Help to try and reduce prednisolone again after 5 months stuck at 15mg

[PPop]

After a bumpy few months with difficulty controlling my symptoms of PMR, due to a return to work in July and Covid infection in August, I have been feeling quite well again for the last 2-3 weeks. I have therefore been advised by my rheumatologist to try and reduce my prednisolone again. I have been stuck at 15mg for the last 5 months and whilst did try to reduce myself to 13.5mg in July, this coincided with my return to work and after persisting for 2 weeks, I just couldn’t manage. ( In retrospect, I realise that it wasn’t the right time to reduce, but I am learning all the time!)

My rheumatologist has advised that I should alternate 15mg with 12.5mg for 4 weeks and then try 12.5mg for 4 weeks before alternating 12.5mg/10mg for 4 weeks. Having tried this alternating regime for the last 5 days, my proximal leg muscles are already feeling very sore, despite me trying not to overdo things. My question is, should I just persist with this regime and hope that the soreness settles over the next few days, or should I reduce the rate at which I am tapering?

[PMRpro Ambassador]

We (DL and I) really don't like this concept of alternating doses, it so rarely works well. There are 1mg plain pred tablets and they are cheap as chips - use them to reduce by a maximum of 1mg at a time and stop confusing you poor body. They are so sold on this idea of alternating doses - I wish I knew why.

[PPop in reply to PMRpro]

Thanks to both yourself and DL for replying so quickly- I do have plenty of scored 2.5mg tablets, so may try cutting them in two for a more gradual and consistent taper.

[DorsetLady PMRGCAuk volunteer]

At only 5 days in it could well be steroid withdrawal (SW) -but to be honest I don’t think the alternating taper15/12.5mg or the proposed 12.5/10mg does anyone any great favours.

You have two options hope it’s SW and ride it out - by day 6 or 7 you should know, or decide to go back to 15mg, get back on track, and try again - with smaller steps.

I would be asking for 1mg tablets and reducing by that amount…..if you have 2.5mg tablets provided they are plain white uncoated ones you can cut to get 1.25mg - smaller steps are much easier especially as you have had difficulty previously.

15/14mg maybe be doable….but it’s not my preferred option, think it confuses the body…but that’s just my opinion.

[DorsetLady PMRGCAuk volunteer in reply to DorsetLady]

PS…and PMRpro’s as I now see 😊