Tapering Prednisone

[BuddyBearF]

I dropped from 10mg to 9mg Prednisone 6 days ago. My pain level has stayed at 1 or 2 out of 10. Is it too early to drop to 8mg? Do I need to stay at 9 for a while longer??

[DorsetLady PMRGCAuk volunteer]

What was your pain level on 10mg? Ideally it shouldn’t be any higher/worse at the end of taper than at the beginning.

I’d stay at current level and see if it improves …it may still be steroid withdrawal and hopefully not the beginning of a flare.

But if it continues for another week then you may need to return to 10mg…and maybe consider reducing by 0.5mg rather than 1mg in future -and consider a slower tapering regime rather than an “overnight” drop.

[BuddyBearF in reply to DorsetLady]

The pain level is the same at 9mg as it was at 10mg. Barely noticeable. I really haven't felt any different at 9mg which is why I was thinking of dropping again.

[DorsetLady PMRGCAuk volunteer in reply to BuddyBearF]

Okay, but it’s sensible to stay at each dose for 4 weeks once you get below 10mg…. It very often gets more difficult the lower you go, less surplus Pred sloshing around to mop up inflammation.

[BuddyBearF in reply to DorsetLady]

Thank you

[piglette]

Really your pain level should not be more than when you first took pred and had the initial relief. If you feel any niggles, do not reduce. PMR always wins.

[PMRpro Ambassador]

Yes - it can take a couple of weeks for the fact the new dose is too low to show up. It is said in the literature than a reduction rate of more than 1mg per month is predictive of a flare. This isn;t a race - and if you reduce too quickly you can easily miss the dose you are looking for, the lowest effective dose for you. Overshoot, and you may not know where you crossed the line and have to go back to a higher dose than you were at to get things under control. In the end you take more pred than if you'd gone slower in the first place.

[BuddyBearF]

Good to know. Thank you!

[Flivoless]

You are at a similar stage to me. I am at 7.5mg but never reduced more than 0.5mg at a time (every 4 or 5 weeks) since 10mg. Perhaps I'm lucky but no pain, well not of the PMR variety.

[alangg]

Whatever you do, don't try and rush the tapering - especially as you get to the lower doses. Your body needs time to adjust to the new dose and make its own arrangements to compensate for the reduction - adrenals resuming production of cortisol, etc.

If you have tapered successfully so far, you don't want to have to start 'yo-yoing' the dose because you have reduced too much or too quickly. I left at least 2 weeks before finishing one reduction and starting another and that was after taking 4 weeks to taper down to the new dose.

Good luck!

[BuddyBearF in reply to alangg]

Thank you! When you say you took 4 weeks to taper down to the new dose, how did you do that?

[alangg in reply to BuddyBearF]

I did it by using a slow taper plan (I think from the wonderful DL!)1 day new dose followed by 4 days old dose

1 day new dose followed by 3 days old dose

1 day new dose followed by 2 days old dose

1 day new dose then 1 day old dose.

I might stay alternating new and old for a couple of days to be certain that I was in a good place to carry on tapering. Then:

1 day old dose followed by 2 days new dose

1 day old dose followed by 3 days new dose

1 day old dose followed by 4 days old dose

1 day old dose followed by 5 days new dose

Then stay on new dose. It takes about 4 weeks to get here.

That plan worked for me but the reduction in dose was never greater than 10%. I bought a pill cutter and my GP prescribed 5mg, 2.5mg and 1mg tablets so I could ensure that the reduction was small each time.

Hope this helps.

[PMRpro Ambassador in reply to alangg]

That pattern in my DSNS *Dead Slow and Nearly Stop) version, slightly different from DL's. But they all get to the same place in the end ...

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

True! 😊

[alangg in reply to PMRpro]

You're wonderful as well!

[PMRpro Ambassador in reply to alangg]

I try. Some say I'm very trying ...

[DorsetLady PMRGCAuk volunteer in reply to alangg]

Not mine /PMRpro’s 😊

[BuddyBearF in reply to alangg]

It does. Thank you!

