It’s important to taper steroid medications gradually to avoid unpleasant side effects, but tapering schedules will depend on individual needs and may differ for everyone. A doctor can work with you and come up with a plan.
Glucocorticoids, or corticosteroids, are hormones produced by the adrenal glands, the pea-sized glands situated on top of the kidneys. These hormones are essential for many bodily functions, like managing how your body absorbs nutrients, lowering inflammation, and even managing your blood pressure.
One important steroid hormone is cortisol. Cortisol is responsible for how you respond to stress, or your fight-or-flight response. It also manages your sleep and wake cycle. Its highest levels are at 8 a.m., and its lowest levels are between midnight and 4 a.m.
Steroid medications are synthetic hormones used to treat autoimmune diseases. Autoimmune diseases typically mean that the immune system starts attacking organs and tissues in the body instead of working as it should. Glucocorticoids are different from anabolic steroids, which some people might take to build muscle.
Read on to learn how to taper steroids safely, and what the side effects and risks associated with it are.
Synthetic glucocorticoids are anti-inflammatory medications. They come in various forms, ranging from tablets and inhalers to nasal sprays and injections, and down to creams, lotions, and even gels. Healthcare professionals prescribe them to treat various conditions, including:
It’s very important to discontinue medications according to your doctor’s inctructions. Your tapering schedule can vary and will be dependent on indvidual factors such as the severity of your condition or the duration of your treatment.
For short courses of steroids, your doctor may advise abrupt discontinuation, especially if the condition has been resolved. This, however, doesn’t apply in all cases, as abrupt discontinuation may cause side effects or a flare-up of the condition you’re treating.
In these cases, your doctor will most likely advise you to taper your medication gradually to avoid side effects.
For long-term conditions such as rheumatoid arthritis, long-term use of the medication at lower doses may actually prevent a flare-up in symptoms.
These are some general tapering recommendations for several conditions, but your schedule will be based on your particular disease and your doctor’s personalized recommendations. Do not discontinue any of your medications without asking for your doctor’s advice first.
Healthcare professionals usually try to prescribe the lowest possible dose of corticosteroids for the shortest possible time to avoid side effects that can occur with this type of therapy. The side effects of steroids will usually be dependent on different factors such as:
- type of drug
- dose
- strength
- duration of treatment
- time of administration
- individual reaction
Steroids don’t cause significant side effects if they’re taken for a short period of time. Prolonged use of certain steroids may cause a host of unpleasant symptoms such as:
- increased appetite
- sleep disturbances
- weight gain
- high blood pressure
- diabetes
- decreased bone density
- decreased muscle mass
- gastrointestinal issues such as an ulcer or acid reflux
- mood disorders such as depression
- glaucoma
- delayed wound healing
Risk factors
Prolonged treatment and exposure to steroids can suppress the hypothalamic-pituitary-adrenal (HPA) axis, which means the body will have an impaired stress response and may be unable to properly defend against infections.
This can occur in the first few days after stopping treatment with steroids, if these have been taken for a long time. The HPA axis usually recovers quicker if the steroid treatment is short term, rather than long term.
Tapering the medication gradually is important to avoid unpleasant side effects. Side effects are more likely to occur with oral medications, rather than sprays or topical creams.
Medications with a lower risk of HPA suppression include longer-acting and stronger corticosteroids, such as:
- dexamethasone
- betamethasone
- beclomethasone
Intermediate acting and shorter acting steroids come with a lower risk of HPA suppression, and therefore fewer side effects. These medications include:
Other factors associated with lower or higher HPA suppression can be found in the table below:
| Factors | Higher HPA suppression | Lower HPA suppression |
|---|---|---|
| Dosage | higher daily dose | lower daily dose |
| Duration of treatment | short-term use, usually less than 2 to 3 weeks | prolonged use, usually more than 3 to 4 weeks |
| Route of administration | oral medications | inhaled or topical medications |
Other medications
Taking certain medications at the same time as your steroid medication can increase the risk of HPA suppression. These medications include:
- clarithromycin
- erythromycin
- itraconazole
- ritonavir
- lopinavir
- mifepristone
- amiodarone
Steroids, corticosteroids, or glucocorticoids are anti-inflammatory medications used to treat a variety of conditions, including asthma, lupus, and rheumatoid arthritis.
Depending on your specific condition, your doctor will recommend a tapering schedule that suits your needs. For a shorter course of medication, you might be able to discontinue your treatment without tapering, if your doctor things it’s appropriate for you.
For a long-term condition or longer-term treatment, your doctor might recommend gradual tapering or employ different strategies to help you discontinue steroids.
Talk with your doctor if you have any questions or concerns about how to safely taper your medications, and what side effects might apply to you.