J Clin Endocrinol Metab

How to taper glucocorticoids: Endocrine Society recommendations

August 22, 2024

Regarding tapering systemic glucocorticoids used for non-endocrine conditions, recommendations from the Endocrine Society Joint and European Society of Endocrinology clinical guideline include:

• Short-term use. No tapering is required for patients on short-term (<3-4 weeks) glucocorticoid therapy, regardless of dose; glucocorticoids can be stopped and testing isn’t required.
• Long-term use. Taper only if the underlying disease warranting glucocorticoids is controlled, and glucocorticoids are no longer required. Taper until approaching the physiologic daily dose equivalent (e.g., 4-6 mg prednisone).
• Long/short-acting. Patients on long-acting glucocorticoids (e.g., dexamethasone, betamethasone) should switch to shorter-acting drugs (e.g., hydrocortisone, prednisone) once long-acting glucocorticoids are no longer needed.
• Ending tapers. Patients on a physiologic daily dose equivalent who aim to discontinue glucocorticoids should either undergo a gradual taper while being clinically monitored for signs/ symptoms of adrenal insufficiency or be tested for morning serum cortisol.
• Glucocorticoid withdrawal syndrome. May occur during the taper. If severe, the glucocorticoid dose can be temporarily increased to the most recent previously tolerated dose; thereafter, increase the taper duration.
• Stress coverage. Patients with current/recent glucocorticoid use who didn’t undergo biochemical testing to exclude glucocorticoid-induced adrenal insufficiency should receive stress-dose coverage when exposed to stress.

Source:

Beuschlein F, et al. (2024, June 17). J Clin Endocrinol Metab. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. https://pubmed.ncbi.nlm.nih.gov/38724043/