Advice needed on handling taper symptoms.

[Mick19]

I was diagnosed with PMR two years ago, and have managed to get down to about 4mg of pred. Lately, as I have tried to taper a bit more, I have been experiencing a lot of profound anxiety and a lot of low blood sugar events. Blood pressure has been elevated as well. No aches and pains, but I wonder if the nervousness could be caused by inadequate cortisol, or is it a withdrawal symptom? Also wondering whether a little Prozac would be safe to layer on? I don't get much advice from the doctors, so I'm hoping there are some PMR veterans out there who could give me some advice. Yours very truly and Merry Christmas, Mick19.

[PMRpro Ambassador]

Anxiety and low blood sugar can be symptoms of adrenal insufficiency - although raised BP is unusual.

If it were me I'd go back to 5mg - assuming you feel OK there - and stick there for a few months to let your body catch up. The try a small reduction again. One top PMR rheumy we often talk about on the forum likes to keep patients at 5mg for anything up to 9 months - and finds the rest of the reduction goes better.

One mg more of pred at this level has fewer side effects than adding in another layer of medication.

[Mick19 in reply to PMRpro]

Thanks.

[Hindags]

Your symptoms sound familiar, though I was having them at 8.5 and my blood pressure went a bit low. I called them the weak wobblies. Also given that, for me, they are correlated with getting up and active after being sedentary, and not as much correlated with an empty stomach, I don't recognize those episodes as low blood sugar. I went back up to 9mg and by and large they went away. I'm now doing the 26 day taper alternating 9 & 8. Fingers crossed as I'm one week from the end, do heading into mostly 8. So far so good except for sleep is less restful and more interrupted, and I'm more emotionally reactive....Though with what is going on in my country, I have plenty of reasons to feel pretty upset, I know it's hitting me in a way that says I'm feeling more vulnerable than I would ordinarily feel. Was actually thinking along the lines you are thinking. Not Prozac though. Maybe nortriptylene, a bit sedating, good for pain. I took it done years ago in the pain clinic when I had neck and lower back issues. It made me brave, lol.

[Mick19 in reply to Hindags]

Thanks for your input, I appreciate it.