what happens if you stop a steroid without tapering?

[kiko]

Does it matter if it is a long term steroid or a medrol dosepak?

Patient called the pharmacy and said that her antibiotic was tearing up her stomach and that she wanted to quit it. Looked at her profile and realized that she was really taking medrol. Counseled that taking medrol without food would really make her uncomfortable. She had done 2 days of treatment. It was day 3 (early afternoon), and she had skipped the breakfast and lunch doses. All I could find was failing to taper a steroid could cause "unpleasant side effects." And, her condition would not be fully treated.

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[zelman]

Does it matter if it is a long term steroid or a medrol dosepak?

Patient called the pharmacy and said that her antibiotic was tearing up her stomach and that she wanted to quit it. Looked at her profile and realized that she was really taking medrol. Counseled that taking medrol without food would really make her uncomfortable. She had done 2 days of treatment. It was day 3 (early afternoon), and she had skipped the breakfast and lunch doses. All I could find was failing to taper a steroid could cause "unpleasant side effects." And, her condition would not be fully treated.

After 2 days, nothing. They will just stop getting benefit. The reason for a taper is to help the body slowly realize it needs to start producing glucocorticoids again. They haven't been taking it long enough for their body to stop yet.

 

[Quiksilver]

Does it matter if it is a long term steroid or a medrol dosepak?

Patient called the pharmacy and said that her antibiotic was tearing up her stomach and that she wanted to quit it. Looked at her profile and realized that she was really taking medrol. Counseled that taking medrol without food would really make her uncomfortable. She had done 2 days of treatment. It was day 3 (early afternoon), and she had skipped the breakfast and lunch doses. All I could find was failing to taper a steroid could cause "unpleasant side effects." And, her condition would not be fully treated.

Whoa long term steroid use is not the same as a 5 day course of methylpred. It starts with understanding what steroids do in the body (minus the androgrens) and how the body determines how much steroids to produce. If you are pre-pharmer ,start looking this stuff up... Its simple biology.

In some cases the affects of abrupt discontinuation can have bigger side effects than a baby daily dose of methylpred of 32 mg.

 

[rph3664]

Nothing adverse would happen to her, but she also wouldn't get the benefit of therapy. I do emphasize, yes, she needs to take it with food.

Several years ago, my dad was prescribed a 5-day course of prednisone, and he was reluctant to take it because his "Family Drug Guide" said it could cause diabetes and osteoporosis. I told him that it could if he took it for 5 YEARS, but not for 5 days.

 

[kiko]

Thanks for the replies. I realize I need to update my status.

It looks like the "unpleasant effects" of abruptly stopping or even tapering, for that matter, are things like joint pain, loss of appetite, and moodiness - that's what I was at a loss for and what she wanted to know. And, of course, whatever process the dosepak was prescribed to treat probably would not have been resolved in 2 days.

 

[group_theory]

Thanks for the replies. I realize I need to update my status.

It looks like the "unpleasant effects" of abruptly stopping or even tapering, for that matter, are things like joint pain, loss of appetite, and moodiness - that's what I was at a loss for and what she wanted to know. And, of course, whatever process the dosepak was prescribed to treat probably would not have been resolved in 2 days.

Depending on degree of adrenal insufficiency, it can lead to a wide range of presentation, from an acute surgical abdomen picture, to EKG changes (mimicking an MI), to hemodynamic instability, and even death. Some can present with only mild symptoms (such as the joint pain, loss of appetite, moodiness). Some might not even notice any effects.

You probably won't get any of this with a medrol dose pack. But for someone who needs to be on chronic steroids, abrupt discontinuation is not only unpleasant, but can be life threatening (in addition to allowing the underlying disease to flare-up)

 

[Carboxide]

Does it matter if it is a long term steroid or a medrol dosepak?

Patient called the pharmacy and said that her antibiotic was tearing up her stomach and that she wanted to quit it. Looked at her profile and realized that she was really taking medrol. Counseled that taking medrol without food would really make her uncomfortable. She had done 2 days of treatment. It was day 3 (early afternoon), and she had skipped the breakfast and lunch doses. All I could find was failing to taper a steroid could cause "unpleasant side effects." And, her condition would not be fully treated.

Okay, let me be clear here...you are pre-pharmacy, you should NOT be answering those questions for patients. You need to refer them to the pharmacist. That is not acceptable.

Patient should have been counseled to take with food or milk on each dose, start again when her next dose is due, and complete pack - probably skipping doses she missed. If she absolutely refused to continue taking it, I'd want to know what she was taking it for before determining if she needed to contact the doctor.

Long-term steroid use can decrease or stop the natural production of cortisol, so abruptly stopping it can put a patient into Addison's. Slowly tapering will allow the adrenal gland to start making it again slowly. This isn't an issue with short term treatment like a dose pack. However, those AEs you mentioned in your last post are probably not an issue either (joint pain, appetite suppression, moodiness).

 

[Blackboxrx]

Start doing primary lit searches (or for something like this, a review article is fine) on pubmed. Internet forums are not appropriate places to solicit drug therapy recommendations.