Increasing Prednisone when you have the flu or Covid

[Skier321]

I read 6 months ago somewhere that if we have pmr and are taking prednisone and then get the flu that we should increase the dosage substantially for a few days till our flu symptoms improve. What happens to us and what should we do if we get Covid as well. I have had pmr since may and started on 40 mg got down to 8 mg in December had a flair up went to 15 mg now at 12.5 and will reduce to 11.5 in a few days not reducing more than 10% at a time and only when 1 to 2 on symptom scale of 0 best 10 worse. Thank you for your suggestions

[PMRpro Ambassador]

This is explained in the Sick Day Rules - post under the Pinned Posts and also in the FAQs.

You should discuss it with your doctor just in case. But basically it means doubling the pred dose up to a maximum of 20mg if you are ill and have been on long term pred while you are ill to reduce the risk of an adrenal crisis because your adrenal response is blunted.

[CarolF1312 in reply to PMRpro]

I got a right telling off from my GP when I increased from 5.5mg to 7.5mg when I had Covid. He said I shouldn't do that without referral to Rheumatologist I explained , that although I was not ill with Covid my PMR was significantly worse He advised that he was very reluctant to issue my repeat prescription for 5mg tablets as I should now be down to 4mg.

So frustrating like I really want to be taking Prednisolone!!

I am now charged with contacting my Rheumatologist before next repeat .....a near impossible task at present.

[Skier321 in reply to CarolF1312]

What doses of prednisone were you on when you got each of your Covid shots I was on 40mg for my second shot and 10 for my 3rd. The first shot I think triggered my PMR sorry to hear your doc is giving you grief.

[PMRpro Ambassador in reply to CarolF1312]

I do despair about the plain ignorance of some GPs. And to threaten you, a long term steroid patient, with withholding a pred prescription is appalling. No chance of speaking to another doctor with a better background? The new steroid cards were developed and made available BECAUSE of problems with healthcare professionals not recognising the risk of adrenal insufficiency.

[CarolF1312 in reply to PMRpro]

Its ridiculous isn't it. For majority of the time left completely alone together on with managing the condition then next told off like a naughty school girl for making what I believe to be an informed decision. Thank goodness for this forum.

[MrsNails in reply to CarolF1312]

Hi Carol

This is a grey area, the Sick Day Rules especially regarding Covid we’re introduced to help during the Pandemic particularly in Lockdown, even though it can be equally important anytime.

Contacting a Rheumatologist re what you should do is debatable - if l had Covid l would have spoken to my GP in the first instance.

I personally would write to my Rheumatologist to explain your GP has requested you contact him before your next repeat is due, keep it dispassionate, only the facts

No one on Steroids should be kept to a very tight repeat of tablets as you never know what might happen & you may need to change your dose.

Good Luck 🍀

MrsN

[PMRCanada]

I had COVID (Beta/UK variant), in May 2021. I was on 9mg of pred at that time and increased my dose to 12mg as it increased my PMR symptoms somewhat and I was feeling lousy enough to attend our local hospital (where they tested me) at the recommendation of the TeleHealth nurse I spoke to on the phone.

When my GP called 2 days later with the results that I tested positive, I told him I had upped my pred dose by 3mg. He said to continue at that dose for 7 more days, and confirmed it was the right decision, along with getting the vaccine. He felt both actions likely reduced the severity of my COVID infection, and resulted in a good chest X-ray, and only a moderate elevation in my CRP level. He also recommended staying hydrated, taking vit c and zinc, and being mindful to not miss my Tylenol to combat the fever. No scolding…just sound medical advice and compassion.

[Skier321 in reply to PMRCanada]

Great news and good info. I am in Victoria and our GPs are few and far between 25 % have no GP. They are retiring or leaving. I have one my wife doesn’t glad you got through Covid Ok all the best and thank you again