Cessation of cortisone – What must be observed and what are the consequences?
Cessation of cortisone becomes a problem primarily when it is taken over a long period of time and in high doses, as well as systemically. Systemic means that the application takes place in such a way that it affects the whole body. This is the case, for example, when taking cortisone preparations in tablet form.
If used locally, for example as a nasal spray or ointment, discontinuation is not such a big problem. However, if cortisone preparations have been taken as tablets over a longer period of time and in higher doses, the tablets should not be discontinued immediately but the dose should be reduced slowly. This is because the body produces cortisol itself, in the adrenal cortex.
If, in addition to the body’s own production, cortisone is now supplied from outside, i.e. in tablet form, the body believes there is too much or enough cortisone and reports this to a control centre in the central nervous system. This message leads to a significant reduction in the body’s own production of cortisol. If this is the case over a longer period of time, as is the case with cortisone therapy over months or years, the adrenal cortex slowly recedes because the cells that produce cortisol become less and less.
This leads to a so-called adrenal cortex atrophy. If the cortisone tablet is suddenly discontinued, an acute lack of cortisone occurs because the “sleeping” adrenal cortex cannot react as quickly. This can have life-threatening consequences.
It is therefore important to get the adrenal cortex used to the fact that it has to resume its own production. To do this, the dose of cortisone tablets is slowly and gradually reduced. How and at what intervals the dose is reduced must be decided by the treating physician.
If cortisone is released sufficiently slowly, there should be no undesirable side effects during discontinuation. If it is expelled too quickly or even discontinued abruptly, it can lead to circulatory crises with possible fatal consequences. For this reason, patients who have been taking cortisone preparations for a long period of time should never discontinue their tablets on their own.
Cortisone and alcohol – is that compatible?
The general rule is that if you take medication regularly, alcohol consumption should only be very controlled. For drugs from the group of corticosteroids, which includes cortisone, the higher the cortisone dose, the lower the alcohol consumption should be, otherwise there may be undesirable effects or a reduction in the effectiveness of the cortisone. Since the long-term intake of higher doses of cortisone is already associated with numerous possible side effects, alcohol consumption should therefore be avoided or severely restricted if possible.
In addition, many patients who have to take cortisone or prednisolone report that they suddenly no longer like or tolerate alcohol well. In principle, the family doctor treating the patient should be asked whether alcohol consumption is permitted in moderation, as it also always plays a role which medications are taken in addition to cortisone.
