Alternate dose or half one pred

[Casia]

Firstly I want to thank you for the fantastic advice and experiences you share in this forum. It’s really helped me a lot. I’ve been comfortably on 4 mg pred for about 3 months after going to 3 too quickly and having to go back up. The rheumy has advised me to taper to 3 by alternating daily between 4 and 3. Having got the idea from one of your posts to try a slower taper of taking 4mg for 5 days and 3mg for 2 days the first week, then 4mg for 4 days and 3 mg for 3 days the second week , till i got to 4mg one day then 3mg the next, I decided to try it. I’m on the second week only and tonight felt a little stiffness Im shoulders, hips and knee, so wonder if it’s withdrawal or the beginning of a flare though that does seem a bit too soon. But my question is about whether you think it’s best to alternate the dose daily or cut the tiny 1mg tablet in half so I drop to 3.5 mg . Any thoughts would be hugely appreciated.

[DorsetLady PMRGCAuk volunteer]

Personally I think it’s better to take the same dose every day - the body copes better.

If you take 4mg one day and 3mg one day - that’s a 25% different from one day to next.

At such a low level of Pred the slower the taper the better.

[Casia in reply to DorsetLady]

Thanks DorsetLady. My instinct told me this was the best course of action and your view confirms that. Best wishes.

[Rokerman]

You heard it first from Dorset Lady - and I wouldn’t go against that advice! - a constant dose would be better, I think. At 3.5mg, I took one 2.5mg (coated) plus 1.0mg. I don’t know if there’s an argument for not mixing the types(?) but I found it ok to do so - if it ‘spread’ the daily dose age over a longer release time, it seemed like a good idea to me.

Now - I’m coming towards 1.5mg per day - so I’ll have the same dilemma as you soon.........

[Casia in reply to Rokerman]

Many thanks Rokerman. I will get a pill cutter or did you mean you can get 2.5 on prescription ? I thought they didn’t make the .5 size ?

[Rokerman in reply to Casia]

Yes, I have the 2.5mg pills which are coated (I see them as black - PMRPro assures me they’re brown....!). Haven’t had any problem getting them on prescription. Let us know how you get on.

[Casia in reply to Rokerman]

I see. I will request them from my GP. Thanks again! And good luck with your taper !

[Valnvaughan in reply to Rokerman]

I have a prescription for 2.5 mg uncoated. In UK.

Plan to half for a 1.25 dose when I get there. At 2 mg just now. Valerie

[Rokerman in reply to Valnvaughan]

Good point - I haven’t seen those?

I realise that my current drop (from 2.5 to 2.0mg is 20% ) - so I’ll need to bear this in mind! Thx

[Casia in reply to Valnvaughan]

That’s really interesting and very helpful. Thank you Valnvaughan.

[linda49]

I find the 5mg uncoated pred pill easier to cut with a pill cutter as it’s slightly larger.

You could make 3.5mg by using a1 g and half of a 5mg. Good luck.

[Casia in reply to linda49]

Thank you linda49. That’s very helpful. I currently have uncoated so will do my best with these and see whether I can get coated with next appointment. Thanks again for taking the time to reply.

[Hidden in reply to Casia]

Hi Casia

You can get 2.5mg Uncoated your GP will write you a prescription if you ask, then you can make 3.5 easily, that’s what I’m using to get to 7.5mg from 8mg - I always used to use the coated 2.5mg but by chance l found out about the uncoated recently.

Good Luck with your next taper 🍀

[Casia in reply to Hidden]

Hello ! That’s really helpful MrsNails. Will def ask my gp. Thanks again!

[PMRpro Ambassador]

There isn't a real answer - everyone is different and it also depends on the tablets you have. But personally, if I could (I can't, I can't cut my tablets) I would only drop by 1/2mg at a time anyway and I woud slow even DL's approach further now you are at such a low dose.

Enteric coated/gastro resistant pred comes in 2.5mg doses as well as 5mg and 1mg tablets, and can be combined to take the same dose daily at 1/2mg steps down to 2mg. They are only available in the UK and many doctors are reluctant to prescribe them on (false) cost grounds. But they release in a different way, much more slowly, and switching to them may cause the individual problems. There is also 2.5mg uncoated if you are lucky and half a 5mg tablet using a pill cutter is cheaper...

And don't be misled: if you are already very close to the minimum dose you need to manage the inflammation it won't take long for the bucket to overflow - you can have a flare in quite a short time.

[Casia in reply to PMRpro]

Brilliant advice as usual from you and very much appreciated. Thank you so much

[Sandradsn]

I dropped from 4mg to 3.5 over the summer,then stayed on that for 5 weeks,now I've reduced to 3 gradually.I did the DSNS way and used a pill cutter. I seem to be OK and will just tell my GP when I see her next week.

[Casia in reply to Sandradsn]

That’s good to hear Sandradsn. Thank you for taking the time to reply and good luck with your taper !

[christine2715]

You can get 2 1/2 mg tabs Which help when reducing.