Reducing

[Jizer]

Hi everyone reduced from 7mg to 6mg feeling very fatigued slight pain in thighs and pain in rear rib cage Area this is 7th day on 6mg noticed the change on day three of 6 mg looking for advice.

Thanks. Jizer

[PMRpro Ambassador]

I assume you went from every day 7mg to every day 6mg in a single step? That is quite a big change, 15% or so. Top experts recommend that any step down in tapering should be no more than 10% - the bigger it is relative to your daily dose the more the body has to adjust and why keeping changes small is less noticeable. You are also at a level where your body is also going to have to adjust to the reducing dose of pred in order to function - above about here the pred you take replaces the cortisol made by the adrenal glands and they go into hibernation. Now they have to wake up and pull their weight again - and that takes time.

[Jizer in reply to PMRpro]

Do u think I should try to continue on 6mg for a longer period or increase to higher dosage.

Thanks. Jizer

[PMRpro Ambassador in reply to Jizer]

I can only tell you what I would do in the same situation: I would go back to 7mg immediately. If that solves the problems, I;d then stick at 7mg for a few weeks and then try 1/2mg or one of the slow reduction approaches with 1mg which may work, If not, slow approach with 1/2mg.

This one:

healthunlocked.com/pmrgcauk...

[DorsetLady PMRGCAuk volunteer]

Good advice from PMRpro - no need to add anything.

[Pym1]

My own experience leads me to Agree with PMRpro and DL

Pym

[PMRnewbie2017]

Ditto. For what it's worth, I saw my Rheumy this week. We have had some "tussles" over the past year regarding Alendronic acid, dose reduction schedules etc, but he actually agreed that half a mg (0.5mg) reductions were the way to go and do this gradually over at least 4 weeks. (I'm now on 6mg).

We also had a discussion about recognising the difference between a flare and the muscle discomfort one gets as the body complains that its supply of Pred is being reduced and the consequent temptation to increase the dose again. He reckons that around 3mg is when the muscles really complain, and of course since steroids can cause muscle myopathy the picture is muddied even further the longer one has been taking Pred. So we have a double whammy. Sleepy adrenal glands and damaged muscles!!!

[Soraya_PMR]

Hi, I struggled from 8 to 7mg, and it wasn’t til I thought of it another way that I fully realised what I was expecting of my poor body..... despite everyone advising a S-l-o-w reduction!!

If you have dropped 1mg a day.... then you have dropped 7mg per week!!!!!! Is it any wonder you ache? We’d never miss out an entire day’s dose and not expect repercussions. Hope that different way of looking at things is helpful?

I’m now doing the one day low, 6 days higher; one day low, 5 days higher etc etc thing and having success, conquered the 8 to 7 hurdle, down through 6, now trying 5.

[PMRpro Ambassador in reply to Soraya_PMR]

Despite KNOWING that, I'd never thought about saying it...

[Soraya_PMR in reply to PMRpro]

Yup. Know what you mean, it’s obvious really! But it wasn’t til I had that Eureka! Moment.... ‘7mg a week’ that I truly got my head round it.

[Jizer in reply to Soraya_PMR]

Hi soraya I think you have misunderstood I have been on 7mg for 6 weeks and have reduced to 6 mg for about six days and I am struggling

Thanks jizer

[PMRpro Ambassador in reply to Jizer]

I think she did get what you meant: on 7mg per day you would have taken a total of 42mg over that 6 days. On 6mg per day you have only taken 36mg. You have had the benefit of an entire day's dose less this week. If you had forgotten to take a dose one day - would you be surprised if you ached?

[Soraya_PMR in reply to Jizer]

No I don’t think I have misunderstood you jizer. It’s just a subtle shift in thinking about your dose as a WEEKLY TOTAL, rather than as a daily amount. As PMRpro has calculated. This makes you realise the dramatic fall in dose that your body is trying to cope with.

If you’re taking 8mg a DAY, your weekly total is 56mg.

7mg per day = 49mg per week.

6mg per day = 42mg per week.

Look at the massive drop PER WEEK if you drop 1mg per day.

Sorry! Don’t know how to explain it in words alone. I’m better when I can ‘act’ it out and wave my hands about!