Prednisone reduction

[Mgeorge]

I began on 60 mg. of prednisone in May and have reduced to 30mgs. four days ago. Previous reductions were pain free. Once I started 30mg, I developed a pain in the left hemisphere of my brain and a pressure pain in my left eye. Is that prednisone withdrawal or GCA symptoms coming back?

[PMRpro Ambassador]

Not something anyone could say one way or the other I don't think - really you need to speak to your doctor. How big steps have you been reducing in? Maybe you need to try smaller ones - 2.5mg at a time now perhaps.

[Mgeorge in reply to PMRpro]

I see the RA Thursday. I'll have medical answer then

[DorsetLady PMRGCAuk volunteer]

Hi MGeorge,

Looking at your previous post I see you reduced at 10mg a time, that's quite a big reduction in percentage terms, and obviously gets bigger each time as the doses get smaller. 10% is the usual rate recommended, so you can see that even at the beginning going from 60 to 50 you were above the recommended level.

I think that's where your problems started, the inflammation wasn't kept under control at each drop, and once you got to 30mg then your symptoms may have resurfaced - unfortunately.

PMRpro usually relates it to a bucket of water being filled by a dripping tap - you don't know you have problem until the bucket overflows! That's like your inflammation, if it's not controlled by the Pred at all times, it consistently gets worse little by little without you realising it, until it's at the dose which is not controlling it at all.

That's we we're always saying - take little steps, both in dose and time. That way, you've more chance of stopping a problem before it gets out of hand.

Difficult to say whether flare or withdrawal, but usual rule of thumb is - if pains come on almost straight away (say next day or two) after reduction likely to be withdrawal, but if they don't surface until 4, 5 or 6days later more likely to be flare. But, as said, we are all different, so best get checked.

[PMRpro Ambassador in reply to DorsetLady]

Yup - didn't look to see if there were other posts. DL's probably right - far too big steps. Even at this level 5mg is kinder all ways round.

[christine2715]

Had same problems at 25 mg and have had to go back to 30mg. Even then took 4 days to settle. Have been told to wait 4 weeks before reducing again but may try just an odd mg or two over the four weeks if I am well

[PMRpro Ambassador in reply to christine2715]

Don't - let it settle really well first.