Is there a minimum effective dose for prednisone?

[Marinescience]

Good day everyone, I am curious if there is a minimum effective dose for prednisone. I have tapering really (really) slowly, reducing 1/4 mg/week. Currently, I am taking 1/4 mg three times a week. Can the body really differentiate this from no prednisone at all? Given the difficulty in precisely cutting a 1 mg pill into quarters, it would be interesting to know this. I imagine it might be related to the particulars of the patient, including body mass and severity of symptoms perhaps, but I was curious if there any experience on this point.

Thank you very much in advance!

[piglette]

Amazingly enough the answer seems to be YES.

[PMRpro Ambassador]

There IS a minimum effective dose - but it varies from person to person and over time. It is what you are looking for when you taper your dose of pred - the lowest dose that gives you the same symptom relief as the starting dose did.

You don't say how long you have been on pred but the test of whether the underlying cause of PMR has burnt out and gone into remission is being able to stop pred and the symptoms don't return over a period of say 6-8 months. The underlying cause can reduce to a very low level and patients assume it is gone and stop pred, only for the symptoms to return some time later. But unless you stop the pred you can't find out. I do know of patients who were taking 1mg every few days and were fine but when they stopped, the symptoms returned a few months later. It is like a tap dripping into a bucket - eventually it can fill up and overflow, however slowly the tap is dripping.

[Marinescience in reply to PMRpro]

Thank you, that's very interesting. Your observation of patients taking 1mg every few days and experiencing recurring symptoms after stopping suggests that the body is sensitive to very slight changes indeed. The titration analogy seems very appropriate, and finding the "end point" does seem a little tricky at low doses.

[PMRpro Ambassador in reply to Marinescience]

If you are that low then it makes sense to continue taking less and less slowly - and you may well get off pred altogether. That is the aim and over 90% of patients DO achieve it sooner or later. The only way to find out though is to try.

[Marinescience in reply to PMRpro]

Thanks again. I think that the one of the important messages here is that doses <1 mg/day are not equivalent to zero, based on PMpro's recounting of patients who were on such low doses having recurring PMR symptoms when they stopped altogether. So continued slow tapering seems well advised even at those low doses. It is a pity that the smallest tablet available is 1 mg (at least here in Canada).

[PMRpro Ambassador in reply to Marinescience]

It is everywhere - and in some countries there is nothing under 5mg!

Using one of the slowed tapers (to be found in the FAQs) also helps, with zero as the "new dose". The DSNS was developed partly to enable easier tapering when patients were on enteric coated pred and the smallest dose at the time was 2.5mg. It seemed to work OK.

[marigolds in reply to PMRpro]

I have asked my doctor if I could try going on 2.5mg to see if it would cure my fatigue and hips and she said "no" I have been off steroids for three years. Would have liked to try it.

[PMRpro Ambassador in reply to marigolds]

The request you should have tried was if you could have a synacthen test to see if your adrenal function really is OK or if that is causing the fatigue. The hips - depends on the cause. If it is bursitis then a low dose of oral pred probably wouldn't help;

[marigolds in reply to PMRpro]

Thanks for that I am toying with giving in and taking bone strengthening drugs as it maybe my fractures. Which one would you have?

[PMRpro Ambassador in reply to marigolds]

If you already have compression fractures then that is a perfectly reasonable decision - but I would discuss which is best for you with an expert - and that doesn't mean a GP. You could ring the ROS helpline or ask for a referral to whoever deals with osteoporosis locally

theros.org.uk/

[marigolds in reply to PMRpro]

Most interesting thank you, I persuaded her to put me onVagifem 10, Estradiol, twice a week as I get on alright with HRT. but wonder if that's enough.

[Bcol in reply to Marinescience]

On a purely practical note, my last prescription of 1mg tablets was from a different brand to the ones I've normally had and these are so small that it's difficult to cut them in half successfuly let alone quarters.

[Theziggy]

Professor Dasgupta suggests keeping people on 2 mg for quite a long time healthunlocked.com/pmrgcauk...

[Marinescience]

Thanks very much for sharing your experience. That was quite a rebound, and a quick taper on the second trial. I am glad it is working out for you.

[Gossiplady]

well done my friend! It gives us all hope to know there is a light at the end of the tunnel.