First Flare at 5.75 mg

[Ronswife]

I've been a year reducing from 15 mg and was about 6 weeks at 6 mg before I reduced to 5.75 mg Prednisone. The flare has put me back to 8 mg but it leaves me still in pain after about 12 hours when it wears off until a morning dose kicks in. I hate to go up to 10. Is that the answer? So discouraging to feel so badly still.

[DorsetLady PMRGCAuk volunteer]

Hi Ronswife,

How disheartening for you. Usual recommendation is to go up by about 5mg when you have a flare, but not everybody needs that much.

Were you really okay at 6mg? Maybe it was only just enough, hence the flare with such a small decrease.

Might be worth trying a split dose at 8mg - say 5mg am, 3mg bedtime - that might be better. A week or so should prove whether it is. If not, then maybe you'll have to go to 10mg. It a bit trial and error really.

Do hope you get things sorted soon.

[piglette]

How rotten Ronswife, you will find if you go up to 10mg and it solves the problem you can usually reduce pretty quickly back to a lower dose that originally worked, you do not have to go through the slow tapering. That is provided you reduce again reasonably soon after increasing your dose.

[PMRpro Ambassador]

Was it a problem before? Another way of dealing with the effect not lasting the full 24 hours is to split the dose - usually about 2/3 in the morning, the rest later in the day at a time that suits you - i.e. doesn't keep you awake.

To have got to below 6mg in a year is pretty good - that is lower than I am after 8 years! But as piglette says - maybe a few days at 10mg would clear things out and you could drop straight back to say 7mg. As the others say - maybe 6mg was barely holding things so be wary about going back to 6mg straight away. And remember - this is adrenal wake-up territory now.

[Ronswife]

Thank you all for the excellent suggestions and I will split the dose 2/3 and go to 10 if still in pain. I was so naive about the amount still lurking. Trying to feel normal and know what is Prednisone bad feelings pushed me to reduce though I did not have this pain while reducing. My RA also suggested the 10 and I hesitated as I hoped it would be better soon at 8.Now I know. Thank you for responding so quickly and courage to PMRPro.

[Patience_1 in reply to Ronswife]

Not naive, Ronswife - hopeful. I think most of us will have tried to push on a bit quicker than we perhaps should, as we desperately want to feel we can be rid of this chronic condition. I know I have (egged on by my GP). Luckily, I had a salutary lesson early on, when going down too far too fast resulted in having to go right back to my starting dose. I found that so depressing I vowed I would crawl along in future - and I've only overshot very slightly a couple of times and managed to avoid any serious flares.

It really is trial and error all the way - good luck!

[Retailmonkey]

Like you I have come down very quickly (too quickly for most people on the forum) from 40 in August 2016 (GCA as well as PMR) to 6 mg about the middle of April at which point my consultant upped my Methotraxte to 25 mg and advised me to come down by 1 mg every 3 weeks from then!!! Like everybody has advised in the forum I listened to my body rather than him and watching the reaction carefully have actually hovered between 6 and 7 mg since then as I didn't feel quite right on 6. As PMRpro says, this is adrenal wake up time and you need to make sure it is waking up. I now feel secure enough at 6 to start to go down to 5 but through increasing the number of days on 5 and decreasing those on 6 over time (yesterday was the first 5 day and back to 6 today). There really is no formula it is just action and response that should guide you no matter what the formal professionals say