My aunt has been battling polymyalgia and the steroid cure for over 2 years now. Her doctor is encouraging her to wean off prednisolone and get her adrenal system to start up again. Lots of weakness and depression, to the point where doc said to increase steroids.
My question is whether there is a preference between prednisone and the prednisolone. I wish that the pills came in smaller dosage so the stepping down can be more gradual. Also has anyone used liquid prednisolone ? Cutting these tiny pills into 4 is proving difficult.
Thanks. Think all of you are warriors fighting a terrible battle
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Darmahcat
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I'm quite new to polymyalgia, having been diagnosed in July, so I'm still finding my feet, but I'm sure much more experienced people will be along shortly with their expert advice.
As far as I'm aware prednisone and prednisolone are the same drug - the former is the US name and the latter is the UK name. Prednisolone comes in 5mg and 1mg (possibly 2mg as well).
It does sound as though your aunt's doctor made her reduce her steroids too quickly. If there's one thing I've learnt over the last couple of months - you can't rush things! What dosage is she on now?
I'm sure you'll find this forum very helpful. Please let your aunt know she's not alone, and to ask any questions - someone on here will be able to help, I'm sure!
I am at the same stage as your aunt...waiting for my adrenals to kick in again. I felt like your aunt at 6.5mg and a few weeks ago went back up to 7 and will try again a few weeks time.
What dosage is your aunt on? And what dosage of pills has she been dispensed?
Prednisone is used in the US and prednisolone in the UK. Where does your aunt live? It sounds like you may be cutting 5mg tabs in 4, and it might be better for her if she could get 1mg tabs to cut in half, so it would be a smaller drop in dosage (.5mg instead of 1.25 mg.). I hope that makes sense.
It sounds like your aunt’s doctor seems pretty sensible. It sounds like your aunt is suffering from some of the side effects of pred, which can be pretty miserable. Prednisone is actually converted into prednisolone by the liver so effectively the result is much the same except the liver has to work for prednisone! Prednisolone seems to be available in U.K. and prednisone in the US. In the U.K. you can get 1mg tablets.
Thank you all for replies. We are in the U.S., I just looked at the bottle and comes in 4 mg pills. I was told by pharmacy that they do not have a lower dosage prednisolone pill and doctor confirmed that. That was about a year ago and not sure if things have changed. The pills she has are very small and cutting into quarters almost crumbles it.
Currently 18 mg. Will soon be going down to 16 mg, after the move.
We are in the process of moving her in to live with us. Means a new doctor and another opinion on course of treatment. See that prednisolone comes in liquid and may ask about that with new doctor.
Think this forum is a wonderful resource and may have to come back with questions as she begins lowering her dose of prednisolone again.
There is a difference between the two drugs in that prednisone has to be converted to prednisolone by the liver, but for all intents and purposes they work the same way to reduce inflammation. You should be able to get 1 mg prednisone in the US. Prednisone is what is usually prescribed for adults in both the US and Canada. If your aunt has been prescribed prednisolone maybe that's the issue? Is there a reason why she has, somewhat unusually for North America, been prescribed this form of pred?
I am wondering why your aunt is at 18mg after 2 years, and why her doctor is talking about getting her off prednisone or prednisolone to restart her adrenals.
Are the dosages you listed perhaps a typo?
It will take time and patience to taper down to the dosages that will send out the signal to her adrenals that they have to start working again. For most people that happens around 7mg. Usually by 5 mgs. they are functional. Two things guide the pace of tapering: 1) the amount of the steroid needed to control PMR symptoms, and 2) the reawakening of the adrenals/HPA axis.
I'm approaching my two year anniversary in December. I started on 20mgs and am currently tapering from 5mg to 4mg using the DSNS taper you can find here:steroidtaper.azurewebsites.... . I use this taper because I'm taking the Rayos formulation of delayed release Prednisone. I can't cut the pills I take because that would destroy the delayed release function. You might find these tapers useful for your Aunt.
I have been lucky with my PMR journey to date. One minor flare at 14mgs but since then symptoms pretty well under control. My biggest challenge was from 6-5. Emotions all over the place, no buffer, uneven energy levels. I decided, with the help of PMRpro, on this forum, that it was probably the whole adrenal issue that was making me so weird. I was never offered a test. I was very tempted to go back up, but since I wasn't having PMR symptoms and I feared only having to go through the transition all over again if I did go up, I held out at 5mgs. Fortunately at about 6 weeks I felt things level out. I'm midway through 5-4. So far this 5-4 taper seems much easier. Fingers crossed.
If you are in the USA I doubt she is on prednisolone - but methylprednisolone, yet another version of corticosteroid drugs. It is usually sold under the name of Medrol and generally does only come in 4mg tablets. Prednisone is also used in the US and comes in 1mg tablets which does make reducing simpler. There is no real reason why she couldn't be switched to it even now. Or to injections of depotmedrol which can also be used to manage PMR.
But why is she still at 18mg after 2 years? Someone somewhere along the line didn't know much about PMR - nothing new there then!!!! The idea is to start the patient at about 20mg and then, once the symptoms are under control, to reduce slowly to find the lowest dose that gives the same result as that starting dose did. Often it is less than 10mg - often considerably less. This reduces the side effects that are so common with pred.
Restarting her adrenals is really not even on the cards at the moment - that won't be an issue until she is down to under 10mg. What is crucial now is whether the PMR is still active and how much steroid she needs. Even after 2 years it is likely the PMR is still there - only 1 in 5 are off pred in 2 years. PMR has a median duration of something under 6 years - whatever some doctors will try to tell you. It's likely she still has it - but she should be on far less steroid by now.
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PREDNISOLONE? 
