Tapering question

[Booklover21]

Hi, I started on 15mg of Pred and had a good response to this dose. I reduced this dose to 12.5 this week on the advice of my GP. When I opened the 2.5 pack I noticed that they are coated and the 5mg ones I have are not. Does it make any difference taking a combination of tablets? Some pain in my thighs has also come back when I stand up and when I climb the stairs. Does this mean I should go back to the 15mg dose?

[bussell]

Just on the question of a mixture of coated and uncoated, I faced the same situation. It didn't seem possible to get 2 1/2 mg uncoated, so when I got to the end of the 5mg uncoated I asked to be prescribed everything coated in future. This works much better for me. I like the delayed action (can take them in the evening and feel good next morning) and it has solved the indigestion and heartburn issues. Maybe worth thinking about?

[PMRpro Ambassador in reply to bussell]

You can get 2.5mg uncoated - but they are relatively expensive because they aren't used much. But the easy answer is to use a pill cutter ...

[Amkoffee in reply to PMRpro]

I got some 1mg tablets to use as a way to reduce slowly. I'm in the US and here prednisone is cheap regardless of mg.

[Sharitone in reply to bussell]

I have 2.5mg uncoated...which is a pain, because the 5s and 1s are all coated!

[DorsetLady PMRGCAuk volunteer]

This post gives difference between steroid withdraw and a flare - and it may be a bit soon to know - how many days ago did you reduce?-

healthunlocked.com/pmrgcauk...

The 2.5mg may have been too big a step, although it is a recognised taper, not everyone can do it successfully. Personally I would be asking for 1mg tablets.

The issue with taking a mixture of coated and uncoated is they get into the system at differing times, so that may cause problems.

Others who have experience of that situation will be along shortly to advise.

If you think it’s a flare you may need to return to 15mg, and then take smaller steps .

[Booklover21 in reply to DorsetLady]

Thank you a useful article for me to refer back to in my tapering journey. Legs are a bit better today so may be just getting used to a lower a dose and to take it easy every time a reduce

[DorsetLady PMRGCAuk volunteer in reply to Booklover21]

Sometime it's a bit difficult to know, especially during early day like you. Once you get to know how you react to each taper, your illness and your body you will fare better, like everything it's all a bit confusing at the beginning.

Plus as I said the guidelines are just that, guidelines, they may be fine for some people, but not all, so you need to let your doctor know either way...and remember it's not your fault if you can't do things by the book.

[PMRpro Ambassador]

Are you already using the enteric coated tablets?

I do not understand why they keep trying to mix them - enteric coated take from 4 to 7 hours to get into the system and reach a lower peak dose than the plain sort that are in the system in an hour or two. Used intelligently that can be a good thing, especially later as you are reducing but for you at this stage I suspect you have effectively reduced more than 2.5mg at time and many of us would say it was too much in the first place. And some people need more pred than others - you can't know, so why not feel your way in smaller steps?

You could get a pill cutter from the chemist and try cutting the plain 5mg tablets to get 2.5mg - see if that works better. If it does, you have more information. How long have you been on a steady 15mg? Two months? It could also be your body protesting at the change in dose and if so that should improve over the next week, it can take a couple of weeks for some. The best way to avoid that is to reduce in smaller steps but too many guidelines say 2.5mg at a time - so that is what doctors do and it doesn't always work. In fact, I'd say if very often doesn't work!!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Maybe using Covid and/or Brexit (still) as an excuse when not getting supplies in on time.

Was talking to supermarket delivery driver a couple of weeks ago, (for once no substitutions) and he said said there seems to be no rhyme nor reason for what provisions etc they do or do not receive.

[PMRpro Ambassador in reply to DorsetLady]

What do you mean "Brexit (still)" - the next stage comes next year ...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Oh.. thanks, that cheered me up!

[PMRpro Ambassador in reply to DorsetLady]

Why do you think I'm staying here?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Not just the price of Prosecco then..silly me! 🤣

[PMRpro Ambassador in reply to DorsetLady]

Well ... Now you mention it ...

[Booklover21 in reply to PMRpro]

Thank you

[Booklover21 in reply to PMRpro]

Thank you

[diana1998]

I reduced 1mg every 4 weeks at your stage. Could never have dine 2.5 in one hit, altho some can.

[Doraflora in reply to diana1998]

Well, after my first attempt at tapering by 1mg &then suffering repercussions, this time I’ve reduced by just half a milligram each month. So far so good as today I’m now on 4 mg.

Sorry! I don’t know how to get the underscore off, I’m pressing the ‘U’ but it won’t change.

[DorsetLady PMRGCAuk volunteer in reply to Doraflora]

Select the text first and then press the U It should change from blue to black.

[Investigator1]

HiBookcover21. Dorset Lady has made a brilliant point (as usual) taking coated and uncoated together can “stagger” the effects because the half life is different. On the subject of tapering I tapered down from 60mg by 5 every month, then when I got down to 15 it went down by 2.5 every 3 weeks but mine was done differently i.e when dropping from 15 to 12.5 my consultant did it by me taking 3 5mg on say Monday then 2 tablets the next, then 3, 2 alternatively so every time my dosage was something .5 that’s the method she told me to adopt. It worked for me. I finished with the beggars in July. I was knackered for about a month because my adrenal gland got lazy but I forced myself to exercise and go for walks etc and after a few weeks it improved. The good thing is your tapering. Always a good news story. Take care. Nick.

[Booklover21 in reply to Investigator1]

Thank you for your reply

[Suedeshayes]

Hi. I mix enteric and non coated prednisone without any noticeable problem. I take the enteric ones mostly, but if I need to halve the 1mg ones, I use the non coated as they cut easily. I don’t have any concerns with mixing.

[Booklover21 in reply to Suedeshayes]

Thanks

[singingloud]

I had to go down by 1mg also from 15mg till I got to 10mg. The transition was much easier. Now only going down by .5mg now that I'm below 10mg. Everyone is different though.

[Booklover21 in reply to singingloud]

Thanks

[New2pmr]

I'm still early from PMR diagnosis & tried reducing 15mg to 12.5mg then 10mg but struggled so took advice from the forum and followed slow tapering by 1mg which was much more successful.

[Booklover21 in reply to New2pmr]

Thanks it seems to have settled down now