When switching a patient from one steroid to another (i.e. 0.5mg Dexamethasone to 5.0mg Prednisone), do you suggest weaning? What would you recommend as the best course of action?
0.5mg of Dexamethasone is a little more glucocorticoid than 5mg of Prednisone. I would suggest stopping the Dex and then starting with 7.5mg of Prednisone (1 tablet a.m., tablet p.m.). If all is going well, consider stopping the p.m. half tablet. Why do you not prefer your patients to take dexamethasone, and instead prefer they take cortisone? I have read that dexamethasone stays in ones system for 24 hours and thus may make someone feel better. Your question about taking dexamethasone for glucocorticoid replacement is a logical one. The body normally secretes hydrocorticortisone (cortisol) in small bursts throughout the 24 hrs. The bursts are more frequent starting about 4 AM so that the blood level of cortisol is highest when we get up in the morning. The timing of these bursts is governed by the time we usually rise in the morning. During the day, the bursts are less frequent, so the average blood level falls throughout the day and is lowest around midnight.
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