PMRGCAuk
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Is it withdrawals or have I reduced too far

Hi I have been reducing in the slow method used on the forum, I was on 10 mg Prednisolone have just started on reducing to 6 mg, I am getting the pain in my right shoulder that started off this PMR in 2016 July are these pains just withdrawals from the Prednisolone or is it PMR telling me 6 mg is too little, I am seeing my Rhumatoligist on the 4 April so hope he will be able to help but I think there is far more experience and knowledge here.

Thanks in advance Mike

PS what is the difference between Prednisolone and Prednison

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The timing might help you to decide. For me steroid withdrawal happens days 1-3 and then abates. Recurring symptoms from day 7 and worsening.

Paracetamol may ease SW, but won’t touch PMR, so that might be another way to test.

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Thank you I will give the Paracetamol a try.

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Hi I have taken two Paracetamol twice today and the pain has already greatly reduced to I must have hurt my shoulder again and the pain is not the result of reducing too much or two quickly

Mike

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Fantastic :)

Take it easy now, maybe stick at 6/7mg til you’re sure your shoulder is hunky-dory.

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You are never reducing relentlessly to zero - you are looking for the lowest dose that keeps the symptoms at bay. Stop reducing this time, give it a month or so and try again. Sometimes that works. But you are at a low dose which is less than your body makes anyway in the form of cortisol - no worries sticking for a while. It is far better than letting in a flare and having to go much higher so don't mess about.

Prednisone is an inactive form of corticosteroid which must be processed by the liver to produce prednisolone which is the active form of the drug.

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Thank you I will continue with 7 mg but as Soraya suggests I could try Paracetamol if that reduces the pain then it is not PMR.

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So...are you saying that prednisolone is not processed by the liver? How does this work? I thot it was just the same med only a different name in Europe.

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No, not quite the same thing: prednisone which is inactive must be processed in the liver to form prednisolone which is active. They are different substances.

en.wikipedia.org/wiki/Predn...

en.wikipedia.org/wiki/Predn...

You will note that both pages say "Not to be confused with..."

Once the prednisolone gets into the blood stream it can attach to the cell receptors that allow the prednisolone to produce its effect. I'm sorry but I can't find a simple pharmacology text that explains it in ordinary language.

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From those references I understand that in the US we are taking the “synthetic” version. Which is probably cheaper. Europe takes the “real thing”. Am I correct? Seems like the one that doesn’t metabolize in the liver, would be preferred. I notice both of them indicate a ‘Biological half life’. Does this refer at all to the 24 hour release formula they both claim?

Thanks for your info.

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No - they are BOTH synthetic corticosteroids and there are others, dexamethasone, hydrocortisone etc. In some ways it is just like all the different sorts of a group of antibiotics. Made by different companies, with slightly different characteristics and effects/side effects.

The biological half life is just the time it takes for the blood level after given dose to halve in the body.

The version not metabolised in the liver is preferable for anyone with any liver problems which might affect the way the inactive version is processed to active. Why the USA tends use prednisone and the UK is more likely to use prednisolone I have no idea.

I am not aware of a 24-hour release version - other than depot-medrone injections which last for several weeks, slowly releasing an ever-decreasing amount per day. The tablets are either plain white uncoated immediate release where they break down immediately they are swallowed and are absorbed quickly or, in the UK alone, gastro-resistant which have a coloured coating, much like an M&M, which resists the stomach acid and are then absorbed further down the gut in a more alkaline environment but even then they are absorbed within maybe 5 or 6 hours.

If what you mean is Rayos/Lodotra, it is NOT a 24-hour sustained release formula, it is a DELAYED release form. The tablets are taken at 10pm, within 3 hours of a meal or with food, and 4 hours later the special coating breaks down and releases the entire dose all at once, just 4 hours later, so that you don't have to get up in the middle of the night to take a dose that works most at 4am to avoid morning stiffness.

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Thanks. I’ve switched my evening dose to 11-11:30 pm & it does it’s job swimmingly.

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Quite a few have found that - so glad it works for you.

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😊

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