Tapering

[Flosy]

Would like to know if it is OK to go down til 8mg.on jan1st.am on 10mg.at mo,been on that for 2 months now,am suppose to go to 7.5mgs.,but been having pain in my shoulders,and lots acid reflect,am taking 40mg omeprazole at mo.just want abit advice.so to be pain.thanks alots.

[PMRpro Ambassador]

The basic recommendation is that reductions step-downs should never be more than 10% of the current dose - at any level. Various tapers say any drop below10mg should be 1mg -or less, whatever was suggested at higher doses.

Personally, I would say that if you have any PMR pain at the current dose, your body is not ready to reduce at all - and absolutely not by 20% of the current dose which is what going from 10 to 8mg is. To 7.5mg is a full 25%.

However, it is something you really need to get clarified with your doctor, whether it is the GP or a rheumy. You can try either drop - and see what happens. But the most likely result will be that you struggle, either with returning PMR symptoms or with steroid withdrawal. I suppose if you try it and the PMR goes mad, you can tell the doctor very clearly that it doesn't work for you. It is all very well rushing down the dose of pred - but when that results in a flare, you have lost all the perceived advantage of a lower dose of pred.

[cranberryt]

That is much too big of a drop. 1mg drop max is recommended when you hit 10. I wasn’t able to do even that and had to do 1/2mg every other day for at least a month, but usually several. I wouldn’t drop that much at once. Your pain is sure to come back full force. Honestly, if you are having shoulder pain already, it sounds like you need to increase your dose at this point. Not decrease.

[piglette]

I personally think that is much too big a drop below 10mg where things seem to get trickier and the adrenals will soon have to start waking up. I found 0.5mg a month worked well, but some people can manage 1mg, but not me!

[DorsetLady PMRGCAuk volunteer]

“Would like to know if it is OK to go down til 8mg.on jan1st.am on 10mg.at mo”…

Highly unlikely at the best of times and for people that have no issues with tapering previously —- in your case a definite no, no!

Didn’t we discuss this issue a couple of weeks ago, and suggested you went really slowly….

[Flosy in reply to DorsetLady]

Hi.yes we did,so do you think I should stay on 10mgs for how much longer,does it hurt to stay on one dose longer period,than should do.

[DorsetLady PMRGCAuk volunteer in reply to Flosy]

With the issues you seem to having, yes personally I would stay on 10mg until things settle significantly.

It is a balancing act, you obviously don’t want to be on higher dose than necessary. but being too low can cause it’s own problems - uncontrolled inflammation and pain.

But you do need to have a meaningful discussion with your medical team - and they should be supporting you, which seems to be missing at the moment.

[Flosy in reply to DorsetLady]

Thank you. A happy new year to you.x