[Miacaro45]

Slow and steady wins

[singingloud]

Below 10mg I reduced by .5mg on the the slow taper. I got to 8.5mg and the flare began to build as I moved to 8mg. Should have stayed longer at 8.5mg. Had to go back to 15mg and now at 12.5mg and in a few weeks to 10mg. So go slow and listen to your body. I may never get down past 8.5mg or it will take sometime to wait for pmr to burn out for me. It may not happen until my 88 year old mom with dementia no longer lives with us. Stress certainly is a big factor for my pmr I’m sure. Take care.

[autumnlass in reply to singingloud]

I’ve been reducing from 8mgm to 7.5mgm on DL 7 week reduction. Am at week 6 and yesterday was beginning to flare so upped it to 8 mgm yesterday, but realised today I needed to up another 5 mgm making it 13 mgm which I’ll stay on until Tuesday & coincidentally I have a prearranged phone appointment with my GP, so will see what he says. Every time I try to get to 7.5mgm it won’t let me the rotter! When settled I’ll try over 14 weeks DL way.

[PMRpro Ambassador in reply to autumnlass]

It doesn't matter how slowly you reduce - you will not get below the lowest effective dose at any given time. At present you need 8mg - and if you try to force it you will end up yoyoing the dose and it becoming harder and harder to get things under control.

[autumnlass in reply to PMRpro]

Thanks PMRpro. It’s seems thus. I hope my GP will understand as well as you do about the 8mgm dose. It’s been a choppy 13 months with 2 ops and now the Pseudoexfoliation Syndrome causing IOL problems and glaucoma. Seeing Consultant for Eye on the 8 September. (All the 8’s!) 🙂

[autumnlass in reply to PMRpro]

I’m sure ‘it’s a daft question PMRpro but how will I know when I can at least try to reduce to 7.5 mgm? What a capricious illness this is! 😵‍💫

[PMRpro Ambassador in reply to autumnlass]

I don't think there is an answer. When you flare repeatedly at about the same dose, that is clear. But I think all that is really possible is to wait a few months (2 or 3) and enjoy the release from the stress of trying and worrying and counting pills and then try a 1/2mg again. For most people it will succeed sometime - and taking away the stress often is enough - but the trick is to recognise when it isn't working.

[autumnlass in reply to PMRpro]

Many thanks Pro - the first time time I flared when reducing to 7.5 was in February when at the final hurdle at DL 4 week taper. This time I fell at the 6 week of the 7 week taper! I’ll wait as you suggest 2-3 months and do the 14 week one of DL reduction plan! It’s been a rocky 13 months with other health issues which might indicate being sensible not to rush things. Don’t feel nearly as resilient now as I did 2 years ago! Thank you again. 🙂

[PMRpro Ambassador in reply to autumnlass]

Doesn't matter how slow you go - you won't get past the hurdle of "it isn't enough"!

[autumnlass in reply to PMRpro]

I hope my GP will understand …🤔

[PMRpro Ambassador in reply to autumnlass]

You have the tools to educate them

[autumnlass in reply to PMRpro]

Indeed!

[DorsetLady PMRGCAuk volunteer in reply to autumnlass]

Totally agree with you know who!

[autumnlass in reply to DorsetLady]

YKW and YOU are great. Thank you, 🙂

[BuddyBearF]

I'm so sorry. Prayers that life becomes less stressful and your body heals

[Bcol]

Afternoon BBF I always plan/take a minimum of five weeks on each taper down and use a slightly modified DL taper plan. At moment going from 4.5mg to 4.0mg and struggling, not with pain but fatigue which for me is an unwanted first.

[MiloCollie]

It seems complicated really but then all of a sudden you’ve moved on and you’re feeling ok! 😎a few months ago I never thought I’d feel good on 5mg. Good luck

[OldPenny]

Hi there, BuddyBear. I'm in a similar place. I'm feeling pretty well during my slow tapering since a flare in March. Here's my current schedule as an example. BTW, I split my dose currently - e.g. 3mg before bed; 6mg after breakfast 👍 Best of luck....

Spreadsheet screenshot of pred tapering schedule

[BuddyBearF]

Thank you!