Corticosteroid Tapering Protocol

Introduction to Tapering

The American College of Physicians recommends tapering IV hydrocortisone over 1-3 days if the precipitating illness permits, transitioning to oral therapy 1
The American Society of Clinical Oncology suggests tapering over 5-10 days from stress doses to maintenance for moderate symptoms 2
The American Society of Clinical Oncology also recommends tapering over 7-14 days after discharge from hospital for severe symptoms 2
The Endocrine Society advises tapering over 5-7 days down to oral maintenance doses when tapering from high-dose IV therapy 3

The American College of Physicians recommends tapering prednisone 1 mg/kg/day over 1-2 weeks, then transitioning to physiologic maintenance once down to 5 mg prednisone equivalent 3
The American Society of Clinical Oncology suggests reducing to physiologic replacement doses first (hydrocortisone 15-20 mg daily or prednisone 5 mg daily) 3, 2
The European Society of Endocrinology recommends restarting fludrocortisone (0.05-0.1 mg daily) for mineralocorticoid replacement in primary adrenal insufficiency when tapering below 50 mg hydrocortisone daily 1, 4

The American Society of Clinical Oncology recommends monitoring morning (8 AM) serum cortisol and ACTH when approaching physiologic doses 5
The Endocrine Society suggests monitoring electrolytes (sodium, potassium) to assess for adrenal insufficiency 2, 4
The American College of Physicians advises monitoring blood pressure, including orthostatic measurements 1, 4
The American Society of Clinical Oncology recommends increasing glucocorticoid dose temporarily to 2-3 times maintenance for true adrenal insufficiency 2

The American College of Physicians recommends educating patients to never stop corticosteroids abruptly without medical supervision 5, 4
The Endocrine Society suggests educating patients on stress dosing protocols: double or triple dose during illness, fever, or physical stress 5, 4
The American Society of Clinical Oncology advises educating patients on the use of an emergency injectable hydrocortisone kit (100 mg IM) with self-injection training 5, 4
The European Society of Endocrinology recommends educating patients to seek immediate medical attention for severe illness, vomiting, or signs of adrenal crisis 3, 2, 4