How does one reduce pred doses by less than 1mg when, to the best of my knowledge the min dose of pred is 1mg, please excuse my ignorance.

[JOHNONE28]

Or does one have to cut the tablets, if so how do you achieve the accurate correct dose.

[Annodomini]

The way I do it is to alternate daily doses; for example, currently I am down to 1.5, so one day I take one and the following day I take two! Hope that helps.

[Celtic PMRGCAuk volunteer]

Hello Johnone28

If you are already on 1mg then I found the easiest way was to cut the 1mg pill in half - I got my pill cutter from Boots. It can be a bit of a challenge achieving equal halves but you will still get the complete 1mg dose over 2 days. It sounds as though you're doing well if you've reached as low as 1mg - well done!

[JOHNONE28 in reply to Celtic]

No at the moment I am on 6mg/ day but some posters recomend reducing by .5 or .25 mg. How does one achieve these low reductions

[Celtic PMRGCAuk volunteer in reply to JOHNONE28]

Johnone - once on the lower doses below 5mg, I reduced in 0.5mg decrements by cutting the 1mg pill in half, as explained in my earlier reply, and tapered slowly, taking the new dose on one day of the first week, two of the second, three of the third etc until I reached the new dose each day. I haven't personally experienced trying to cut our tiny 1mg pills into .25mg - 0.5 was enough of a challenge! It could be that the 1mg pills are prescribed in larger sizes in other countries - perhaps someone will join in with their experience?

[DorsetLady PMRGCAuk volunteer]

Hi Johnone28,

As Celtic says, easiest is to cut pills in half, most pill cutters are very good. The only thing to check is that it is okay to actually cut Prednisolone, some tablets have a special coating to protect the stomach and shouldn't be cut. I found this out when my husband was alive, and got told off by the pharmacist when I asked the question.

If there is a line on one side of the tablet then this usually means its okay to cut, my Pred doesn't, so I would suggest you check first!

Wish I had your problem, one day perhaps. Dorset Lady

[iforget]

I plan to ask the pharmacy to do this for me...

[PMRpro Ambassador]

You must never cut any pred that has an enteric coating - the purpose of the enteric coating is to protect your stomach from the effect of the pred. They just come in 2.5mg and 5mg pills. It isn't economic to make a 1mg version. As an example, I take another form called Lodotra which is taken at night and is released in your gut at 2am, the highest level in your blood is at 4am. The 5mg, 2mg and 1mg versions all cost exactly the same price, about £25 for 30 tablets! So when I was on 8mg a day it cost £75 a month, at 6mg now it is £50, when I get to 5mg it will be £25.

You don't have to take the same dose every day: alternate days of 6mg and 5mg is the same as 5.5mg. I actually reduce in even smaller steps: I take the new dose for 1 day, the old for 7 days. New dose again, old dose for 6 days. Then I continue reducing the days between until I get to alternate days - and that is a successful reduction of 1/2mg! The next 1/2mg is done by INCREASING the days of the new dose between days of old dose until I'm taking the new dose for 6 days with 1 day of old dose. Then I take the new dose every day. By going this slowly I have reduced to 6mg for the first time in 4 years without suffering a flare instead of getting stuck at about 8.5mg. Since I know this sounds complicated this is the regimen I used to go from 7 to 6:

7/6/777777/6/77777/6/7777/6/777/6/77/6/7/6/7/66/7/666/7/6666/7/66666/7/666666

It helps to use your diary or an excel file or something like that. Any time I feel wobbly I just repeat the current pattern a few times - for example I stay at 777/6/777/6 a few times instead of progressing to 77/6. And if there is any stress or I'm ill I mark time for a week or so until it's past.