Purpose of gradual withdrawal	To allow recovery of normal pituitary-adrenal responsiveness to secretion of endogenous corticosteroid without exacerbating the underlying disease state. In most patients, endogenous corticosteroid secretions are equivalent to 5 to 7.5 mg of prednisone.
Recommended tapering schedules	Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment (more than 1 year).
	Depending on dosage, duration of therapy and risk of systemic disease, decrease dosage by the equivalent of 2.5 to 5 mg prednisone every 3 to 7 days until a dosage of 5 mg of prednisone is reached. Then perform a challenge to determine the extent of HPA axis recovery.
	Depending on the results and patient's symptoms, therapy may be discontinued or a slower taper considered.5
Symptoms of adrenal insufficiency due to rapid withdrawal	Headache, dizziness, fainting, fatigue, lethargy, myalgia, joint pain, dyspnea, orthostatic hypotension, nausea, vomiting, anorexia, weight loss, fever, hypoglycemia, desquamation of skin.
	If symptoms do not subside when steroid dosage is adjusted, other causes must be considered.