A question about DSNS reduction

[Pippah45]

Brilliant to have this printed out - thank you so much. My question is at what point do you think I would go to the 1mg drops as described. I am currently on 17.5mg various hiccups along the line from 40mg in August. I was planning on sticking to this for four weeks. I have already obtained some 2mg tablets from the GP and have a pill cutter.

[DorsetLady PMRGCAuk volunteer]

I guess you’re doing 2.5mg at the moment - some can manage that to 15mg, some to 12.5mg, some even to 10mg.

But if you are one of those that has ‘hiccuped’ in the past it might be wise to start at 15mg.

Good luck whatever you decide.

[Pippah45 in reply to DorsetLady]

Thank you - yes 15mg seems a good place to start it. The 2.5 reduction was from this great forum - otherwise they seemed to think 5 at a time.

[DorsetLady PMRGCAuk volunteer in reply to Pippah45]

Higher doses 5mg is fine when you have plenty of spare Pred to juggle with - but at lower doses you need to remember the mantra - not more than 10% of existing dose.

So at15mg that’s only 1.5mg!

[Pippah45 in reply to DorsetLady]

Oooh thank you for that - my maths is not great but even I can manage 10% I must remember that mantra.

[PMRpro Ambassador]

As soon as you struggle with 2.5mg drops - and everyone is different. Originally I worked it out thinking it would be people below 10mg who needed it but then a lady had a flare because of being forced to reduce too far and too fast and having got things under control again at above 20mg - at the time thought to be a very high dose for PMR - couldn't reduce at all without major pain and stiffness. By using DSNS and 1mg drops she steadily reduced to below 10mg before getting stuck again.

You can do 5mg at a time when you have only been on pred for a few weeks and that is how most doctors are used to using pred. At the start I did 2 weeks each of 15/10/5 and stop with no trouble at all until 4 hours after missing the first 5mg dose when I seized up completely and went to bed in tears. I have never managed that again.

The basic rule is never more than 10% of the current dose but some are lucky and manage a bit more. At 15mg that is 1.5, by 10 it is 1mg - so why not start at 15mg?

[Pippah45 in reply to PMRpro]

Brilliant thank you - yes I did the reduction quite fast the first time when my diagnosis was supposed to be wrong! But now I am learning! I take comfort in what a great teacher (business teacher) said - was that most people need to hear/read/see things 6 or 7 times before they GET it - I think I am just about there now!

[PMRpro Ambassador in reply to Pippah45]

Hmmm - OH doesn't get it even after a couple of dozen times!!!! And I'm a monkey see monkey do learner ...

[Pippah45 in reply to PMRpro]

As a matter of interest would the same apply to MTX my brother is hoping to reduce again soon. Not that he would listen to me - he is placing his faith in his rheumy. (who could be ok of course)

[PMRpro Ambassador in reply to Pippah45]

Using the DSNS approach you mean? Of course. And reducing with MTX may not be any different from trying to reduce without ..