Tapering

[Stradbroke13]

Hi is cutting down from 20mg to 15mg in a week too fast please

[MhairiP]

Yes, it seems a bit too fast. The rule of thumb is not to reduce by more than 10% at a time. Was 20mg your starting dose? How long were you on 20mg for? Are you symptom-free?

[Mary63]

I started on 20mg, and was after 5 weeks told by another GP that I should have been started on 15mg and was told to immediately reduce to 15mg. I was fine, but others on the forum have not been. My next instruction was to go straight down to 12.5mg, and that was too far too fast for me. Flared and had to go back to 15mg. At that stage I started taking notice of the tapering schedules and suggestions on this forum.

How long have you been on 20 mg? And have your symptoms improved a lot?

[piglette]

Some people have no problem cutting down that much initially, in my case it was a total disaster!

[Blearyeyed]

5 mg is too fast in a week in my opinion.

Especially if it's the first dose reduction you are doing , personally I wouldn't go down more than the guideline of 10 % , so down to 18 mg or 17.5 mg if it's easier with the pills you have.

Getting down by 5mg in a month is feasible , as long as you don't have any other things to get in the way of it like a lot of Positive or Negative Stress or events or an infection or injury , but if you are celebrating Christmas at the moment that counts as a lot of extra Positive Stress and Physical activity.

I would personally read the DSNS or Dorset Lady posts on Tapering , that you can read in the right side bar , and I also wrote a post for over Christmas called , Aunty Bees Advent Calendar, To Taper or Not to Taper which might help.

But 17.5 in two weeks possible then maybe down to the 15 mg by month end .

See what you think .

[Stradbroke13]

I started on 40mg .then went down 5mg over 6 weeks then down to 30mg over 6 weeks but now I've done from 30mg to 25mg in a week & I'm now down to 20mg in a week .now reached 15mg but he wants me to go to 15mg & 10mg alternate days for 2 weeks , I feel it's too fast .

[MhairiP in reply to Stradbroke13]

When you say you feel it's too fast, are you experiencing any pain and stiffness? 40mg to 30mg in 12 weeks sounds reasonable; but from 30mg to 15mg in 3 weeks is fast.

[jinasc in reply to Stradbroke13]

GCA diagnosed Oct 2019 - have I read that correctly?

If so that is a very quick progress downwards.............watch out for any returning symptoms please, especially your eyes.

[Blearyeyed in reply to Stradbroke13]

Just read back through some of your posts , didn't realise this was such a fast taper for GCA , did the Consultant explain if the reason for reducing so quickly was because of steroids causing problems with your other Health issues?

[Mary63]

I think that is much too fast. Take note of 10% rule and never reduce by more than that. Therefore 20mg to 17.5 or 18 Then depending on strength of your tablets down to 16ish maybe 15. From there I did 13.5 to 12. Them 11 then 10. Then down by only 0.5 mg at a time. And stay a month at least on each dose I would think. It ain’t slow if it works. Good luck.

[Poppylop]

I'm wondering the same thing, my rheumatologist wanted me to reduce 5mg every week for 6 weeks, I was on 35mg at the time , starting dose was 40mg which I've been on since August, and he said he wanted to scan my temples again at 10 mg at my next appointment which was 6 weeks time, I was a bit worried to do 5mg because when I've tried before I got bad headaches so started at 2.5 drops, I didn't want headaches over Christmas. The only problem is I'm not on track now to be at 10mg when I see him on 15th jan, I dropped another 2.5 last night so I'm now on 25mg, if I can drop by 5mg next week and the week after I will be at 15 mg when I see him, hopefully he won't tell me off for not doing what I'm told 😀

[GOOD_GRIEF in reply to Poppylop]

Remember that your doctor works for you, not the other way around.

[PMRpro Ambassador]

If it works for you maybe not - and it is a step that would be used in the more usual short term use of pred. It really depends on how long you had already been at 20mg and also on what your end dose is likely to be which of course you cannot predict. While many doctors seem to think that everyone will be able to get to 10mg or 5mg and then stick there for a time that doesn't work for everyone with PMR.

BUT - and here comes the BIG BUT: you have GCA, and your reduction from your starting dose is already far too fast for comfort. This paper suggests a far more reasonable and comfortable reduction plan:

rcpe.ac.uk/sites/default/fi...

A study found evidence of the GCA still being active after 6 months at above 20mg/day. I don't think that level will show on u/s scans but I might be wrong.

The pred has no effect at all on the underlying disease process - it is purely symptom management to reduce the damage done by the inflammation. 40mg was the bottom end of the range for GCA anyway, to hurry you off those doses is asking for trouble. Now you are at 20mg I htink he should be slowing the taper, allowing you a month at each new dose to be sure it is still adequate to manage the symptoms. And you should be tapering - that isn't achieved by reducing the dose 5mg at a time. For successful tapering the drop should be no more than 10% of the current dose - for various reasons. The lower you get the nearer you are to your target and that target varies from patient to patient - I need 15mg, the next person may be fine on 5mg but no-one can predict which you will be.

[discoballs]

I did exactly that and ended up in A and E.

[AndrewT]

Dear Stradbroke13,

I agree, this Does seem rather a 'Quick' Reduction. Though this does depend on 'How long' you had been 'On', this high dose. If it is Three DAYS then yes 'Drop' it back, by all means....but, and I suspect this is Much Closer to the truth, you have been on this High Dose FAR Longer (or this is the First Level, that you have been Put on) then you need to Reduce this MUCH Slower. Personally I wouldn't 'Reduce' by more than 1mg per Week.

Absolutely DO speak, to your Doctors/ Consultants/ Registrars about ALL 'this'. Tell them about your Fears/ Worries regarding, such a Fast Reduction Regime, though DON'T, do this, in an 'Angry' way. You expressing your 'Worries/ Concerns' and Asking their Advice...You are seeking Re-assurance NOT 'Folding Your Arms And Shouting'! Do you see what I'm 'Getting At' here?

I know that a number of us, would appreciate Knowing, your Doctors/ Consultant's advice, on this 'Matter' Stradbroke13. Can I ask you to Pass This on please. Many thanks and

Happy New Year 2020

AndrewT