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Table 14 Prednisone tapering regimen for children

From: A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

1. Taper GC dose as guided by underlying condition until 30 mg/m2/day of hydrocortisone equivalent is reached (if taper not required for underlying condition, reduce to 30 mg/m2/day)

2. Then taper by 10-20% every 3–7 days until patient is on physiological GC dose (8–10 mg/m2/day hydrocortisone equivalent)

3. Switch to hydrocortisone 8–10 mg/m2/day, given in the morning

4. Discontinue/continue hydrocortisone based on assessment of morning cortisol:

  < 171 nmol/L*:

HPA axis has not recovered

→ continue daily hydrocortisone

→ continue stress hydrocortisone as needed

→ re-evaluate patient in 4–6 weeks

  > 500 nmol/L:

HPA axis is intact

→ discontinue daily and stress hydrocortisone

  171*-500 nmol/L:

Sufficient GC production for day-to-day functioning†

Further evaluation required to determine if stress dosing required:

→ discontinue daily hydrocortisone

→ continue stress dosing as needed

→ low-dose ACTH stimulation testing

↓

If with ACTH testing:

  Peak cortisol > 500 nmol/L:

HPA axis is intact and GC can be discontinued

  Peak cortisol < 500 nmol/L:

Steroids required at times of stress and illness until normal ACTH response is noted

  1. GC: glucocorticoid; HPA: hypothalamic-pituitary-adrenal; ACTH: adrenocorticotropic hormone.
  2. *If lab norm for morning cortisol is >171 nmol/L, use lab norm.
  3. †If symptomatic despite normal first morning cortisol, continue daily and stress hydrocortisone and contact pediatric endocrinologist.