Tapering pred dose.

[Hankb]

I live in South Africa and the smallest prednisone tablets available here are 5mg. I am now down to 10mg from 20mg a day following DL plan and have tapered by 2.5mg per month since January. I've had no pain since starting on pred but I do suffer from fatigue and light headedness.

My question is: Because I can only get 5mg pred tablets would it be ok to take 10mg and then 7.5mg every other day which would work out over 30 days an average dose of 8.75mg a day.

I've used 7.5mg as it'fairly easy to cut a 5mg in half but to cut it into a quarter is very hit and miss whichever way I try.,

This is my calculation for information.

i.e ( 15x10)+(15×7.5)= 262.5.

262.5/30 = 8.75 mg average over 30 days.

Any thoughts on this would be appreciated.

[MrsNails]

Hi Hank, That make tapering very difficult for you, have you checked with your Pharmacy if liquid Prednisolone is availability?…..

The see saw effect of going up n down by 2.5mg every other day can be hard on some people…..

PMRpro may have some suggestions, have you discussed it with your Doctor?

Kind Regards

MrsN

[Hankb in reply to MrsNails]

Thank you for your reply MrsNails.

I did ask the pharmacy if they did smaller doses of pred tablets and they said no but I didn't ask about liquid pred, I will follow that up this morning.

On my last visit to the doctor in February she said the smallest dosage available in SA is 5mg. I'm going to see her again this morning and will ask again but I think the answer will be the same.

Regards

Hb

[MrsNails in reply to Hankb]

It’s always worth a chat with your Pharmacy as they often know more, we have 2.5mg uncoated & my GP knew nothing about them, Pharmacist’s know more as Doctors are so much more used to prescribing Pred for short term use. Let us know how you get on!

MrsN

There’s definitely Syrup - you’d just need some small syringes 💉 to measure the dose accurately 😉

pharmacompass.com/south-afr...

[Hankb in reply to MrsNails]

I'll let you know as soon as I've chatted to the Pharmacist they are always very helpful and easier to get hold of than a doctor.Hb

[MrsNails in reply to Hankb]

See above, l’ve edited my reply - you can get Liquid Pred (Syrup)

[Hankb in reply to MrsNails]

Thanks so much, I'll check syrup availability with pharmacist this morning it's sounds a very good option.

[Hankb in reply to MrsNails]

Sorry for taking so long to reply about Liquid Pred. I'm pleased to say that I did finally get some after telling my rhuemy about it. She googled it and then wrote out a script for me, I can now start tapering more accurately compared with chopping up the 5mg tablets into quarters.The liquid is called Aspelone out here.

I propose to use a combination of tablets and liquid to get the correct dosage. I'm now down to 10mg a day after staring at 20mg last November ( no adverse effects so far other that the dreaded fatigue) and will reduce gradually from here on down uding DL's plan.

Most grateful for you suggesting I look for pred in syrup for. Many thanks.

[MrsNails in reply to Hankb]

That’s Excellent News Hank! Make sure to follow the instructions & they probably give you a string to draw up the correct dose. There may also be a time life on it to use after being opened so thinks to check but apart from that you’re well on your way! 👏🏼 Let us know how you get on!

[Hankb in reply to MrsNails]

Sorry about the typos in my last message I should have proof read it before posting 😟. I was given a 3ml syringe/dropper to use with it. I'll check "best before date" on label and I'll make sure I don't use it after expiry date. I'll let you know how I get on.

[DorsetLady PMRGCAuk volunteer]

Hi, As MrsNails says, and I agree, the difference between 10mg and 7.5mg on alternating days may not be the best idea…..I know many Rheumies do advise it (as do the guidelines - see below) but not sure the body likes it!

If it were me, I’d be inclined to use my ultra long tapering plan to move in 2.5mg steps…..

that would be 14weeks to get from 10mg to 7.5mg which is roughly equivalent to what is suggested below 10mg in the guidelines anyway….

Then reduction by 1 mg every 4–8 weeks or alternate day reductions (e.g. 10/7.5 mg alternate days, etc.)

[Hankb in reply to DorsetLady]

Thanks for reply DL.Following your plan I feel I've done well so far I don't want to spoil it all by making a wrong move now that I've reached the 10mg a day mark. MrsNails advise on pred syrup also looks like an option if I can get hold of some, I'll check that out this morning. Should it be available here then that could be the answer.

[PMRpro Ambassador]

Absolute accuracty isn't important - cutting the 5mg tablets into 4 would be better in that the variation from day to day won't be as much as some people find the variation hard work. However - part of the reason for developing the Dead Slow and Nearly Stop slowed taper was to allow reductions with non-cuttable enteric coated tablets. If you introduce the drop slowly it is less agonising but does work. DL has also done it with her version.

[Hankb in reply to PMRpro]

Hi PMRpro.Thank you for your advice it does make sense. I try it.