawing from steroids. Only your doctor, who is familiar with your
medical history can determine which, if any can help you.
?Bisphosphonates can reverse the negative impact of steroids.?
According to this Myeloma-Web site
http://www.myelomaaustralasia.com/myeloma-web/myeloma-news/autumn-2000/steroids-why-we-love-them.asp
This personal webpage has a nicely done chart on steroid tapering.
While aimed at fibromyalgia patients, the steroid weaning effects are
the same. http://members.cox.net/cnsv/Steroid%20Effects.htm
Using a medical ID bracelet or carrying a medical alert card is suggested.
http://dermatology.ucsf.edu/autoimmune/medstaper.htm
http://www.mca.gov.uk/ourwork/monitorsafequalmed/currentproblems/volume24may.htm
I must add here that information in my answer is not meant to replace
sound medical advice from your physician. Please refer to the
disclaimer at the bottom of this page. Please also discuss your desire
to withdraw from corticosteroids, with as little discomfort as
possible, with your physician. Your doctor will take into account your
medical history and current medications to find an appropriate
withdrawal regimen for you.
If any part of my answer is unclear, or I have duplicated information
you already have, please request an answer clarification, and I will
be happy to help further.
Good luck and good health!
crabcakes-ga
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