Different tapering protocol

[Donna5658]

A friend who was diagnosed with GCA in February and PMR about the same time was given a tapering protocol by his rheumatologist that after 3 months involves more than one dose a day while one is tapering. I am including below. He is currently down to 8 mg prednisone daily.

 

03/09/22

--INCREASE to 60 mg daily x 2 weeks, then

--DECREASE to 35 mg daily x 2 weeks, then

--30 mg x 2 weeks, then

--25 mg x 2 weeks, then

--20 mg until further instructed.

 

 06/24/22

12.5 mg AM, 5 mg PM for 7-10 days, then send an update.  If OK, will reduce to

12.5 mg AM, 2.5 mg PM for 14 days, if ok then

10 mg AM, 2.5 PM for 14 days, if ok then

7.5 mg AM, 2.5 mg PM.

 

 08/25/22

 9 mg daily (7 in AM, 2 in PM) x 4 weeks, then

8 mg daily (6 in AM, 2 in PM) x 4 wks, then

7 mg daily (5 in AM, 2 in PM) x 4 wks, then

6 mg daily (4 + 2) x 4 weeks, then

5 mg daily (3+2) x 4 weeks.

Just wondering if this kind of taper is familiar to anyone here. Is there any advantage to the two dose a day regimen?

Thanks!

[PMRpro Ambassador]

What a strange and complicated approach!! Never come across anything like it before. Though I suppose if it works ...

A lot of doctors don't like split doses in GCA although a study did show it is OK.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

“if it works …”

Hmm… good luck with that then !

[DorsetLady PMRGCAuk volunteer]

When l had GCA it was always recommended that a single dose be taken - although splitting has often been discussed.

As GCA is a much more serious illness, and needs a higher dose to control inflammation I think a single dose is better -but that’s just my opinion.

[piglette]

I wonder why he split the daily dose? Perhaps if you see him you could ask. It is not usual with GCA. Hope it works, if you have any problems though just stop reducing don't try and tough it out.

[Rugger]

When I started pred for PMR I noticed that it seemed to last only 18 hours for me. I devised a similar system of splitting my dose to try and cover the 24 hours. I suppose if it works for us as individuals, that's fine. At least your friend has a rheumatologist who is interested enough to have devised this taper!

[Bobbury in reply to Rugger]

Good point. I wished I had a rheumatologist who was that interested!!

[DorsetLady PMRGCAuk volunteer in reply to Rugger]

..as long as it works....🙂.

[lkcreedon]

I have used Dorset Lady's DSNS tapering regime. It is working for me currently. Tapering from 7.5 tp 7 mgs. Very happy with it.

[emmamom in reply to lkcreedon]

I am unfamiliar with that. Could you share it?

[PMRpro Ambassador in reply to emmamom]

You will find the various slowed tapers in the FAQs - although that mention is a mixture: DSNS is one form which I worked out and DorsetLady has a slightly different approach. But they are both described there.

[AyJayBass]

That looks like a pretty rapid tapering plan to me, never mind the split doses. Going down from 10mg by 1mg every 4 weeks is what the literature recommends but many of us here have tried this and found it wanting. From 7 or 8 mg a slower taper of ½mg per 5 to 7 weeks works more reliably. See the FAQ for examples of tapering plans.

[Gellybabie]

Hi, Wow looks complicated! I decided myself to split my dose morning and evening , it really worked for me. I didn’t know at the time if it was “allowed “ but I have had minimal input from Rheumatology, after being diagnosed PMR as Corona hit. Everyone’s journey is different! Good luck to your friend 😊