วันอาทิตย์ที่ 4 กรกฎาคม พ.ศ. 2553

632. Steroid taper

วิธีการลดขนาดของสเตอรอยด์ที่ใช้มาเป็นเวลานานคือ

* If a patient has been receiving daily high doses for 5 days or less, they can be abruptly stopped (or reduced to physiologic replacement if patient is adrenal-deficient). Full adrenal recovery can be assumed to occur by a week afterward.
* If high doses were used for 6-10 days, reduce to replacement dose immediately and taper over 4 more days. Adrenal recovery can be assumed to occur within 2-4 weeks of completion of steroids.
* If high doses were used for 11-30 days, cut immediately to twice replacement, and then by 25% every 4 days. Stop entirely when dose is less than half of replacement. Full adrenal recovery should occur within 1-3 months of completion of withdrawal.
* If high doses were used more than 30 days, cut dose immediately to twice replacement, and reduce by 25% each week until replacement is reached.
* Then change to oral hydrocortisone or cortisone as a single morning dose, and gradually decrease by 2.5 mg each week. When a.m. dose is less than replacement, the return of normal basal adrenal function may be documented by checking 0800 cortisol levels prior to the morning dose; stop drugs when 0800 cortisol is 10 μg/dl. It is difficult to predict the time to full adrenal recovery after prolonged suppressive exogenous steroids; some people may take nearly a year.
* Flare-up of the underlying condition for which steroids are given may require a more gradual taper than outlined above.
Physiologic หรือ replacement หรือ maintenance dosing คำนวนจาก 6-12 mg/m²/day (m² refers to body surface area (BSA), and is a measure of body size; an average man is 1.7 m²).

Ref: http://en.wikipedia.org/wiki/Glucocorticoid

ไม่มีความคิดเห็น:

โพสต์ความคิดเห็น