Anxiety from taper?

[crochetlover]

I'm slowly coming down from methyl prednisolone and am doing fine pain wise but when I just went from 6 mg (1.5 tabs) to 4 mg ( methyl is not available in pills less than 4 mg ) I am having a lot of anxiety episodes where I feel my heart pounding and I get some shortness of breath. Is this normal in the taper?

[SheffieldJane]

You have arrived at the level of methyl - Prednisalone that doesn’t meet your body’s Cortisol needs. So your Adrenal glands will be waking up and trying to meet the shortfall. Many of us experience additional symptoms such as yours. However, if you report this to your doctor she or he will examine you to ensure that all is well. Perhaps you could also discuss a referral to an Endocrinologist that can be additional support and advice at this time. The jittery feelings are unpleasant, I managed by using relaxation and mindfulness techniques and sleepy tea ( camomile).

I haven’t personally used methyl- Prednisalone and didn’t know that it couldn’t be got in 1 mg tablets. This maybe something your doctor and or pharmacist could solve for you. You could really do with the option to drop by half a mg ( a 1 mg tablet cut in half with a pill cutter) this makes for a gentler taper that is more likely to succeed. Good luck with this tough little bit.

[crochetlover in reply to SheffieldJane]

Thank you for explaining to me what was going on with my body. It is quite scary!

[PMRpro Ambassador]

Methyl pred also comes in 2mg tablets - but you have to ask for it usually.

Had you never had any palpitations before starting steroids or at higher doses? I had had some very occasional palpitations after PMR started and before pred (plenty of time to notice) but they then seemed to disappear at higher doses of pred only to return as I reduced. Eventually I was diagnosed with atrail fibrillation because of a violent drug reaction and once it was treated I realised the episodes of palpitations had almost gone. The arrythmia consultant is confident it is due to the autoimmune part of PMR. Always worth getting your doctor to check it out - but if you get a long term ECG test (24 hours minimum) you will need to watch there is an episode while you are wearing it or they'll try and say you are imagining it!

[crochetlover in reply to PMRpro]

Thank you!

[Blearyeyed]

I've not used this but it does sound like the effect of tapering 2 mg has been the same as it would be on Prednisone , to big a jump down in doseage at a point when the dose has a bigger impact on your Adrenal Function.

I'd take Pros suggestion , go to the surgery and politely push for 2 mg tablets instead .

Go back on 6 mg for a few weeks while your symptoms settle then try reducing to 5 mg instead. The slower taper may reduce symptoms especially things like Palpitations , Shortness of Breath , Dizziness and Anxiety like symptoms , all common Adrenal related reactions.

Also keep well hydrated , especially when starting a new Taper. Dehydration can happen even when you aren't thirsty and especially when your body is making changes , this can increase these sorts of symptoms.

Increasing Magnesium and Potassium in your diet may also be helpful.

Get a full body MOT too. You want to have the peace of mind that it is dose related and nothing else . If you haven't had a heart , liver and kidney check up for a while it's worth doing it now. Get your full blood count , liver function , kidney function ( especially your electrolytes like Sodium) thyroid profile and iron checked. Any deficiencies in these can make Tapering harder or could be an added cause for your symptoms.

Relax as much as you can , pace yourself and allow yourself more rest in the first week of a new Taper and when these symptoms emerge go and sit , do some deep breathing and relax for half an hour , eyes closed . Sip cool water as you do this or when you are having the symptoms during the day too as this can calm the heart if your palpitations .

Let us know how you go in an update or and what the cause was . Take care , a fellow lover of crochet x

[crochetlover in reply to Blearyeyed]

Thank you so much for taking the time to reply to me! I will try all your suggestions

[PMRpro Ambassador]

Forgot to mention before - ideally no reduction step in a taper in chronic illness and use of steroids should be more than 10% - you had to ask your body to cope with a 33% change in dose. If you can't cut the tablets smaller, at least try this or something like it to spread the change over longer:

healthunlocked.com/pmrgcauk...

[crochetlover in reply to PMRpro]

Thank you! I’m talking to my doctor today to see where I can find some 2mg pills.

[di-bach]

Hi I had great difficulty reducing even using the slow taper method even when down to half mg . To finally get off the preds I would take alternate days for a month finally got off them but was on them for six years, compromise now with osteoporosis and vertebrae fractures but looking for alternative to analdronic acid because of reflux hope your treatments go better best wishes.

[PMRpro Ambassador in reply to di-bach]

There are also infusions - once or twice a year depending on what substance.

[di-bach in reply to PMRpro]

Hi thanks for that I have just moved house and have a new gp so have been prescribed Analdronic acid I did mention the reflux also prescribed ppi which I take from when on preds . See the gp again this week on another mater, but will have to mention severe upper back pain occurred over night I think it’s aspiration from reflux, or another fracture it makes coughing which I get from the reflux an adventure, reading on osteoporosis website Teriparatide is useful but as a seventy five year old man is it appropriate

[PMRpro Ambassador in reply to di-bach]

Actually - if you already have reflux then AA is contraindicated and the GP should know that.

I discovered earlier today that ranitidine is preferred for overnight problems - it targets the cells that release acid in the evening.

I wouldn't have thought age had anything to do with teriparatide - it should be need that dictates what you are given.

[di-bach in reply to PMRpro]

Thanks for your replI’ll see gp this week and see what there response is