Is prednisone (5 milligrams) adrenal suppressive?

From the Guidelines

Prednisone 5mg can cause adrenal suppression, particularly when used for more than 1 month, as it represents an adrenal suppressive dose in a proportion of adults. According to the guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency, a daily glucocorticoid dose equivalent to prednisolone ≥ 5 mg, for longer than 1 month, can lead to adrenal suppression in some adults 1. This is because exogenous corticosteroids like prednisone reduce the body's natural production of cortisol through negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis.

Some key points to consider:

• The risk of adrenal suppression increases with higher doses and longer duration of treatment 1
• Patients on long-term prednisone therapy should be monitored for signs of adrenal insufficiency, such as fatigue, weakness, dizziness, nausea, and hypotension, particularly during times of stress when cortisol requirements increase 1
• It is recommended to taper the medication rather than stopping abruptly to allow the adrenal glands time to resume normal cortisol production
• A pragmatic approach to adrenal replacement during major stress is required, considering factors such as dose, duration, treated condition, and the degree of physiological stress 1

In terms of management, it is essential to consider the individual patient's needs and circumstances. For patients requiring longer courses of prednisone, even at 5mg, it's generally recommended to taper the medication rather than stopping abruptly. Additionally, patients and their treatment teams should be consulted for problems with glucocorticoids, and a cross-sectional study among general practitioners showed insufficient guidance on glucocorticoid use for patients with exacerbations of chronic obstructive pulmonary disease 1.

From the FDA Drug Label

The following should be kept in mind when considering alternate day therapy: ... Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenocortical suppression for 1 1/4 to 1 1/2 days following a single dose) Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every 6 hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used Current recommendations suggest that all interventions be initiated in any patient in whom glucocorticoid therapy with at least the equivalent of 5 mg of prednisone for at least 3 months is anticipated

Adrenal Suppression with Prednisone 5mg:

• The provided text does not directly state that 5mg of prednisone is adrenal suppressive.
• However, it does mention that glucocorticoid therapy with at least the equivalent of 5 mg of prednisone for at least 3 months is anticipated to cause adrenal suppression.
• It also mentions that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used.
• Therefore, it can be inferred that long-term use of prednisone 5mg may be adrenal suppressive, but the exact duration of use required to cause suppression is not specified.
• Short-term use of prednisone 5mg may not be adrenal suppressive, as the text states that other corticoids, including prednisone, are considered to be short acting (producing adrenocortical suppression for 1 1/4 to 1 1/2 days following a single dose) 2.

From the Research

Adrenal Suppression and Prednisone

• The use of prednisone, a systemic glucocorticoid, can lead to adrenal suppression upon discontinuation of the medication and adrenal insufficiency after utilizing supraphysiologic doses for more than one month 3.
• Identifying risk factors for adrenal suppression, such as doses greater than 5 to 7.5 mg of prednisone equivalent, can help risk-stratify patients 4.
• A study found that cumulative dose and exposure to prednisone were predictive for adrenal insufficiency, suggesting that even lower doses like 5 milligrams can be adrenal suppressive if used for an extended period 5.

Risk of Adrenal Insufficiency

• Adrenal insufficiency is frequent in patients treated with long-term glucocorticoids for systemic inflammatory disorders and is related to duration and cumulative dose of steroids 5.
• The risk of acute adrenal crises secondary to glucocorticoid withdrawal can be fatal and arises from chronic suppression of the adrenal glands 4.
• A case study reported a patient diagnosed with secondary adrenal insufficiency caused by chronic corticosteroid treatment, highlighting the importance of monitoring and screening for adrenal function 6.

Dose and Duration of Prednisone

• Doses greater than 5 to 7.5 mg of prednisone equivalent can increase the risk of adrenal suppression 4.
• The duration of glucocorticoid use greater than 3 weeks can also increase the risk of adrenal insufficiency 4.
• A study found that adrenal insufficiency is related to the cumulative dose and exposure to prednisone, suggesting that even lower doses can be adrenal suppressive if used for an extended period 5.