The dosage of which drug must be tapered off slowly to prevent acute adrenal insufficiency?

Prednisone, a corticosteroid, is commonly used to reduce inflammation and suppress the immune system. When a patient has been on long-term corticosteroid therapy, their body’s own production of corticosteroids may become suppressed due to feedback mechanisms. If prednisone is discontinued suddenly, the adrenal glands may not be capable of producing adequate levels of cortisol, leading to a serious condition called acute adrenal insufficiency, which can result in symptoms such as fatigue, weakness, and even life-threatening crises.

To prevent this, the dosage of prednisone must be gradually tapered down, allowing the adrenal glands time to resume normal function and cortisol production. This tapering process helps minimize the risk of withdrawal symptoms and ensures that the patient's body can adjust to the decrease in exogenous steroid levels safely.

Other medications listed, such as ibuprofen, levothyroxine, and metformin, do not typically require tapering. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and does not lead to adrenal suppression. Levothyroxine, a thyroid hormone replacement, and metformin, used for managing diabetes, are not associated with adrenal insufficiency either. Thus, tapering is specifically critical for corticosteroids like prednisone to ensure patient safety.