Which drug dosage must be tapered off slowly to prevent acute adrenal insufficiency?

The correct choice is cortisone, which is a glucocorticoid medication that can suppress the hypothalamic-pituitary-adrenal (HPA) axis when used over an extended period. When the body is exposed to high levels of corticosteroids, such as cortisone, the natural production of cortisol is diminished. If cortisone is stopped abruptly after long-term use, the body may not be able to produce adequate cortisol in a timely manner, leading to acute adrenal insufficiency. This condition can present serious symptoms, including fatigue, weakness, and low blood pressure.

Gradually tapering off the dosage of cortisone allows the adrenal glands to gradually resume their normal production of cortisol and helps to minimize the risk of adrenal crisis. It is important to manage the tapering process carefully to avoid the complications associated with sudden withdrawal.

While other corticosteroids like dexamethasone, hydrocortisone, and prednisone also require tapering after prolonged use, cortisone is specifically pointed out in this context as needing careful adjustment to prevent the risks associated with acute adrenal insufficiency.