2mg to 1mg

[DaveyJohn]

Hi, I have tapered down over approx 14months from 25mg of prednisolone to 2mg without any big problems or flares. However, I have tried a couple of times now to reduce from 2mg to 1mg but when I do the morning pain and stiifnes returns. It goes away when I return to 2mg. Any tips on managing this reduction?

[SheffieldJane]

This seems to me to be a great position to be in. I would honestly take a breather. This is what your body seems to need, possibly because it is supporting a recovering adrenal function. As you may have learned from here, the highly respected Professor Dasgupta, keeps some of his patients on around 3 mgs of Pred for life, to prevent relapse. He is very highly regarded in our field of medicine. 2 mgs is a relatively harmless dose. I would give it a few months personally and I believe that my Rheumatologist would back me up as she usually does. Run it past yours. You could seek Endocrinologist input at this stage, with a morning cortisol test and or a full Synacthen Test, that tests the potential of the Adrenals to work.

[SnazzyD]

Try 0.5mg introduced slowly over at least 4-14 weeks is what I did at doses under 5mg. Slower the better. If your doctor is happy with that of course.

[TheMoaningViolet]

Hi, I am reducing down from 2 mg using DSNS method and 0.5 mg increments. I was quite unwell with adrenal issues when I reached 1 day on 1.5 mg after only 3 days on 2 mg, so I repeated this step three times. We are also travelling over Easter break, so when I dropped to 2 days on 2 mg and 1 day on 1.5 mg, I decided to keep repeating this step until we are back. Just slow it down and repeat the steps until you feel stable and then take another one. You are doing very well to be were you are after 14 months, so no need to rush things.

[PMRpro Ambassador]

Accept gratefully that you have probably achieved your end point at a very low dose: you are not tapering relentlessly to zero, you are tapering to find the lowest effective dose that provides the same pain relief as the starting dose did.

I'm not saying you won't get lower, but just not yet. I'd stick at 2mg for a few months and then try one of the slowed tapers with 1/2mg at a time to try to get the rest of the journey done. Even after only 14 months, there will be some adrenal insufficiency and that may be contributing - 2mg is an ideal dose to let that settle down a bit and become more reliable.

Remember, going from 2 to 1 is a 50% reduction in dose - even if the absolute figures sound small.

[rkmel in reply to PMRpro]

Excellent suggestion.

[DorsetLady PMRGCAuk volunteer]

Try a slower taper as listed in link, and only 0.5mg at a time -

healthunlocked.com/pmrgcauk...

[DaveyJohn in reply to DorsetLady]

Thank you I’ll try that. New to forum so hadn’t seen these plans.

[PMRpro Ambassador in reply to DaveyJohn]

Do have a look at the FAQs - you will find all sorts of useful information there, all in one place.

healthunlocked.com/pmrgcauk...

The link appears at the top of every thread, just below the post.

[DaveyJohn in reply to DorsetLady]

I used the 'Dead slow and nearly stop' plan and have now got from 2mg to 1mg in 7 weeks with no major issues/pain. Thank you so much for directing me to these plans.

I wil stay on 1mg for a while before trying to reduce again. when that time comes I may invest in a tablet cutter and try dropping to 0.5mg rather than straight to 0 ... if anybody has any comment or advice on that, please do reply.

[DorsetLady PMRGCAuk volunteer in reply to DaveyJohn]

That’s what I did successfully ……it’s still a 50% reduction, but that’s much better than 100% ! Good luck

[PMRpro Ambassador in reply to DaveyJohn]

Or repeat each stage of a slow taper a few times ...

[Grammy80]

DaveyJohn, I have a good friend in New Hampshire (USA) who was diagnosed with GCA about 24 years ago. After all the customary rollercoaster rides she got down to 1 mg per day. Everytime she tried to drop by half a mg....problems. She has happily taken that 1 mg each day for then forward and is celebrating her 86th birthday! I'd just listen to your body.My best to you💕

[cranberryt]

While we all hope to get off prednisone as sson as we can, the goal is to find the lowest dose that controls your symptoms. For you, that seems to be 2mg. Stay there for another month. Then you can try again, but with a 0.5mg or 0.25mg drop instead. Pain for the first couple days of a drop is normal as your body adjusts but if it starts after or lasts for a week, you need to go back to the higher dose.