That old tapering question

[braininjurythepits]

On my second attempt at reducing from 10mg to 9mg, for almost a month I’ve been taking 10mg and 9mg alternate days on the advice of my rheumy. It seems to be working, and I feel absolutely fine. My question is, as it’s going so well, should I start the next month on 9mg only, or 9 and a half? After my last attempt I had to go back up to 10 again soon after trying to reduce, I really don’t want the same thing to happen, should I take the cautious way and go very slowly? Thank you in advance for your very helpful advice.....

Female 66 years

Diagnosed PMR Sept 2018, starting dose 10mg Prednisolone

[Soraya_PMR]

Well if you look at it this way : 10 + 9=19 over 2 days, = 9.5 per day. So if you went to 9.5 you’d be at the same level.

How about 2 days at 9 then one day at 10: 3 days at 9 then one day at 10 etc, til you get to a solid 9 daily.

How quickly did you have to go back up to 10 again last time?

[braininjurythepits in reply to Soraya_PMR]

After about a fortnight Soraya, previously I had been doing the method you describe, but once I went down to a solid nine, the problems surfaced

[Soraya_PMR in reply to braininjurythepits]

Well you certainly started on a low dose, and 7 ish months later you’re still there. Just checked my records and started on 20, didn’t get to 10 til around 11 months, and it was at that point that I started splitting my dose (bedtime and 8am)

There’s no guarantees that you will or won’t get the same problems second time around.

Why did you start on such a low dose? Do you have pred risk factors?

[braininjurythepits in reply to Soraya_PMR]

No, I knew nothing about PMR and just went along with my first rheumy’s ‘conservative approach’

[Soraya_PMR in reply to braininjurythepits]

Did the 10mg clear out the pain and stiffness? How long did it take to feel ‘better’?

[braininjurythepits in reply to Soraya_PMR]

Within hours hip, leg and wrist pain disappeared, took a couple more weeks for shoulder and neck pain to go, after that I was ship shape until I tried to reduce to 9mg. My current rheumy believes that I was started on too low a dose and I agree with him!

[PMRpro Ambassador in reply to braininjurythepits]

Which is fine when a conservative approach works - but what does he do when it isn't enough to relieve the symptoms?

[braininjurythepits in reply to PMRpro]

He suggested methotrexate, which was when I decided to change my rheumy!

[PMRpro Ambassador in reply to braininjurythepits]

Crackers - start with the proven level of pred first. Too low a dose of anything won't appear to be the right drug!

[piglette]

Why did you stay on 10mg for so long?

[PMRnewbie2017]

Perhaps the DSNS method or PMRPro's schedule would help. Have you considered them?

[DorsetLady PMRGCAuk volunteer]

Try this method tapering 0.5mg at a time - starting at 9.5mg

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

And this is my way:

healthunlocked.com/pmrgcauk...

If you are at alternate days now, I would start adding an extra day of 9 between the 10mg dose for a week or two. For example, you would do 10/9/10/9/9/10/9/9/10/9/9/9/10 ...

I would be ready to stop at any point. Maybe 9.5mg is enough, 9mg is not. And if it is, if you have plain cuttable pred, I would get a pill cutter and use a steady dose.

[braininjurythepits in reply to PMRpro]

Thanks for all the advice, I’ve got a few days to mull it over before I start, will keep posted for benefit of others

[SusanEleven]

My starting dose was 10mg as well. My rheumatologist starts all her pmr patients there but raises it quickly if their pain does not resolve. My pain resolved well at 10, and fast. She quickly moved other pmr patients to 15, 20 or 25 daily if the 10 wasn’t enough. One needed 30 mg per day. She says if anyone needs more than 30 mg a day for pain relief of pmr she figures something else is going on. (We chat a lot about pmr.)

That said, going from 10 to 9 caused a flare because I dropped 1 mg after as she asked. I told her I’d rather follow one of the slow taper methods from this group. She said she was confident I could manage my own taper and said she’d write prescriptions for whatever strength prednisone pills I needed for tapering.

If I remember correctly I ended up going to 11 mg and going down really slowly from there. I’ve only done 1/4 mg drops chopping up pills

After 3 years I’m at 3mg/day and she’s happy that I sit there for as long as it feels right. (I stayed at 4mg for 11 months.)