Nausea While Tapering

[Admiral06]

I have been plagued with nausea each time I reduce my dose. After one week I feel better, but the nausea returns on the next decrement. Is this an expected withdrawal side effect

[PMRpro Ambassador]

Not really one I've heard anyone complain of. However - what dose are you now on? It could be the time it takes for your body to adjust and increase the amount of cortisol it is making to top up the artificial pred. Nausea is a common symptom of adrenal insufficiency.

[Admiral06 in reply to PMRpro]

Thanks for your reply PMRpro. I am tapering depo-medrol at the rate of 4 mg every 2 weeks, and the current weekly dose is 32 mg. Based on Pfizer release profile data, this week’s pulse by day is approximately: 8.3, 6.4, 5.7, 4.3, 3.5, 2.7, and 2.4. I further spike on days 4-7 (at midnight) with oral medrol to smooth the curve. After spiking, this week’s curve was as follows. 8.3, 6.4, 5.7, 4.3, 4.5, 3.7, and 4.4.

As 4.0 methylprednisolone is the equivalent of 5.0 Prednisolone, I am now testing the

5.0 level. This began when my dose hit 44 mg and since then I have been experiencing nausea early in the week that normally resolves on the last two days.

It has also occurred to me that the high serum levels I experience on the day of the injection may cause adrenal insufficiency that resolves later in the week???

[PMRpro Ambassador in reply to Admiral06]

It wouldn't matter - the pred is the replacement for the not-present cortisol, the body doesn't care whether it is natural or artificial. If you were going to have problems then it would be more likely towards the end of the week where the level has fallen to well below the required level of cortisol. Adrenal insufficiency is not a response to a day or two of high pred - it is a response to persistat high blood levels of corticosteroids, In this instance it would be more likely to manifest towards the end of the week

Possibly it is the other way round - your body is now producing enough cortisol since you are below the threshold for most of the week and in the early part of the week you have too much present. Perhaps the nausea is the same as the nausea of excitement, fight or flight.

[Admiral06]

Thanks PMRpro, that's as good an explanation as I have heard. Interestingly, when I reduced from 80-70 mg, I experienced occasional facial flushing, sweating, and headaches. From 70 to 60 I had dizziness (on-and-off) for one month. When I tapered from 60-52, I had no symptoms whatsoever and thought I was home-free. From 52-44, however, I experienced several days with nausea on each of the first three weeks of the month, but was well on the fourth week.

At this point I went on a Florida vacation where my practitioner (based on my low CRP) recommended reducing by 4 mg per week from 44 mg to zero. I was subsequently nauseous 3 days at 40 mg, and 5 days at 36 mg. At this point she repeated the 36 mg dose, and I was symptom free for that week. I next requested a reduction of 2 mg from 36 -34 mg, but she over-ruled my request and went to 32. At this level, the nausea began on the middle of the third day and was accompanied by fatigue for two of the next three days. Surprisingly, I recovered from these symptoms and felt well on day seven. I am now repeating the 34 mg dose and will see what happens.

So far, the PMR has not reared its ugly head, and while I have been on a bit roller coaster ride, I think I am getting off easy ---- so far.