Corticosteroids for Arthritis.
Last updated Thursday, December 30, 2004
WithdrawalWhat are corticosteroid withdrawal symptoms? It may be difficult to lower your dosage of corticosteroids. If you
have been on corticosteroids for more than just a few days, it can be
dangerous to suddenly stop taking them.
Your body must have corticosteroids in case of stress, but the
adrenal gland that produces them may not respond quickly enough. That's
why your doctor usually will prescribe a "tapering schedule" for you,
which is a gradual dose reduction. Be sure to follow your doctor's
advice on how to do this.
Anyone who has taken corticosteroids for a couple of weeks or months
will experience some discomfort when going through a dose reduction
period. This "steroid withdrawal syndrome" may involve aching in the
muscles, bones, and joints; nausea; weight loss; headache; and/or
fever. Fortunately, the symptoms usually are not very severe, and they
don't last more than a couple of weeks at the most. If your
corticosteroids are being tapered and you develop symptoms, check with
your doctor to make sure it is not the disease flaring up. How can corticosteroid withdrawal symptoms be reduced? Sometimes, when you have been on corticosteroids for a while, your
doctor may prescribe an "alternate-day" schedule. This means you take a
higher dose one day, then a lower dose or none the next day, then the
higher dose the third day, and so on. The regimen is altered so your
body can function with less corticosteroids on low-dose days while the
overall total dose (over two days) will keep your disease under
control. Writing the dosage schedule on your calendar will help you
remember it.
Your doctor may prescribe a "steroid-sparing agent" if your disease
flares when corticosteroids are tapered. A steroid-sparing agent refers
to another medication that can help keep the disease under control
while corticosteroids are being tapered. It usually is an
immunosuppressive drug. A steroid-sparing agent might be safer for
long-term medication use than corticosteroids. You still will need to
taper the corticosteroids slowly, though. The most commonly used
steroid-sparing agents are methotrexate (Rheumatrex), azathioprine
(Imuran), and hydroxychloroquine (Plaquenil). If you only have muscle
or joint symptoms while tapering, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to control your symptoms.
What happens after a patient finishes using corticosteroids? If you have been on corticosteroids for more than a few months, and
now you are off, be sure to mention this to your doctors for the next
year. This is especially important if you become very ill, require
surgery for any reason, or need invasive diagnostic tests. In such
instances you may be given a brief course of corticosteroids because
your body may be making less than what would be required under those
stressful circumstances.
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