Increasing Pred dosage during a flare

[Jomaur]

I hope I have understood the advice for increasing Pred dosage during a flare. As I understand it you go up to 5mg over the dosage you last felt comfortable on and wait 3- 4 days to see if your symptoms improve. If they don’t improve do you then increase by 1 mg steps or go back to the level you were originally started on. I started on 20mg in Feb 2021 was at 7.5mg end of last week and have increased to 12.5 but no better. Should I go back to 20 or maybe raise to 15? Seems awful to go up so high after all the work of tapering but finding it very painful and walking very difficult at the moment. Blood test due to check inflammatory levels on 27th.

[DorsetLady PMRGCAuk volunteer]

This link contains usual advice for dealing with flares, just change the doses in the example to reflect your situation.

But you may well need more than 3-4 days, depends how much inflammation has been allowed to built up - if after7-10 days you may need to go to 15mg (20mg is a bit too much), or there may be something else causing the problem, so if that’s the case, it might need checking -

healthunlocked.com/pmrgcauk...

[Jomaur in reply to DorsetLady]

Thank you think I’ll leave it at 15 for a week or so to see how it goes.

[DorsetLady PMRGCAuk volunteer in reply to Jomaur]

👍

[PMRpro Ambassador]

No chance of speaking to a doctor sooner than 2 weeks - though I do realise Easter totally messes everything up!

What dose were you on when you last felt well? Has this happened suddenly? Nothing going on that might not be directly PMR? Doing more in the garden? Preparing for Easter?

But first - be patient. Rome wasn't built in a day.

[Jomaur]

Really difficult to say when I last felt really well as back at the end of November I had a fall and fractured my humerus in three places. Obviously I was less mobile for a while and the pain I have been experiencing mainly in my lower back and legs seems to have built up gradually since then. Trouble is the pain from my arm and the fact I was less able to do things I normally did overshadowed my leg and back pain. My arm has healed really well so I am now getting back to normal mobility except for this pain. My appt with my GP is a prebooked one, I could probably ring for an on the day emergency appt but not sure that it warrants that and no guarantee which dr I will get.Will stay with 15mg and see how it goes. I also have a blood test booked for when I see my dr so will have inflammatory levels checked although I know symptoms are a better guide than blood levels.

[Exflex]

As most of us have built up a ‘stash‘ of Pred above and beyond our daily needs, it begs the question whether we should self administer added dosage without getting approval from our GP. Even for 5 to 10 days?

[Jomaur in reply to Exflex]

I did inform my GP practice that I was going to increase my dosage as had to request more tablets. My request has been approved and they have been made aware of my forthcoming appt. In an ideal world we would just be able to ring and speak to our dr for advice but although our practice is good unfortunately this is impossible. I have discussed my pain with one of the drs quite recently and they aren’t able to come up with any other advice.

[DorsetLady PMRGCAuk volunteer in reply to Exflex]

No you shouldn’t -unless Dr has agreed to you doing that. Some are happy to let you self medicate, many are not -,and even those that are still need to be kept informed.

It’s a prescribed medication for a good reason.

[PMRpro Ambassador in reply to Exflex]

It is the instruction many rheumies give for a flare - and it is also worth discussing it with a GP before you end up in the situation purely because done immediately a flare appears because you tapered too far, you will be able to return to the previous dose within days. Allow a flare to get established and you may end up having to go back to a higher dose and tapering again which results in far more accumulated dose over the period. It doesn't take long to negate the perceived benefits of a faster or forced taper when it results in a flare.

[Exflex in reply to PMRpro]

Sound advice, I’ll mention this to my GP when I can. He / she (2 of them) would be annoyed if I self medicated, I know them too well.

[Jomaur]

Mine has been happy to let me decrease as I need to and I am sure that if upon reading my request and explanation of why I needed more medication they had felt it was unwise I would have been contacted.