Maximum dose of Prednisolone

[24gillrub]

What is the safest maximum dose of prednisolone? I am on 15mg and this does not seem to be killing the pain

[PMRpro Ambassador]

Pred isn't a pain killer as such - it is an antiinflammatory drug which reduces the inflammation that causes the symptoms we have in PMR. Reducing the inflammation relieves the pain and stiffness.

Safest maximum dose? Patients with GCA (the related arteritis which can affect vision) who have any visual symptoms are commonly started on a dose of 60mg/day, if they have more severe visual symptoms they may be given 80mg or even up to 100mg/day for a short period. It isn't dangerous - but it does have some severe side effects at that sort of dose though.

You say it "does not seem to be killing the pain" - have you had any relief from the pain? How long have you been on it? Are you resting for the moment? Or are you trying to catch up with everything you haven't been able to do?

All the pred can do is relieve the inflammation - it does nothing about the underlying autoimmune disorder that causes the inflammation. It continues in the background - and leaves your muscles intolerant of acute exercise so if you do "too much" you will feel as if you have a done an awful lot and your muscles will be sore. And "too much" is not the "too much" it was before PMR - you have a new normal now.

For some people it takes a few days for the pred to work - even when they rest appropriately. And others may need a bit more - but if you need too much more for PMR symptoms - it calls into question whether it really IS PMR.

[24gillrub in reply to PMRpro]

Many thanks for your reply. I have been on 15mg Pred for 5 weeks after probably overdoing it walking the previous weekend - I felt perfectly normal then - did not know that I should be careful with exercise. Nobody informed me when I was diagnosed three years ago! Since then the 15mg has only partially worked. Thr Doc has raised the dose now to 20mg, so we shall see.

[Rokerman in reply to 24gillrub]

Hi 24gillrub,

I too was started on 15mg Pred and it didn't have the miracle effect that others on the forum have experienced. However, after speaking to my rheumatologist, he was more than willing to increase the dose to 20mg and that did have a rapid effect. Within a further couple of weeks, I could do most of the things that were normal before the PMR struck! Regular, reasonably gentle exercise helps along the way too.

Good luck on the dreaded journey!

[24gillrub in reply to Rokerman]

Thanks for your encouraging reply!

[PMRpro Ambassador in reply to 24gillrub]

That's a start - but it may also just be your muscles are taking a long time to recover if you did a lot of walking. Pred deals with inflammation - it won't deal with sore muscles from overdoing it.

[HeronNS in reply to 24gillrub]

Can I just get this straight - are you saying you've been on pred for three years? And what has your dosage regimen been in that time? Why have you been at 15 for 5 weeks - was that a reduction or an increase from former dose?

[24gillrub in reply to HeronNS]

It was an increase from 10mg as I was experiencing a lot of pain - am now on 20mg

[DorsetLady PMRGCAuk volunteer]

Hi 24gillrub,

It's not a question of what is the safest maximum dose of Pred - it's what is the lowest dose that controls the inflammation.

I started on 80mg - and obviously that was safe - but it's not a dose you'd want to be on!

See from your previous post this could be a re - occurance of PMR,GCA? Not sure whether walking brought it on?

If the pain has not lessened then are you sure it's PMR? Have you tried other painkillers in case it's not?

Whatever, think you need to discuss with GP, even if just on phone, before you increase the Pred -not something you want to do unnecessarily.

[zebsky]

When you say Prednislone is that the same as Prednisone? I've never heard of it till I came on this site.

[PMRpro Ambassador in reply to zebsky]

No, they are not quite the same except they are both corticosteroids.

Prednisolone is the active form and is available for utilisation by the body as soon as it is absorbed by the body. Prednisone is an inactive form which has to be processed by the liver to become the active form prednisolone. The doses are, to all intents and purposes, the same (there is a slight difference)

Generally, prednisolone is used in the UK whereas in the USA prednisone is used. The USA also uses a form of corticosteroid called methyl prednisolone and all over the world it is the form used for injections or for infusions. This is prednisolone which has an extra organic group added to it, the methyl group, and it is described as being "methylated". This is claimed to make it more effective as an antiinflammatory agent. It also makes it more likely to cause side-effects.

[zebsky]

Thanks for the info - I'm in NZ so that would probably be why I hadn't heard of it.

[PMRpro Ambassador in reply to zebsky]

Every country has its own set of steroid medications. I live in Italy and here they use methyl prednisolone (Medrol). It really made me ill and so now I am on a much more expensive version of prednisone - the only other option here.

[nancyannehanson]

I am on 30mg daily, every time I try to lower my PMR gets BAD. Finally seeing rheumatologist but not until January 26th.2017 goodness. However.......thankful for all of you and your wings around me.

[PMRpro Ambassador in reply to nancyannehanson]

How much are you trying to reduce each time?

Have you tried reducing just 1mg at a time? Some people are very sensitive to the change in dose - and the symptoms of steroid withdrawal are almost the same as PMR so you think it is coming back. The smaller the reduction the less likely it is to happen.

[nancyannehanson in reply to PMRpro]

5 mg

[PMRpro Ambassador in reply to nancyannehanson]

That is a big drop - try 1mg at a time and you will very likely manage to get your dose a bit lower by the time you see the rheumy. If you can't - it's quite an important bit of info for them.

[24gillrub]

I have also experienced returned symptoms when being told by my Doc to reduce too steeply. I have since changed my Doc to one who is more sympathetic to my case. i have had PMR for 3 years. Recently, I reduced from 10mg to 7.5mg overnight. Symptoms returned - went back to 10mg. Felt pain free - walked a little too much - horrendous pain in the leg muscles - went back to 15mg for 5 weeks - did not kill the pain - and am now on 20mg. Hoepfully, I will now reurn to normal having been housebound for 6 weeks. Warnign to everyone - take it easy - you will not be aware of the strain you are putting your body under.