Taper
Formal Definition
A gradual, stepwise reduction in medication dose over a defined period, used to avoid withdrawal syndromes, prevent rebound physiologic effects, or allow the body to adapt to decreasing drug levels.
How It's Used on the Ward
"Steroid taper" or "taper the prednisone" — the plan to come off a medication slowly rather than stopping abruptly.
Example
""Discharged on a 10-day prednisone taper for acute COPD exacerbation: 40mg days 1–3, 30mg days 4–5, 20mg days 6–7, 10mg days 8–9, 5mg day 10, then stop. Abrupt discontinuation after 7+ days of steroids risks adrenal insufficiency.""
Clinical Context
The clinical logic for tapering: HPA-axis suppression (steroids), physical dependence (opioids, benzodiazepines, alcohol), rebound effects (beta-blockers — abrupt discontinuation causes rebound tachycardia and hypertension, precipitating ACS in at-risk patients). Steroids >3 weeks require taper — below 3 weeks, it's debated. Never abruptly stop long-term steroids, beta-blockers, or benzodiazepines without a plan.
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