Corticosteroids may be withdrawn abruptly provided that the patient has:
Received less than 3 weeks treatment
and not received recent repeated courses of corticosteroids
and received doses less than 4-6mg dexamethasone (or equivalent) total daily dose
and adverse effects are not anticipated by an abrupt withdrawal.
1. Initially reduce rapidly (e.g. halving the dose daily) to physiological doses (dexamethasone 1mg/24h or prednisolone 7.5mg/24h).
2. Subsequently more gradual reduction is advised (e.g. by 1mg–2mg prednisolone per week).
3. Patients should be monitored for any deterioration, in particular for signs of adrenal insufficiency.
If beneficial, corticosteroids should only be continued at a set dose for a maximum of 2–4 weeks, with planned review date to consider withdrawal. Aim to prescribe the lowest dose that controls the symptoms.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.