Lower prednisolene

[Shandon1]

I am on 15mg pred and should be for the next 3 weeks. Having heavy after effects, kind of spaced out, but all the pain has gone. Only have 5mg tablets and would like to self experiment by going down to 10mg even for the odd day. Would welcome advice.

[PMRpro Ambassador]

A 5mg drop is a lot at this stage - I can't remember how long you have been on pred but it doesn't feel very long. Kirwan and co in Bristol keep patients at 15mg for 6 weeks, 12.5mg for 6 weeks and then 10mg for a year and achieve a relapse rate of 1 in 5 - faster reductions give a rate of 3 in 5. So basically I'm saying - wait for another 3 weeks. If you rush you risk a flare-up of the symptoms and you'll be on a higher dose for longer so you won't have achieved anything. And then do not go down further than to 12.5mg at first. We think reducing 1mg at a time is better, there is less risk of steroid-withdrawal pain which is very similar to the PMR pain and feels like a relapse.

If you are on ordinary pred in the form of plain white tablets you can cut them if you must - although I would recommend getting 1mg tablets from the GP. To cut tablets you can buy a pill cutter from any dispensing chemist and that makes things simpler.

If you are on coloured enteric coated pred pills YOU MUST NOT CUT THEM. They come in 5mg and 2.5mg pills, red or brown coated. These must be taken with the coating unbroken.

I know you feel strange, I know you want to reduce your pred dose - but really the name of the game with PMR is patience and you might as well learn it now as rush at reducing and having a flare and ending up yoyoing the dose which just makes it all more difficult. Take my word for it - reducing too fast only leads to tears in the end.

[Shandon1]

Thanks. Good detailed advice!