Prednisone Reduction Plan

[Jim-CJ]

I am the husband of a GCA wife. We have been struggling with Prednisone reduction for over a year. We have found that my wife's steady state level is 20mg, but couldn't get below it by trying first at 15 and then at 17.5. Nothing worked with flair-ups stopping our progress. About three weeks ago we have started a new technique as follows:

Days at higher amount = 8

Days at a lower amount = 1

Days at a higher amount = 3

Days at a lower amount = 1

Days at a higher amount = 2

Days at a lower amount = 1

Days at a higher amount = 1

Days at a lower amount = 2

Days at a higher amount = 1

Days at a lower amount = 3

Days at a higher amount = 1

Days at a lower amount = 8

We are reducing at 1mg increments and started at 19mg. It is too early to know if this will work or not, but we would appreciate any comments that you all would have.

Thanks So Much

[DorsetLady PMRGCAuk volunteer]

Hi Jim-CJ

Sorry to hear about your wife's problems with reducing. But what a lucky lady to have to you help her!

Your plan seem eminently sensible, the slower one reduces the better the outcome usually, and its seems to fool the body so you don't get the steroid withdrawal pains, nor more importantly, a flare.

There are various methods of the slow reduction plan, I think you have to find what suits you best. The one I devised runs over a 5 week period, and I then usually stay at the new dose for at least a week to see how things are.

If your wife has any problems during the reductions, she can always stop for a week until she stabilises, and then move on again.

The trouble with relentlessly reducing, which some doctors want, is that you can get below the level of Pred that controls the inflammation without always realising until it's too late - you've gone too far, and wham, you're into a flare.

As I said, once you get to the end of one reduction, and you feel okay, you can then go on to the next one. Just make sure your wife has blood tests done on a fairly regular basis to keep track of things.

If she's particularly susceptible, she might find that once she gets to 10mg, a 0.5mg might be better for her. Lots of people do have more problems once they get into single figures.

But for the moment it sounds as if you both have things under control , and that's good. Long may it continue!

[Jim-CJ in reply to DorsetLady]

Thanks for the encouragement and the advise on .5mg.Will keep in touch as we progress.

Thanks Again

[PMRpro Ambassador]

Yours is basically the same as several in use by various people on the 3 PMRGCA forums in the UK, one of which (mine) is shown here:

healthunlocked.com/pmrgcauk...

which comes with an explanation as to why these slow tapers may work better. This particular one is being used in a clinical study by a PMR research group in the north of England and has been approved by several rheumatologists when patients have taken a copy along to see what they say.

You do have a big jump between the 8 day and the 3 day stages at both ends and I would be inclined to smooth that out a bit. One mg will be fine - unless your wife is very sensitive to the change which is possible even with the taper - until you get below 10mg at which point either slowing the taper or investing in a pill cutter and using 1/2mg drops is a good idea.

All the very best - for you both!

[Jim-CJ in reply to PMRpro]

Thanks So Much,

I copied the reduction plan and will possibly use that as a fall-back plan. We wanted to press a bit at first and then perhaps back off as we get closer to 10mg. Our current plan is a 24 day reduction. Will see how it goes.

Again Thanks