What is the correct approach to discontinue long-term corticosteroids?

• A. Always abruptly discontinue after 2 weeks
• B. Gradually taper the dose when stopping
• C. Stop during illness without adjusting dose
• D. Stop if symptoms persist

Answer: (B)

When stopping long-term corticosteroids, the goal is to allow the body's own cortisol production to recover gradually. These medications suppress the hypothalamic-pituitary-adrenal (HPA) axis, so stopping abruptly can lead to adrenal insufficiency—symptoms like fatigue, weakness, low blood pressure, and potential crisis, especially if the person faces stress or illness. That’s why a slow, stepwise taper is used instead of a sudden stop. The taper usually involves small, incremental reductions over weeks, with the pace adjusted based on how long and how high the dose was. If withdrawal symptoms appear, the taper can be slowed or paused and then resumed more gradually. In times of illness or significant stress, the dose may need to be temporarily increased to mimic normal cortisol needs and prevent adrenal crisis.