From the FDA Drug Label
The initial dosage of hydrocortisone tablets may vary from 20 mg to 240 mg of hydrocortisone per day depending on the specific disease entity being treated. ... After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. ... If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually, rather than abruptly
The tapering protocol for Solu-Cortef (hydrocortisone) involves:
- Decreasing the initial drug dosage in small decrements at appropriate time intervals
- Gradually withdrawing the drug if it is to be stopped after long-term therapy, rather than stopping it abruptly 1
From the Research
For patients who have been on high-dose or prolonged Solu-Cortef (hydrocortisone) therapy, I recommend a gradual taper rather than abrupt discontinuation to prevent adrenal insufficiency, with a taper schedule that reduces the dose by approximately 20-25% every 3-7 days, depending on the patient's condition and duration of prior steroid use, as suggested by the most recent study 2. When tapering Solu-Cortef, it is essential to consider the patient's individual circumstances, such as the duration of prior steroid use and the presence of any underlying medical conditions.
- The taper schedule should be tailored to the patient's specific needs, with more gradual tapering required for patients who have been on steroids for more than 2-3 weeks, as they are at higher risk for adrenal suppression 2.
- During the taper, it is crucial to monitor for signs of adrenal insufficiency, such as fatigue, weakness, nausea, hypotension, or hypoglycemia, and adjust the taper schedule as needed 3.
- The use of short- or intermediate-acting glucocorticoid preparations, such as hydrocortisone, is recommended, as they allow for more precise control over cortisol levels and minimize the risk of adrenal insufficiency 2.
- Patients should be advised to carry a steroid alert card and to increase their glucocorticoid dose during periods of acute medical or surgical illness to prevent adrenal crisis 2. The goal of the taper is to allow the adrenal glands to recover their normal function and resume adequate cortisol production, while minimizing the risk of disease flare-up or symptoms of adrenal insufficiency 2.
- A gradual taper, rather than abrupt discontinuation, is necessary to prevent adrenal insufficiency, as exogenous corticosteroids suppress the hypothalamic-pituitary-adrenal axis, and abrupt discontinuation can lead to insufficient cortisol production by the adrenal glands 3.
- The most recent study 2 provides the best guidance on tapering Solu-Cortef, and its recommendations should be followed to minimize the risk of adverse effects and ensure the best possible outcomes for patients.