Taper Every Other Day?

[Jgyles]

Hello PMR - Chat group,

I just had an interesting conversation with a friend, who is also an Internal Medicine - Specialist. Her suggested, (with out any Science to back up) - about cutting back on the Prednisone with every other day treatment. I currently am on 21/2 -3mg and seem to be floating on this does for the last several months. (PMR for 2 1/2 years). She suggested this to reduce the accumulative dose of prednisone over the year...

5mg 3x per week, (15mg), vs 3mg-7x per week (21mg). Having a day off the prednisone could “test” my body and symptoms, vs daily dosing. I understand it is a short acting drug, so this may not work. And would there be a risk of rebound worsening symptoms vs staying stable.

Has anyone tried this?

This seems to be more an ART, than a SCIENCE.

JG

[piglette]

I have been told that although with some things, such as Myasthenia gravis, taking pred every other day works well, it is not a good idea with PMR and is not recommended.

[DorsetLady PMRGCAuk volunteer]

We don’t usually recommend it - your body is likely to be confused and certainly not very happy on the days you don’t take Pred.

And , if I read it correctly the suggestion is to take 5mg three days a week - then the other 4 are likely to be hard work.

Personally I think you would be better sticking with the regime you are doing. If it controls the PMR then just be pleased it does. .

As you are only 2& 1/2 years into PMR you are probably on your optimum dose at the moment. You will be able to reduce - but not just yet.

Not so much scientific - more fantasy methinks!

[JaneGyles in reply to DorsetLady]

Thanks for your reply. Appreciated

[PMRpro Ambassador]

It all depends on whether the underlying autoimmune cause of the symptoms we call PMR is still active and also on how long the antiinflammatory effect of pred lasts for YOU. It lasts from 12 to 36 hours depending on the person. I can take double doses of pred on alternate days and the day without pred is fine. Others find they have symptoms returning within the 24 hours, sometimes even by evening.

While her concept of reducing the pred is fine for just persuading the adrenal function to buck up, it has to be balanced with the suppression of the inflammation in PMR - which is a long term and ongoing problem. Once it is gone you can taper how you like but they way you find it is gone is to taper slowly to zero pred and the symptoms not returning.

[SnazzyD]

There’s no way I would have coped with that as my body noticed the drop next day after even a small one at these levels. I don’t see the point of stressing the body out and I challenge anyone who suggests depriving the body if it has adrenal insufficiency to try it. I think it highlights the tendency to separate PMR from the effects of the medication, it’s withdrawal and how they tie in but above all the affect on the quality of people’s lives. I don’t see any explanation of how it is supposed to help people feel better other than get them off steroids as the be all and end all. Anyway, some might be ok. Not sure if this is a rant or not 🙂

[JaneGyles in reply to SnazzyD]

I hear what you are saying. I wake up every morning still needing to take medication because I feel the PMR. I’m more active now than ever. Just cross country skies for 11/2 hours. - So time will tell. Not sure if I will try it after these comments. -thank you

[SheffieldJane]

I am totally in accord with SnazzyD. That regime would make me quite ill, I just know instinctively after 4 years and trying things. If you try it, let us know how you get on.

[HeronNS]

Alternate day dosing is not recommended for PMR. Few people find their a dose lasts more than 24 hours, I'd venture a guess that for most of us it's slightly less as we feel a recurrence of symptoms, hopefully very mild niggles, prior to our next daily dose. Alternate day dosing is used successfully in other conditions which may be why your doctor suggested it. My personal opinion is the smoother you can make your journey the better, which means taking dose at a regular time, once a day (or in some cases splitting the dose and taking twice a day) and when tapering doing it in the smallest possible decrements.

"In contrast to other rheumatic diseases, alternate-day administration of corticosteroids in PMR has largely been unsuccessful."

emedicine.medscape.com/arti...

[JaneGyles in reply to HeronNS]

Thanks Heron NS. Hope your surviving the winter!

[HeronNS in reply to JaneGyles]

So far in the HRM of NS we've hardly had much real winter weather, unlike the ROC from Victoria to St John's! Deep freeze today -16 windchill -21 sunny with a dusting of snow on the ground, and it's supposed to rain again tomorrow. 🙄