When to start tapering?

[SurreyFlower]

Your advice and experience would be appreciated please

I started on 15mg Pred Xmas eve . (for PMR) That didn’t “cut the mustard “so Dr increased to 17.5 last week. This has settled things down nicely. I had blood tests yesterday and have telephone consult and dexa scan next week.

It seems that ,to a certain extent ,we have to manage our own medication and I have looked at the very useful tapering scheme suggestions.

At what point should I start tapering down would people think please and to to what dose of Pred ( amazing how quickly we quick up jargon 😉) as an initial step down

Many thanks

[DorsetLady PMRGCAuk volunteer]

Most official tapers say initial dose for 3 weeks, but 4 is better I think. As the 15mg didn't work for you, I would be inclined to take 17.5mg as your starting dose, but as you were already on Pred, maybe you could say 3 weeks from the start of that dose.

But you only taper as long as you feel okay...you go by symptoms - or rather lack of symptoms! - not just because it’s a certain number of weeks from last reduction. But if you aim for about a month that will probably be okay.

Again, “official” tapers - 17.5-15-12.5-10mg then 1mg. However some people find the 2.5mg tapers down to 10mg are too much. So ask for1mg tablets next time you speak to dr, then you have then option of smaller tapers. Or if you have plenty of 2.5mg you could cut them in half (so long as uncoated plain white). It is recommended that you only reduce 10% of your existing dose - so keep that in mind.

Unless you are having difficulties you might find you don’t actually need to use a “slow” taper until you get a bit lower, but they do stop the steroid withdrawal symptoms that some get for 2-3days after stepping down. I just felt a bit off colour and grumpy, but others feel really bad - just see how it goes.

You also need to remember, that just because you feel better, you still have the underlying illness, so learn to pace your activities.

Good luck.

[SurreyFlower in reply to DorsetLady]

Thank you very helpful

[PMRpro Ambassador]

You first need to have the symptoms well under control and, if applicable, the blood markers should be falling and preferably well into the "normal range" even if they are not already stable. Most experienced good rheumies would leave you at the starting dose for at least a month, preferably 6 weeks.

A reduction step should not be more than 10% of the current dose - although using one of the slowed tapers often means that slightly more will work without you suffering steroid withdrawal discomfort which can be so similar to the disorder for which you are taking the pred that you think you it is flaring up again. Personally I think that from 15mg 1mg at a time is plenty - it may sound slow, it isn't slow when it works!

[SurreyFlower in reply to PMRpro]

Thank you

[piglette]

I agree with Dorset Lady. I found three weeks was a bit fast for me but my rheumie wanted a 25% drop which was way too much for a delicate flower like I am! Four weeks is probably a good wait as it gives you time to ‘stabilise’ and get used to the steroids. Sounds like you have a very sensible doctor and not one that wants you to decrease like a bat out of hell.