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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.