Slow tapering

[Dorsetgirl17]

Question for Dorsetlady. I like the idea of your slow tapering, but is it relevant for pmr, I know you were a GCA sufferer?

[DorsetLady PMRGCAuk volunteer]

It’s relevant for either/both.

I didn’t use it until I got down to single figures. But having said that it can be used at any dose you’re finding it a bit difficult.

[Dorsetgirl17 in reply to DorsetLady]

Started on 15mg for week breakfast time which didn’t kick in until 6pm, so doctor increased to 20 which worked after 3 days. She was all for me coming back down to 15 and I said would prefer 17.5, start today in fact. So should I not be tapering at all but stay on the new dose?

[DorsetLady PMRGCAuk volunteer in reply to Dorsetgirl17]

I would stay at 20mg for a couple of weeks, and then reduce to 17.5mg and from then on reduce at monthly periods.

Whether you do that as a one off drop or stagger it over the month is up to you.

Many plans suggest you reduce fortnightly, but I think that’s too quick - likely to go below the dose you actually need without realising until it’s too late.

Good luck

[Dorsetgirl17 in reply to DorsetLady]

Thank you

[PMRpro Ambassador]

Slow tapering is related to the titration of pred - doesn't matter WHY you need it but if you start at a higher dose and are looking for a lower dose it is appropriate. I developed the DSNS approach (Dead Slow and Nearly Stop) and I officially "only" have PMR.

[Dorsetgirl17 in reply to PMRpro]

Thank you

[SnazzyD]

Slow tapering is to avoid extreme withdrawal symptoms and stress on the body. At the low end of the dose spectrum it avoids adrenal crisis. It also tries to avoid reducing faster than the autoimmune process takes to ‘burn out’. Therefore it matters not whether one has PMR or GCA.

[Dorsetgirl17]

Yes I intend to do it slowly and wonder if the 1 mg route is going to be better than the suggested 2.5 reduction from 20 mg which is what I am on at moment.

[PMRpro Ambassador in reply to Dorsetgirl17]

If you can manage 2.5mg at a time then do it - you can still use the slowed approaches with a 2.5mg drop but they are gentler on the body. Some can manage 2.5mg drops overnight at that level, it is barely above the 10% guide. You only know when you try. If you can't then do 1mg,

The DSNS one was partly developed to help patients on enteric coated pred where the smallest dose was 2.5mg at the time and you needed to use plain pred for smaller steps - some people just couldn't tolerate it.

[Valentina1 in reply to PMRpro]

Goodmorning all. Storm here in Cornwall much reduced. That seems appropriate for me.

I have reduced from 60mgs of Pred a year ago to 6mg of pred. I am not too well in the first 3 days of reducing just 1mg I then pick up a bit. Tiredness balance issues and bladder all over react then I wait at least another month before repeating this regime. This seems to work for me. Always followed Mrs.Nails advise. Thank

[Dorsetgirl17]

Yes I guess everybody is different it is only a suggestion and you have to go with what you feel is good for you, thank you for reply .