Prednisolone Reduction Rate

[Nuff1]

Husband was initially on 40mg pred for PMR/GCA and GP is monitoring the reduction (Rheumatologist died shortly after hospital IP assessment).

After a few weeks she advised 40->35->30 in 2 x 2wk stages - we phased over a slightly loger period.

Late September he saw GP and "blood markers were down considerably" (he didn't think of asking for the figures) and she advised 30->25->20->15 over 8wks. I persuaded him to request 2.5mg tabs to be added to his repeat prescription in order to be able to manage a 10% reduction stage.

He did so 'cos he thought that 8weeks was too speedy.

I put his tablets into one of those 7day comparment thingies to make life easier for him (he's not at all happy with medication).

The taper is nearer 5 months than 8 weeks and similar to one I've seen written out somewhere.

[DorsetLady PMRGCAuk volunteer]

Hi

The plan looks achievable, but life sometimes gets in the way and throws a spanner in the works- so if at anytime things don’t seem to be going right, then just hold at current dose until husband stabilises. Provided he does then carry on as above.

Not everyone can manage the 20-17.5-15 taper - so just be aware that might need a slight adjustment.

Good luck and keep us informed please.

[kellykel in reply to DorsetLady]

DorsetLady, how many days should one wait to “stabilize” as you say above? I wait about 3-4 days, and then go back up to last dose I was ok with. Is that too short a time?

[DorsetLady PMRGCAuk volunteer in reply to kellykel]

It’s difficult to be precise about these things, but I found my steroid withdrawal lasted 2 or 3 days (if that’s what you think it is) .

I wouldn’t let it go on any longer than 5 maximum before doing anything.

[kellykel in reply to DorsetLady]

You are quite an amazing woman for all you’ve gone through and for being so helpful to everyone here. You are a role model for me. I sometimes think “maybe one day I’ll be able to give back here.”

Thank you for your always quick and helpful advice.

[DorsetLady PMRGCAuk volunteer in reply to kellykel]

One day you will give back... I bet you can now. You learn something new about our illnesses every day from yourself as well as others.

[PMRpro Ambassador in reply to kellykel]

Even asking a question may help someone else - the question they hadn't realised they needed to ask.

[PMRpro Ambassador]

I'd say the same as DL. Just be aware that such plans often don't work - if it doesn't work well the first time don't try to force things to keep up with what you planned or he will be back where he started. If it really is GCA then 30 to 15 in 8 weeks is far too soon. Most GCA patients will need at least 4 months at above 20mg and often 6 months - a study showed that the disease is still active after 6 months at 20mg and above. Pushing too hard may lead to a flare and back to the higher doses - losing all the perceived benefits of the faster taper.

[Nuff1 in reply to PMRpro]

Thanks for the info - I'll interrogate him regularly during the taper.

GCA confirmed by biopsy 22 June but symptoms evident late May/eary June -> GP on 12th Jume and -> Rapid Assrssment Unit 13th June (following results of bllod tests requested by GP) Prednisolone commenced 14th/15th June so 6 months by mid-December.

[PMRpro Ambassador in reply to Nuff1]

It really IS GCA - so a fast taper may ask for trouble.

Have you seen this (sorry if I've told you before but I lose count...) and it does have a very sensible taper that does work well.

rcpe.ac.uk/sites/default/fi...

[Nuff1 in reply to PMRpro]

Downloaded thanks _ it looks as though we're in line with that document.

Starting mid June on 40mg then a later decrease

40->35->30 over 6wks to mid September

GP's reduction rate was 30->15 over 8wks from end of September however the rate as in the image I posted is compatible with the Bristol recommendations

<quote>

Our giant cell arteritis treatment regimen over

124 weeks

60 mg daily for four weeks, or until remission

induction, then

• 50 mg daily for four weeks, then

• 40 mg daily for four weeks, then

• 30 mg daily for four weeks, then

• 20 mg daily for four weeks, then

• As per PMR regimen for 104 weeks

PMR

15 mg daily for six weeks, then

12.5 mg daily for six weeks, then

10 mg daily for one year, then

Reduce daily dose by 1 mg/per month thereafter

</quote>

particularly since OH started on 40mg mid June so e could be OK.

[PMRpro Ambassador in reply to Nuff1]

Except the 40mg is much lower - the 60mg extends the time at high dose pred. That's the bit that concerns me, getting to a lower dose sooner. However - be watchful and any sign of symptoms again, stop reducing for a while. If things are OK it doesn't matter how fast you reduce - just when things aren't OK you have to change.

[Fracham]

Reducing by 2.5 mg maybe a step too far, the reduction rate is very up and down. I managed to gradually reduce by steps of 1 mg over several years and I had many flares.

[jevuki]

Hello Nuff1, I had started at 20 and am now to 3 mg a day. I found the reduction of 1mg at a time helped me tremendously. So far so good ...........