From the Guidelines
Steroid withdrawal is a condition that occurs when the body is unable to produce enough cortisol after taking corticosteroid medications for an extended period, leading to symptoms such as weakness, fatigue, and nausea, and can be prevented by tapering the dosage gradually under medical supervision. This condition happens because long-term steroid use suppresses the body's natural production of cortisol by the adrenal glands, and when steroids are abruptly discontinued, the adrenal glands need time to resume normal function, creating a temporary cortisol deficiency 1. Common withdrawal symptoms include fatigue, weakness, body aches, joint pain, nausea, loss of appetite, low blood pressure, dizziness, and mood changes including depression and anxiety.
Key Points to Consider
- Steroid withdrawal can mimic the underlying disease, making it under-recognised, occurring in about half of patients tested immediately after withdrawal of medium- or high-dose prednisolone used for long periods 1.
- Patients receiving prolonged courses of corticosteroids are at risk of adrenal suppression and should have a tapering course if stopping, and should be warned about possible steroid withdrawal syndrome, including non-specific symptoms such as weakness, nausea and arthralgia 1.
- The tapering schedule may last weeks to months for those on long-term therapy, and anyone experiencing withdrawal symptoms should contact their healthcare provider immediately, as severe cases can lead to adrenal crisis, which is a medical emergency requiring immediate treatment.
Prevention and Management
- To prevent withdrawal, steroids should always be tapered gradually under medical supervision, typically reducing the dose by 10-20% every 1-2 weeks depending on how long the person has been taking them.
- Patients on long-term steroids should be assessed for osteoporosis risk factors, and consider prolonged bisphosphonate treatment switch, and/or referral to specialist clinic as appropriate 1.
- The use of corticosteroids should be defined as “corticosteroid resistance” as a lack of a symptomatic response despite a course of oral prednisone of 40–60 mg/day (or equivalent) for a minimum of 14 days, and “corticosteroid dependence” as the inability to withdraw oral corticosteroid therapy (within 3 months of initiation) without recurrence of symptoms 1.
From the FDA Drug Label
Following prolonged therapy, withdrawal of corticosteroids may result in symptoms of the corticosteroid withdrawal syndrome including, myalgia, arthralgia, and malaise. Adrenocortical insufficiency may result from too rapid withdrawal of corticosteroids and may be minimized by gradual reduction of dosage This type of relative insufficiency may persist for up to 12 months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted.
Steroid withdrawal refers to the symptoms and complications that can occur when corticosteroids are stopped or reduced in dosage after prolonged use. These symptoms can include:
- Myalgia
- Arthralgia
- Malaise
- Adrenocortical insufficiency, which can be minimized by gradual reduction of dosage. 2 2
From the Research
Definition of Steroid Withdrawal
- Steroid withdrawal refers to the symptoms that occur when an individual stops taking corticosteroids after a prolonged period of use 3, 4, 5.
- These symptoms can range from mild to severe and may include fever, fatigue, and joint pain 5.
Types of Steroid Withdrawal Syndrome
- There are four subgroups of corticosteroid withdrawal syndrome:
- Type I: symptomatic and biochemical evidence of hypothalamic-pituitary-adrenal (HPA) suppression 4.
- Type II: recrudescence of the disease for which the drug was originally prescribed 4.
- Type III: dependence on corticosteroids, either physical or psychological, with normal HPA function and no recrudescence of underlying disease 4.
- Type IV: biochemical evidence of HPA suppression without symptoms and without recurrence of underlying disease 4.
Implications of Steroid Withdrawal
- Steroid withdrawal can have significant implications for patients, including the risk of exacerbating underlying conditions such as chronic obstructive pulmonary disease (COPD) 6.
- However, studies have shown that gradual withdrawal of corticosteroids can be safe and effective in reducing the risk of withdrawal symptoms 6, 7.