How to reduce pred.

[Patricia10]

I have been taking 15mg pred for the last 6 weeks. The first four were difficult and I was I pain each day till early afternoon, then advice from the forum suggested I take 5 mg in the evening and 10 in the morning, which improved my pain amazingly, but I was not sleeping very well as I was taking the evening dose at 11pm. My doctor said I should take them in the morning and reduce the dose to 12 and a half this week. I have started to take the full dose very early at 5 am but find that again I am in more pain. I am very nervous about reducing the pred and not sure how and when to take the new dose. Any help please?

[piglette]

If you are having PMR pain don't reduce yet. I made that mistake and went through misery which I think could have been avoided. It was just that my rheumy wanted me to get below 10mg as quickly as possible. The aim is to reduce as low as you can and remain comfortable. If you have pain now and reduce you will only have to increase again.

[Patricia157]

In the early months of my diagnosis in January my sleep pattern was not good but it did later. My doctor wanted me to drop from 15 to 10 at one go but having read the advice on this forum I persuaded him to let me go slower. He said 12.5 mg. I did this and had a flare. This meant I had to go back the 15 and start again. I then after a few weeks tried 13.5 and that has been fine. I have nearly reached 12.5 and so far so good. For me I realise it's going to be very slow and steady but I feel better that than having to up the dosage and mark time on my body catching up. I am sure you will get valuable advice from the pros shortly as to when is the best time to take the Pred.

Yesterday I walked a bit more than usual and this morning I am feeling a bit delicate so it can depend on your lifestyle each day too.

Best wishes

[Parijm]

My mistake was to continue to reduce 1mg Pred monthly from 10mg down to 7mg while I was still having pain. I thought I could put up with it. GP suggested return to 10mg about 6 weeks ago which is where I am now. I will continue on 10mg for a while longer before a very slow reduction. (Dead slow and nearly stop). The posts here have given me confidence to 'drive' my own reduction schedule - other people's tried and tested experiences. I am discovering what works for me. Life always throws in a few surprises I know! Good luck Patricia.

[PMRpro Ambassador]

Your doctor has your pain does he? Yes, there are good reasons for taking the pred in the morning between 8 and 9am - unfortunately that doesn't really do much to help the average PMR patient and if you aren't achieving pain control with it it is pointless, if it doesn't work you only have the downsides of pred with no upsides so you might as well stop now. Did you try taking the 5mg earlier in the evening?

If you follow this link you will find the details of the "Dead slow..." plan Parijm mentioned.

healthunlocked.com/pmrgcauk...

What is absolutely important is you must have the pain at its best you can get it before trying to manage with less pred. You find the best you can get with a higher dose and then look for the lowest dose that will give you that for the longer term. You won't be 100% pain-free, that rarely happens, but your quality of life should be far better.

Since your doctor isn't standing over you what he doesn't know won't hurt him. And if this GP won't work with you - find one that will. You don't have to see a particular doctor and it may be that another has more experience of arthritis/rheumatism.

[Patricia10]

Thank you for your comments. I did split my dose to 5mg in the evening, at 11 before I went to bed and 10mg in the morning. This worked very well as far as the pain was concerned, But I was not sleeping well so I set the alarm for 2 am, and again this was OK taking 5mg, then 10mg the following morning. However, when my doctor suggested I would have to reduce this week to 12 and a half, I was not sure how I would do it, not sure which dose I would reduce so I started taking the 15mg at 5 am so that I would be able to reduce it. It was then that the pain returned in the morning. I intend to ask the doctor for 1mg tablets, in order to try the 'dead slow' plan, however the doc seems to be very reluctant and I even have to half my 5mg pills when I do reduce!

[PMRpro Ambassador in reply to Patricia10]

For goodness sake, what a silly attitude - if one GP is unwilling to give 1mg tablets find another. You are using plain white pred tablets aren't you? Not red 5mg pills? The red ones have a coating to protect them from stomach acid and mustn't be cut.

[Patricia10]

Thank you for your replies. I shall speak to my doc tomorrow. I am on the white tablets.