Pred Dose

[SRIXON]

Hi 3 months ago my younger brother (63) was diagnosed with PMR.

He has seen his doctor and had scans.

2+ months ago his doctor prescibed him a Pred daily dose of 10mg one day and 15mg the next in other words alternative daily doses.

He finds on the 15 mg he feels much better but thier is a reluctance to increase his dose to 15mg everday.

I explained to him that when PMR is identified they start you on a high dose then over time you very slowly reduce the amount of daily pred.

Very much appreciate your thoughts on this.

Thanks Carl x

[SnazzyD]

15mg is certainly a recognised starting dose at the low end and if that does the trick, fine. Some people need 20-25mg. Did the doc say anything about tapering? Alternate dosing has not been on anything I’ve read other than some docs using it to trigger adrenal activity at much lower doses, not starting. At either of these doses the adrenal gland activity should be suppressed so there is no activity to be stimulated yet or preserved.

Perhaps this idea is to reduce the accumulated dose of Pred. So by my calculation a thirty day month with 15 of them on 10mg will save 75mg (3 days) per month. Over a year that will be 36 days, so a month and a week per year. That may all be lost if his PMR isn’t controlled. Has he told the doc that he’s still uncomfortable?

[SRIXON in reply to SnazzyD]

Thankyou. I believe he has told his doc

[SnazzyD in reply to SRIXON]

What’s the tapering plan or follow-up?

[SRIXON in reply to SnazzyD]

Not sure, i just felt this was low starting place based on my own experience along with people on here

[Koalajane in reply to SRIXON]

I started on 15mg every day and would not have coped the way you say by alternate days on 10mg. It sounds like his doctor needs to do some reading!

[SRIXON in reply to Koalajane]

I agree thanks for your input

[SnazzyD in reply to SRIXON]

15might be fine but he’s not getting 15mg consistently is he, so the effect might be less than 15mg which is the usual lowest starting point.

[SRIXON in reply to SnazzyD]

👍

[jimcarlow75 in reply to SnazzyD]

Firdt time I've ever heard of that, 15 and then 10.

15 does not do it for me at the moment, so have raised it myself to 20.

[Lmoss in reply to SnazzyD]

Hi - when diagnosed with GCA, I was started on 60 with an immediate discussion on tapering as soon as i was symptomatically clear. Although the steroids were/are a bit of a mare to manage, certainly better than the underlying medical issue which has far greater repercussions if not treated. I am still tapering (at 10 now), and for me this approach worked well. Hope your brother gets this sorted soon.

[DorsetLady PMRGCAuk volunteer]

He needs to be on a consistent dose for at least a month (6 weeks would be better) to get a grip of the built up inflammation.... very strange regime, and unlikely to work satisfactorily.

[piglette]

Where on earth do doctors get these mad ideas? 15mg for a month or so if it works well.

[SRIXON in reply to piglette]

Agreed lol

[PMRpro Ambassador]

Glad that isn't my doctor - not only is 15mg per day a perfectly reasonable dose - making him alternate such a large amount from day to day is most confusing for his body. He might even feel better on 12,5mg per day - by cutting a tablet. Where on earth do they come up with these ideas???

[SRIXON in reply to PMRpro]

To be honest I said much the same. I warned him what all your responses would be. It gives him ammunition when he sees his doctor, thankyou.

[masieg]

I started on 10 mg a day and although it took about 10 days before I felt an improvement - after a month I felt like a different person . I am now on a reducing monthly dosage . Stick with what the Rheumatologist has suggested - that's what they are trained to do !

[SnazzyD in reply to masieg]

It is great that it worked for you but the point is here, that this regime isn’t working for this person. Some people do need as little as 10mg but most don’t, hence the guidelines suggesting starting at 15mg. This study of studies says that alternate day dosing isn’t as beneficial in PMR as it is in other rheumatological conditions.

emedicine.medscape.com/arti...

Doctors are required to practice evidence based medicine so in this case the replies are suggesting the doc be asked to produce their evidence that this is a good approach while a patient is being stabilised initially especially if symptoms aren’t being fully controlled. Above all every guideline says it needs to be tailored to the patient’s symptoms. Yes docs are trained but unless they keep up to date with current knowledge it isn’t useful and given that PMR has been rather neglected as a medical subject except by a few pioneers it appears to be a common case that some rheumatologists aren’t as up to date as they should be.

[SRIXON in reply to SnazzyD]

Appreciate your response. Carl x

[Suezybear]

I agree with all of the above you need to get rid of the inflammation to start with I am now down to 2mg a day and my doctor wanted me to cut down by half every month 5mg-4mg-3mg-2mg On doing this I had a flare! Thanks to the advice by DorsetLady I tapered totally different this time by .5 slower the better and do alternate days but that’s only because I’m on a lower dose and I’ve felt so much better ! On this forum everyone has experienced tapering and steroid levels differently but on here I think we know more than the doctors unless they’ve had PMR ONE SHOE DOES NOT FIT ALL 😁

[SRIXON in reply to Suezybear]

👍

[Cockerpoos]

Hi Carl, I started on 15mg, then next month doctor asked me to take 15mg on odd days and 10mg on even giving a 12.5mg overall, then month after 10mg each day

[SRIXON in reply to Cockerpoos]

Hi, did it work for you.

[Cockerpoos in reply to SRIXON]

Yes it has so far, before I went on Pred I could not sleep very well, put my socks, shoes and lift my arms to get a coat on without going through the pain barrier. Transformation was fantastic. I am now reducing by 1mg a month (currently on 9mg), still ok but reading this site might get a flare up when reducing further.