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Table 3. Risk Factors for Developing Adrenal Insufficiency,
and Susceptibility to Adrenal Crisis, During
Glucocorticoid Therapy and Withdrawal from Therapy
Factors
Risk for adrenal insufficiency and crisis
Low Moderate High
Glucocorticoid
potency
Hydrocortisone
Cortisone acetate
Deflazacort
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
Dexamethasone
Betamethasone
Fluticasone
Administration
route
Nasal
Topical
Ophthalmic
Inhaled Systemic (oral,
intramuscular,
intravenous)
Intra-articular
Concurrent use
of differently
administered
glucocorticoid
Dose Low Medium High
Duration of use <3–4 weeks 3–4 weeks –
3 months
>3 months
Body Mass Index Normal Overweight Obese
Age Younger adults Older adults
Table 4. Suggested Tapering Regimen Depending on
Glucocorticoid Dose
Patient's current
daily prednisone
equivalent dose Suggested prednisone decrements Time interval
>40 mg 5–10 mg decrease Every week
20–40 mg 5 mg decrease Every week
10–20 mg 2.5 mg decrease Every 1–4 weeks
5–10 mg 1 mg decrease Every 1–4 weeks
5 mg In absence of clinical symptoms or negative
testing for adrenal insufficiency continue
1 mg decrease
(if low dosage prednisolone preparations
are not available, alternative: 20 mg
hydrocortisone with 5 mg decrease)
Every 4 weeks
