I'm trying to get an idea of how much pred my dad should be taking as his dosage seems pretty low and he's not well at all. He is on 6mg currently and was only diagnosed in Nov. Others on this site have advised that this seems low. I would be interested in hearing 1) How long you have had the condition and 2) What is your mg dosage of pred. I fear my dad's doc isn't worth his salt and would like to gain some better knowledge of the condition and treatment.
Thanks in advance
There are no real answers as everyone is different. However well he was at 15mg is the guide - you should start with a dose that manages the symptoms well and then reduce it slowly to find the lowest dose that gives the same result. 15mg may even not be enough to start at - anything up to 25mg is now the recommended starting dose. You may not be able to reduce quickly - most people remain at the starting dose for a month to 6 weeks before dropping 2.5mg to try that much lower. Some people reduce steadily to under 10mg - others get stuck. Once you get to 10mg the drops should be not more than 1mg. It isn't a speedy process.
But I'd agree your dad's GP isn't exactly top notch.
That’s a very difficult question to answer.
The idea is to blast the built up inflammation with a relatively high dose (between 15mg-25mg for PMR) - and then once symptoms have subsided to reduce slowly to find the level you (or your dad) needs on a daily basis.
From your previous post, this obviously didn’t happen, so your Dad has gone below the level he actually needs. (The inflammation is produced every day, so it’s a bit of a balancing act).
Most people I would say only 3 months into PMR are probably still on about 12.5mg per day - that the usual step down from 15mg - although not everyone achieves it.
Is there another GP your father can see, because his current one obviously doesn’t under his illness.
Have a look at this - para 5 may be of some help - but it is only guidance - not all patients manage the suggest reduction plan -
pmrgca.co.uk/assets/files/z...
Thanks for the link and the information. From what you are saying inching it back up may not do any good as he has lost the head start gained by blasting it using a higher dose? Personally I would like him to up it to 8mg and see how he feels. Would this be sensible?
It’s a first step - time will tell if it’s enough. He should know after 4-5 days. If it is- then stay at that level for a month.
If it’s not - you may need to go up to 10mg- but try 8 first.
Hi,
I too am inclined to think that your Dad may have reduced too fast - certainly faster than the norm, and it wouldn't be at all surprising if his symptoms have gained the upper hand. It might be worth going back to the doctor and saying as much, rather than letting the GP think that all must be well. One problem with self-medicating is that it lets the GP off the hook. Also, there's always the chance that the doc suspects that it isn't PMR and just hasn't explained this. You might consider printing off the BSR guidelines and taking them with you.
Hi irishlass
If it's any use to you I'm five months in and just reduced to 13mg today having started at 30 for 3 days then to 20 with symptoms then returning so then to 25 which cleared all pain and stayed there 6 weeks. I live in Ireland so it was Irish doctor with diagnosis on referral to neurologist.
It really depends if your father is feeling OK pain wise or not on that dose. Also what dose did he start at? You say he is not at all well, if that is because of the PMR he is definitely at too low a dose. He should talk to his doctor and say he thinks he needs to increase the dose. Asking what happens with everyone else is like asking how long is a piece of string!
I think you are right to be concerned. I have reduced to 6 mgs from 20 mgs over a period of almost 3 years. Perhaps your dad could see a more knowledgeable doctor, or be referred to a Rheumatologist? Has he ever experienced profound relief from his symptoms? If so he should perhaps return to that dose until things settle. He should not have to put up with the symptoms of PMR when they can be relieved and unchecked inflammation is bad for him.
Thanks for all your replies folks, I really appreciate it. The good news is that on the back of this information dad is going to see a different GP today at 2pm. So hopefully he will get stablised and back to enjoying life as much as possible. Thanks again.
I was diagnosed about the same time as your Dad. Took 40mg for 3 days and then down to 20. It was like a miracle the way the terrible pain disappeared. I started to reduce because I didn't like effects of prednisone. My doctor was so hard to contact I did it by myself. In about 4 weeks went to zero and of course all the unbearable pain came back. I went back on 15mg. Now have managed to drop to 7.5 which I split, morning 5 rest in evening. After about 5 days, I seem to be Ok. On Thursday I will see my M.D. and go over it with him. Also try to, have good diet, sugar is the worst for bringing back inflammation, lots of fresh organic vegetables and fruit. Also exercise is so important. Don't know if any of this helps you. Good Luck to your Dad.
Thanks so much, very helpful
When my wife was diagnosed with PMR, she was placed on 15mg. By the 7th month, her first rheumy had her down to 2mg, and she soon was back to ground zero. Her 2nd Rheumy restarted her on 12 and went to 11.5, 11.0, 10.5 but when she got to 10 her pain came back. She is now at 11mg 5 days a week, and 10mg 2 days a week. She's had PMR for almost 3 years.
Joe
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