How long to increase pred

[Meggsy]

I know I’ve seen it written before but just checking. How long can I stay on a 5mg increase and then drop back to previous dose? Thank you in anticipation. 🌻

[HeronNS]

I think a week is customary, provided the flare has been dealt with, but you may wish to drop back not so much to your previous dose, where you flared, but to the last dose where you felt the symptoms were well controlled. So, for example, if you were taking 7 mg and flared, and you are now on 12 mg, you may consider going back to 7.5 or even 8 mg, and recommencing the slow taper from there, rather than dropping all the way back to 7.

[Meggsy in reply to HeronNS]

Thank you Heron, I had a rough idea but thought I would double check. 🌻

[Blearyeyed]

If you have increased your dose to cope with a Flare and the symptoms come under control again an increase of 10 days is often recommended , followed by a more rapid reduction over the next four days , meaning that you can return to the previous dose which was controlling your symptoms again in a straightforward way without the long tapering process again.

For Example , if you had a Flare at 9 mg and chose to go upto 14/15 mg , you would stay on it for a week upto ten days , then drop back down to 10 mg , by possibly doing two days at 13/ 12.5 mg , then one at 12 / 11mg , day 4 at 11 mg then back at 10 mg . During this time you also need to Pace Yourself and rest more to give you the best chance to get over the Flare itself.

Stay on that dose again for 3 weeks to a month , allowing your body to have time to recover from the Flare , build up strength again with good diet , hydration and gentle exercise , and preventing you putting more burden on your body before it is fully recovered by trying to start tapering again too quickly.

The first Taper after a Flare it can be helpful not to reduce by a full 1 mg , but reduce by only 0.5 mg over two weeks at a time to make sure your body can cope with the change.

The month on the dose you were on just before the dose you had your Flare on also helps you see that the increase in Pain wasn't more long term ( because of the PMR /GCA itself , not because you were having extra Stress , not Pacing well or had an infection or injury) .

If at that dose you found that your Pain started building up again over a few weeks you know that the PMR is still more Active and you may need to increase the dose , with GP discussion , to a level higher than that 10 mg but then do the slow taper from that dose.

Hope that helps , good luck

[Meggsy in reply to Blearyeyed]

Thank you Blearyeyed for your wise advice. 🌻

[HeronNS]

I've dealt with a couple of flares, only one of which was particularly notable, and even then I didn't have to stay at that highest dose for more than a couple of days. I didn't drop back at once to just above my previous dose but took a few days to step down. I suppose in the end I took in significantly less pred than if I'd stayed at the higher dose for ten days and was still able to thoroughly deal with the flare. I believe you can stay at the higher dose that long and not need to revert to a slow taper, as one would if you were higher for much longer than that. But you may not need to stay at that higher dose the maximum time. It all depends how it works for you. If you are sensitive to pred you may find the shorter time sufficient, as I did. If you are a bit reisistant to pred and have always needed a bit more, then it may take longer. We are all different, in this as in everything else!

[Meggsy]

Thank you for this advice Heron. I have taken note of it and will see how I go.🌻

[PMRpro Ambassador]

Everyone is different - so while being at a higher dose for up to 10 days shouldn't be a problem in terms of dropping back to a lower dose, an individual may not be able to do it without some discomfort. When I first went on pred I did 15/10/5mg for 2 weeks of each with absolutely no problem changing dose. Could I do that now after so long on pred? I don't know is all I can say. And it also depends what dose you are on at the time - changing doses at high levels is probably easier than at lower ones.

[Meggsy in reply to PMRpro]

Thank you PMRpro, I am on 5mg and have gone to 10. 🌻