Starting a taper

[4683Louise]

Dear moderators- I have just finished up the 4 weeks of 60 mg of predisone that my rhumatologist ordered; I see him again next Thursday. I would like to go in to my appointment with my thoughts and questions prepared (in spite of pred. brain fog) so I am hoping you could give me your perspective on this proposal- I am ready to start a taper; also, I would like to split my dose A.M and P.M.

With starting from such a high dose now, what taper decrease amount would you want if this were you?

Would you see making the change to both the taper and the splitting at the same time? If not, which would you start first, and how long between would you suggest before starting the second phase?

In splitting, what ratio between the first and second daily dose would you recommend?

Thank you for adding your experienced insight to my decision making process, I am very grateful for the education available here.

[DorsetLady PMRGCAuk volunteer]

Hi Louise,

My taper was as follows - 60-55-50-40-30-25-20. From then smaller tapers, but no need to worry about them yet.

All done at roughly 4 weekly intervals PROVIDED I felt okay (no symptoms) and bloods tests okay.

But that doesn’t mean it will be okay for you, but it’s a guide. Plus never reduce if you get a return of symptoms.

With GCA you shouldn’t really split your dose - the nature of GCA means it need the full dose in one go. Why are you considering?

Splitting dose is sometimes recommended for PMR, then it’s usually 2/3rds am, 1/3rd pm.

Good luck with your appointment.

[Rugger]

Louise,

The way I read your first sentance is that you have no more pred tablets - is that so?

You mustn't suddenly stop pred after taking such a large dose for 4 weeks.

I hope I'm wrong, but if not, please get some more TODAY - don't wait until next Thursday.

Apologies if you are now starting the taper.

[SheffieldJane]

Why do you want to split your dose? I don’t think that it is recommended with GCA. I guess because the inflammation is dangerous. Good luck in whatever you decide to do.

[PMRpro Ambassador]

Splitting the dose is not recommended in GCA - the full blast of the dose is felt to be needed to protect your sight.

I hope I am wrong but like rugger I understand you to mean you have finished a course of 60mg - you MUST NOT have any days without any pred having been at that dose for a month.

[4683Louise]

I have enough medication to stay on 60 mg until my Thursday appointment (and beyond if needed). I will definitely not miss any dosages.

I just spent an hour texting on my phone a good long answer to your messages, hit the wrong tab and lost it all. So I'm going to go have myself a little cry and get it out of my system and return later. 😥

[PMRpro Ambassador in reply to 4683Louise]

If it is any consolation - it happens to lots of people.

And phew - that is a relief! Was a bit worried for a while there

[Hidden in reply to 4683Louise]

Yep. Did that this morning. Blame it on the forum software like I do.

[christine2715]

Contrary to what everyone else told you I was told by my rheumy it was ok to split Pred into two doses once you have been on steroids for a while. I split mine 2/3rds morning and one third about 4 pm. It helped me to get some sleep as on high doses I seemed to wake up every hour with what I assume was the predisilone running out. I dont think I did this until I was on 50 mg.