Introduction
Cortisone preparations are among the drugs that have to be discontinued. This means they must not be discontinued abruptly. The dose must be slowly reduced.
The reason for this is that the body’s own cortisone production of the adrenal cortex is suppressed by an external administration of cortisone for more than 10 days. The adrenal cortex needs some time to completely take over the body’s own cortisone production again. An abrupt discontinuation of the cortisone preparations could lead to a cortisone deficiency in the body. This could have serious consequences. It is therefore important to discontinue cortisone preparations.
Is there a fixed scheme for this?
There are recommended fixed schemes, which differ only slightly from each other. These shemata can and should be individually adapted to the patients. Some authors recommend a discontinuation of cortisone preparations after an application period of 10 days or longer.
Other authors describe that the body’s own adrenal cortex is not yet suppressed after 3 weeks of taking cortisone preparations. In addition, they assume that even a dose of prednisone, for example, of a maximum of 5 mg per day does not require any levelling out. Accordingly, cortisone treatment could be discontinued without testing of the adrenal cortex.
According to these authors, an impairment of the adrenal cortex is possible with an intake of 7.5 – 20 mg of prednisone per day for 3 weeks or longer. Consequently, the treatment must be discontinued. Testing of the adrenal cortex may be advisable.
In these cases, testing of adrenal cortex function should always be performed before surgery. The cortisone dose would have to be adjusted accordingly. If treatment with cortisone preparations for about 1.5 or 3 weeks (depending on the author) with more than 20 mg of prednisone daily, a restriction of the adrenal cortex cells is assumed.
The same applies to any so-called Cushing’s syndrome. In this case, the duration and dose of the external administration of cortisone are not decisive. In these cases, cortisone therapy must be discontinued. Here too, testing of the adrenal cortex is possible and an absolute must before an operation.
In which steps should one step out?
Some authors describe a general rule after cortisone preparations should be reduced every 3 – 5 days or in 2.5 mg steps. There are further dose-dependent recommendations. For daily cortisone doses of more than 20 mg, a reduction by 5 – 10 mg daily, every 1 – 2 weeks is recommended.
For daily doses of 20 – 10 mg cortisone, a reduction by 2.5 mg daily, every 1 – 2 weeks may be advisable. For cortisone doses of 10 – 5 mg per day, a reduction of 1.0 mg daily, every 1 – 2 weeks is suggested. For daily doses of less than 5 mg per day, a reduction of 0.5 mg daily every 1 – 2 weeks may be appropriate. In certain cases, a test of the adrenal cortex may be useful.
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