Rationalising oral corticosteroids used for chronic inflammatory conditions in palliative care

Long-term corticosteroids taken for chronic inflammatory conditions (eg rheumatoid arthritis, Crohn disease) are usually tapered over the last weeks of life—seek specialist advice (if available). Follow an individualised dose-reduction plan to decrease the risk of adrenal insufficiency or re-emergence of inflammatory symptoms. The rate of tapering depends on the dose, duration of treatment and stability of disease. For patients who are likely to experience symptom relapse on withdrawal (eg those who have had previous relapses), instead of withdrawing the corticosteroid, it may be appropriate to switch to an equivalent dose of subcutaneous dexamethasone. Approximate relative potency and duration of effect of glucocorticoids in the Bone and Metabolism guidelines lists approximate relative potencies of glucocorticoids; although the subcutaneous route of administration is not addressed in this table, the relative potencies listed can be used to calculate an equivalent dose of subcutaneous dexamethasone.