Decreasing dose of prednisolone

[jlyndauk2002]

Hi all, just had a repeat prescription from docs and he wants me to cut down from 20mg pred to 15 for the next month from next week, this seems a big jump down to me as still got pain in upper arms in eve. He didnt want to see me so wondered if should try to see him, its not easy to do that as can be 2 weeks wait unless emergency, or should i try the lower dose and see how that goes? Cheers x keep well all

PS Started on 20mg of pred at beg of March. x

[DorsetLady PMRGCAuk volunteer]

Hiya,

Personally would say too bit a drop. It's 25%, and as you've probably read on here, not recommended to drop more than 10% in any one go. 

I would try 2.5mg drop (if you have White uncoated tablets they can be cut). Might be an idea to leave a message at the surgery suggesting this before you start and see what his response is! 

Have looked at your other posts, see this is your 1st reduction, and even though you will have been on 20mg for almost two months without any too many problems   - you certainly don't want to rock the boat by dropping too much especially if you still a bit worried about your arms. 

Good luck. 

[PMRpro Ambassador]

Personally I'd say that is a big jump down - longstanding recommendations from US experts years ago are not to reduce more than 10% of the current dose in PMR. It isn't the same as other things where you can give a couple of weeks at 20, another few at 15, 10, 5, stop. You are much better going in smaller steps - and 2.5mg at this level is far better. You may manage the 5mg, some people do, so I suppose you could try - but 2.5mg done twice a few weeks apart is the same drop and more likely to work. If you develop pain the first day after you reduce it is most likely to be steroid withdrawal pain and that should then fade over the following days. If the pain doesn't start for a few days and then gets worse then it is a sign the dose is now too low.

This, or something similar, has worked well for a lot of patients

healthunlocked.com/pmrgcauk...

and is being used in a study in the north of England. After 15mg, 1mg at a time is far more comfortable. Slow and steady wins the race - tortoises not hares. 1mg done ever few weeks is faster in the end than trying to do more, failing and having a flare. That means going back to a higher dose and starting again.

[jlyndauk2002 in reply to PMRpro]

Thanks PMRpro will take on board your comments and hope to get doc on side too!! Cheers x

[breeze43 in reply to jlyndauk2002]

I have followed advice on this forum for a year now. Words can't convey the education from this community I have acquired when I couldn't elsewhere, including family physician. PMRPro and Dorset Lady? Listen to them!

Doing well with GCA after a year, initially in emergency on 60 mg for 4 days, then to 20 for some time.  I reduced in 10% increments, usually using the time frame of at least a month. Am now down to 1mg and soon going to try another drop.  In the last month, after a year,  I am finally with a young Doctor at Henry Ford in Detroit whom I absolutely have so much to be thankful for in finding her. I feel trust, concern, interest, attention and all the things we need. But before her, I had this forum. It saved me from meltdowns, doing the incorrect things and I could go on and on.  Listen . . . and good luck.

[Whittlesey in reply to PMRpro]

Agreed. Very good advice. Prednisone is different than other drugs.

The adrenals have to begin to function again, as the pred is lowered. Often this doesn't go as smoothly as a person might think.

 The slow dosage reduction method is really best, for avoiding flares and working towards a lowered dosage. 

With large reductions, the disease can recur and/or the adrenals may not function as expected. Can be difficult with the pain recurring.