Had face to face with rheumy today. Diagnosed six weeks ago and prescribed 7.5mgs Prednisolone daily. My main concern was GCA, the headaches, shoulder and arm pain, but he seems to have ruled this out because the ultrasound did not show any signs of inflammation!! I have felt better these last few weeks except for the occasional pains in my head and tinnitus last few days. I took the advice of adding amitriptyline10mgs at 8pm in last ten days and have slept so well , my walking has improved and physio will now see me every three weeks instead of two.
Rheumy now wants me to start tapering starting to morrow! This was quite a surprise but I have no idea how to taper with such a small amount to try to juggle. I need some help. I don't have to see him again for two months, so I think I am expected to stay on the reduced Pred for that time.
My thanks for all the help, I so appreciate being able to be here.
Written by
merril
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If you have 2.5mg tablets only, which you advised in previous post, then you really 1mg as well to be able to taper sensibly. Trying to do it by 2,5mg is not really feasible, maybe cutting 2,5mg in half might be achievable.
Did your Rheumy give any indication of how he is expecting you to taper?
...and if you have 1mg then try that (but 1/2mg might be better) - if not then it will have to be 1.25mg (half a 2,5mg tablet ) - pill cutters available online or chemists, maybe some supermarkets.
Good luck, and let us know how you get on.
However I am concerned about the headaches and tinnitus- if it gets any worse, then you do need to seek medical advice - even if it means a trip to A&E.
Hi DL Rheumy didn't say much about how to taper, just muttered to himself as he wrote three things on a piece of paper. I should have asked him if he had a graph. I knew that the forum would be able to help so didn't worry too much. I will read the url you sent after I post this reply to you and I will go back and look at what I can do with the 2.5 mg tabs I have. I will order a cutter from the pharmacy and might ask the best way to deal with cutting them.
I forgot to mention in my post that he is asking the GP to send
me for a bone density scan and my Vit D level.
I take your point about headaches and tinnitus, DL , I won't hesitate if this gets worse.
As far as we are concerned, it doesn't matter how small the dose you are tapering from - in this case you should only reduce by 1/2mg at a time And that really does mean asking your GP for 1mg tablets if the rheumy didn't. I really don't think he knows a lot about PMR ...
Having said that - it does sound as if he thinks you can taper the same way you would using pred for other things: dropping from 7.5mg to 5mg would be a reasonable approach. But in PMR you don't know what dose you are looking for - not zero, the lowest dose that works as well as the starting dose did.
And although cutting the 2.5mg tablets may be a good option it does depend on them being plain non-coated pred - if they are enteric coated pred then they must not be cut.
The DSNS taper was partly developed because we had patients on enteric coated pred who needed to reduce their dose more gently but at the time there was no option for 1mg tablets except plain pred and they had gastric problems with it. You can use it with a very long gap between the new dose days to start with or by repeating the steps a few times before going to the next stage. One day of 5mg followed by 6 or 7 days of the old 7.5mg may be tolerable as a start and you can reduce the interval as your body gets more used to the new dose:
Thanks for the info, my 2.5 mg tabs are enteric coated so duty doc at surgery is now arranging for 1mg tab script to be sent to pharmacy. Now I can relax and wait for the tabs. 👍
Should I laugh or cry?😄 When my script is ready I will go with her to the pharmacy and make sure. The 2,5 I have will last for another four weeks so long enough to sort things out.
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