Stopping corticosteroid therapy
In autoimmune disease, clear end-points should be set before starting therapy. Corticosteroids may improve mood and give patients a feeling of general well-being unrelated to the effect on the disease being treated. Subjective assessments can therefore be misleading. Objective clinical parameters should be used to monitor the need for continuing or restarting therapy . proteinuria in nephritis, spirometry in asthma and creatinine kinase in myositis. Therapy should be tapered off. For example, with prednis(ol)one, the dose is reduced in steps of -5 mg every 3-7 days down to 15 mg/day. At that point, switch to alternate day therapy and reduce in mg steps over 2-3 weeks. This minimises the impact on mood and lessens the drop in general well-being.
Alternatives: As with insomnia (see benzodiazepine hypnotics, above), it's important to identify the cause of excessive daytime sleepiness. Other medications you're taking — whether prescription or over the counter — could be responsible. Drugs with sedating effects, for example, are among the most common causes of excessive daytime sleepiness. (These include alpha- and beta-blockers, anti-diarrheal agents, antihistamines, antipsychotics, antispasmodics, cough suppressants, epilepsy drugs, skeletal muscle relaxants, Parkinson's drugs and some antidepressant medications.)