Clinical situations requiring immediate cessation of glucocorticoids or a rapid reduction

Q: It is always preferred to wean the steroids, particularly in long-term use. However, in which two clinical situations should immediate cessation of glucocorticoids or a rapid reduction be considered?

Answer:

Indeed, weaning glucocorticoids is always preferred instead of sudden withdrawal, particularly in long-term usage. But, immediate cessation or a rapid reduction should be considered in at least two of the following situations: 

- Steroid-induced acute psychosis 

- Herpesvirus-induced corneal ulceration

If steroid-induced acute psychosis is unresponsive to antipsychotic medications, it can become a life-threatening issue. Similarly, herpesvirus-induced corneal ulceration can rapidly lead to perforation of the cornea and potentially permanent blindness. 

 If immediate cessation is not possible, the lowest necessary dose should be used.

#pharmacology

#psychiatry

#optalmology

References:

1. Thomas P. Warrington, J. Michael Bostwick: Psychiatric Adverse Effects of Corticosteroids - Mayo Clinic Proceedings - VOLUME 81, ISSUE 10, P1361-1367, OCTOBER 2006 :: DOI:https://doi.org/10.4065/81.10.1361

2. Sibley D, Larkin DFP. Update on Herpes simplex keratitis management. Eye (Lond). 2020 Dec;34(12):2219-2226. doi: 10.1038/s41433-020-01153-x. Epub 2020 Aug 25. PMID: 32843744; PMCID: PMC7784930.

3. Komminoth M, Donath MY, Hepprich M, Schuetz P, Blum CA, Mueller B, Reny JL, Gosselin P, Breville G, Brändle M, Henzen C, Leuppi JD, Kistler AD, Thurnheer R, Beuschlein F, Rudofsky G, Aeberli D, Villiger PM, Böhm S, Chifu I, Fassnacht M, Meyer G, Bojunga J, Cattaneo M, Sluka C, Schneider H, Rutishauser J; «TOASST» study group. Glucocorticoid withdrawal and glucocorticoid-induced adrenal insufficiency: Study protocol of the randomized controlled «TOASST" (Taper Or Abrupt Steroid STop) multicenter trial. PLoS One. 2023 Apr 5;18(4):e0281585. doi: 10.1371/journal.pone.0281585. PMID: 37018188; PMCID: PMC10075434.