Tapering Question

[Whitner]

I’m tapering from 12.5 to 10 mg of prednisone. When I moved from 15 to 12.5 I started splitting the dose taking 7.5 after breakfast and 5 after lunch. Wondering if it is a good idea to do a similar thing by taking 7.5 after breakfast and 2.5 after lunch? My thinking is it will nudge my adrenal glands into action. Appreciate your thoughts.

[DorsetLady PMRGCAuk volunteer]

Do whatever suits you best, but adrenals do not need much nudging as yet.....usually around the 7.5mg mark .

[PMRpro Ambassador]

Adrenals won't be much of a factor in the equation until you are down to a total dose of 7.5mg and possibly even lower. Even then, the most important thing is having as low a level of pred as possible in the body at midnight - so taking the pred early in the day.

Reducing the dose by 2.5mg at a time is quite a bit - recommended is 10% of the total dose.

[Whitner in reply to PMRpro]

I know. My rheumatologist wanted me to go straight from 15 to 10 so I’m already pushing it. The drop from 15 to 12.5 was uneventful so hopefully this one from 12.5 to 10 will be the same🤞🏻

[piglette in reply to Whitner]

Good luck with the drop, my rheumatologist wanted 5mg drops and it was disastrous!

[Whitner in reply to piglette]

Oh I hope not!

[piglette in reply to Whitner]

You are being sensible and just dropping 2.5mg and listening to yourself not your rheumie, I was just very naive!

[Whitner in reply to piglette]

Only because of this great forum piglette!!❤️

[PMRpro Ambassador in reply to Whitner]

Try a slowed taper - you get to the same place in a month, just it hurts less

healthunlocked.com/pmrgcauk...

[pugrescue in reply to Whitner]

I am in just about the same spot as you. Rheumy wanted me to drop 2.5 every 3 wks, and after 15mg, 2.5 drop every 5 wks. To me that was absurd. At 15 I started dropping 1mg every 2 wks, currently at 13 and so far so good. Same rate as rheumy wanted, but much smoother. At 10mg, I plan to drop by 1/2 each time. Its really up to you, but less drastic changes take away SOME of the pred withdrawl.

[RecentPMRdiag in reply to PMRpro]

Hi PMRPro,

Can you please explain the rationale for lowest dose as possible at midnight - I often take myevening dose mid-evening (currently 5mg)?

[HeronNS in reply to RecentPMRdiag]

I believe PMRpro means the level of pred in the body should be as low as possible at midnight, so take pred earlier in the day to achieve that. This is in reference to giving adrenals as much of a nudge as possible I think, not a recommendation about dosing in general.

[PMRpro Ambassador in reply to RecentPMRdiag]

The natural lowest level of cortisol in the body is at midnight and that triggers the pituitary gland to prod the adrenal glands to produce cortisol in the morning to get the body primed for the day ahead. If the level is too high at midnight the body registers there is plenty of corisol present and so produces less or even none in the morning.

[RecentPMRdiag in reply to PMRpro]

Thanks - that is clear. I've read a lot over the last 6 weeks, but nothing about balancing the artificially stimulated versus natural cortisol. I'll change to my evening dosing to last afternoon and see what effect it has on my sleep.

[PMRpro Ambassador in reply to RecentPMRdiag]

It isn't really of importance until you get below 10mg - what dose are you on?

[RecentPMRdiag in reply to PMRpro]

The sub-10mg guideline is even more useful.

I'm on 11.25mg daily , split 6.25mg in AM and 5mg in evening. But Rheumatologist and GP will be pushing me to reduce to 10mg daily by the end of next week and then start a 1mg per month reduction for 2020.

Many thanks again!

[PMRpro Ambassador in reply to RecentPMRdiag]

Probably not of significance until 8mg even.

[IslandRN in reply to PMRpro]

Hi pro! i just tapered to 7.5 and take 5 mg around 2 am and normally take remaining dose at 6 pm but reading your post on importance of midnight levels suspect I should take evening dose earlier to assist with pituitary gland trigger. What time do you suggest I take the second dose?

[PMRpro Ambassador in reply to IslandRN]

As early as you can and the result takes you over to the next morning which is the main point of splitting, You will have to experiement a bit probably.

[HeronNS]

I have gathered from reading many posts about slit dosing over the years that it is fairly standard to reduce the late day dose more than the early one. It seems to work for most people doing this, but not everyone and only you will know if it's right for you. Try what you propose and see if it works. But I agree that 2.5 is a big step. I'd be tempted to try dropping 1 mg of the after lunch dose and see how it goes, then after a couple of weeks try a further 1 mg drop. Do you have 1 mg tablets? They are almost essential for tapering once you reach 10 mg, and useful even before that.

[Whitner in reply to HeronNS]

No I only have 5 mg tablets which I’ve been splitting. I dropped from 15 mg to 12.5 for two weeks without any real difficulty so I hope this next drop to 10 mg will be successful. I plan to stay at that level about 4 weeks. I will talk with doc about 1 mg tablets when I see her late February. Thanks!

[HeronNS in reply to Whitner]

I think people have actually cut 5 mg tablets into four when they've no alternative. It gives you an approximate 1.5 in each dose (won't be entirely exact) which can be helpful if 2.5 has proven too much.

[PMRpro Ambassador in reply to Whitner]

Using the DSNS slowed approach may also be useful - it was developed partly for the benefit of patients on the enteric coated form of pred which at that time only came in 5 and 2.5mg doses and can't be cut.

healthunlocked.com/pmrgcauk...