Stopping cortisone - how and when is the best way to sneak out cortisone?
introduction
The rules and risks related to discontinuing cortisone preparations are based on the body's own processes.
The hormone cortisone is normally produced by the body in the adrenal cortex. Production is subject to a so-called control loop. This means that when the level of cortisone in the blood is low, the adrenal cortex produces the hormone.
If the level is high, it produces accordingly less. As a rule, the natural cortisone level is highest in the morning between 6 a.m. and 8 a.m. and lowest in the evening. Since natural cortisone is weak in its effect, synthetically produced cortisone preparations are used for medical application. These then ensure an increased level of cortisone in the blood. The body's own production of cortisone is then downregulated. Since the adrenal cortex needs some time to ramp up production again, it must never be abruptly stopped after several weeks of cortisone therapy.
The dose must be reduced slowly over months. In this context, one speaks of a so-called "tapering off" of the cortisone preparation.
What are the consequences?
In extreme cases, taking medication containing cortisone could completely inhibit the body's own cortisone production in the adrenal cortex.
If this happens over a longer period of time, the corresponding cells of the adrenal cortex recede. This is known as adrenal cortex atrophy. As a result, after prolonged inactivity, the adrenal cortex is unable to resume cortisone production from one moment to the next.
How strong and quickly this suppression of the body's own cortisone synthesis is pronounced also depends on the time of day when the cortisone is administered from the outside. If this takes place in the body at the point in time when the body's own daily level is actually lowest, the inhibition of the adrenal cortex is strongest. Accordingly, cortisone preparations taken in the evening suppress the adrenal cortex more than those taken in the morning.
Furthermore, the suppression of the body's own cortisone production depends on the type of ingestion. If cortisone is administered into the vein as a cortisone tablet or injection, the cortisone level varies over the course of the day.
However, if cortisone is fed into the body as a depot injection into the muscle, a sustained, even cortisone level is created. In this way, the body's own cortisone synthesis is particularly strongly inhibited.
Abrupt cessation of external cortisone administration could cause an acute cortisone deficiency in the body. Since cortisone has important tasks in the metabolic processes of the muscles, the skin, the adipose tissue and the protein and sugar metabolic pathways, a deficiency can lead to failures.
Suddenly stopping cortisone could cause the disease to flare up or cause inflammation. Furthermore, the side effects can be more pronounced. Complaints like:
- fatigue
- Gastrointestinal problems
- Joint pain
- Muscle stiffness
- Muscle weakness
- Restlessness
- nervousness
- sleep disorders
- Sweats and fever
can occur.
In addition, a change in mood, often in a depressive direction, can develop. Cortisone also plays an important role as a so-called stress hormone. It therefore has an essential protective function for the body. Should this fail, it can have fatal consequences. In particular, if the adrenal cortex shows weakness, but has not failed completely, the lack of cortisone may initially be normal. In this case the adrenal cortex can produce its own cortisone for "everyday use".
But in a stress reaction, such as in the case of inflammation, an accident, a serious injury or an operation, cortisone synthesis would then not be sufficient. An abrupt drop in blood pressure could occur and other life-threatening reactions could ensue.
The bottom line is that the sudden discontinuation of cortisone can lead to life-threatening adrenal insufficiency.
You might also be interested in this topic: What are the side effects of cortions?
When do I have to start tapering off cortisone?
The general rule of thumb for tapering off cortisone is to minimize the dose every 3-5 days or in 2.5 mg increments.
A short-term treatment of up to 10 days usually does not necessarily have to be tapered. If external cortisone has been administered for more than 10 days, the drug must be tapered off. Tapering should always be discussed individually with the doctor. At best, an intake plan is drawn up in writing that the patient takes home.
If you experience discomfort or uncertainty when tapering off the cortisone, it is advisable to consult your doctor. Before any surgical interventions at the doctor or dentist, it should always be stated if cortisone is being taken or was taken within the last year. In these cases or in other stressful situations, the dose of cortisone may have to be temporarily increased or taken again.
Possible side effects of stopping Cortsion
The side effect of insomnia from stopping cortisone
Normally the body's own cortisone levels are low in the evening and night.
Depending on when the cortisone was taken and the body has adjusted, sleep disorders can occur when the drug is discontinued. It can take some time for the body to adjust to its natural rhythm again. Individual advice from the attending physician can help reduce insomnia.
Side effect weight loss due to the discontinuation of cortisone
Cortisone preparations themselves have no direct influence on weight. They do not cause weight gain. Similarly, stopping cortisone does not directly cause weight loss. But since the appetite can be increased by the administration of cortisone, it can lead to weight gain. In addition, the sugar and fat metabolism, for example, are changed. This can affect the weight.
When weaning, it is possible that the opposite will happen. Weight loss can occur.
Sweating as a side effect of cortisone withdrawal
The hormone cortisone also affects what are known as central nervous reactions. These include:
- Restlessness
- nervousness
- euphoria
- Depression and
- Sweats
If there is an imbalance in the cortisone balance in the body due to tapering off from a cortisone preparation, changes in sweating behavior can also result.
Nausea as a side effect
Since cortisone is involved in almost all metabolic processes in the body, a lack of endogenous cortisone resulting from discontinuation can lead to nausea. As with all side effects, the same applies here that an individual consultation with the attending physician can provide relief.
