How much should I increase my Prednisone by? - PMRGCAuk

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How much should I increase my Prednisone by?

Matua profile image
10 Replies

I have been trying to get off Prednisone..I have been taking it for 2 years now. Over the past 3 months I have using a tapering Schedule and am now on 5 mgs and hoping to continue the slow process..however my latest blood test (1/12/22) has shown a CRP of 22 and I think that I need to increase my dosage temporarily. I would appreciate others experiences of this situation.. I am due to see Rheumy on 20/12/22

My main question is

If I go up to 8 mgs, how quickly can I speed up the tapering process?

It has taken 3 months using the tapering schedule to get from 9mgs down to 5mgs.

Can I just give myself a real boost and go up to say 12 for a week and then quickly reduce back down to 6 or 7 and then restart the tapering schedule?

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Matua
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10 Replies
SheffieldJane profile image
SheffieldJane

2 years and is not that long for PMR unfortunately, in spite of what some doctors tell us, so it is worth bearing in mind that the end may not be in sight yet.

Your symptoms are the best guide for tapering. All kinds of things can raise your inflammation levels, even the common cold. If you are feeling relatively well, I wouldn’t increase your dose at all. If you have the signs of an impending flare - pain and feeling as if you have low level flu, the guidance is to return to the dose that you last felt well at, this maybe, 6, 7 or 8 or maybe 9 was it. I don’t think the “real boost” of 12 would help really. The only time I have increased by that much is in observing the sick day rules when I have had a virus. Patience is the name of this game I’m afraid. You are looking for the lowest dose that controls your symptoms. It is careful work.

Janettechud profile image
Janettechud in reply to SheffieldJane

Would you be so kind as to explain the "sick day rule". I'm in Canada and only a year into this with results that my Drs called "A" typical from their viewpoint. It is proving difficult to reduce my dose of P and therefore I am on the hunt for wisdom and certainly finding it in these marvellous groups. I very much appreciate any help.

PMRpro profile image
PMRproAmbassador in reply to Janettechud

There is a good section in the FAQs about Adrenal function in general (under A) and they also include the "Sick Day Rules" (under S)which are aimed at patient with secondary adrenal sufficiency after long term pred usage.

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

Do take some time to plough your way through the various headings - you will find a vast amount of useful information there to digest at your leisure which we have collated over the years and keep up-to-date.

PMRpro profile image
PMRproAmbassador in reply to Janettechud

Tell us a bit more - how you have reduced and why they claim it is atypical (it often isn't by our standards!) - perhaps start a new thread of your own.

Where in Canada are you?

piglette profile image
piglette

Are you having a flare? If you feel OK there is no reason to increase your dose. Lots of things can increase your inflammation markers even a cold. If you are having a flare increasing by 5mg for a weeks or so should hit the PMR on the head OK. Then reduce to just above you current dose.

Matua profile image
Matua in reply to piglette

Thank you!

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer

Are you having any symptoms ?

Markers can be raised by a variety of things, sometimes nothing to do with your PMR -as well know -and with just a one off result it needs to be rechecked in case it’s just an error/blip. You don’t want to take more Pred for no good reason.

However if you do have a return of symptoms this link contains generic advice of how to deal with a flare -just adjust to your present dose -

healthunlocked.com/pmrgcauk...

PMRpro profile image
PMRproAmbassador

Why are you trying to get off pred? We are all trying to get off pred - but PMR lasts a lot longer than 2 years for the majority of patients and what we all should be attempting to do is get to the lowest effective dose - the lowest dose that gives the same symptom relief as the starting dose did. You identify that by reducing to the dose that allows a return of symptoms - and going back to the previous good dose.

However - a single raised CRP should not be a signal to increase the dose UNLESS you have symptoms. Both CRP and ESR are very non-specific markers and rise in response to any form of inflammation. CRP is particularly responsive to lung problems and injury - damaged muscles with bad bruising is enough. The correct thing to do in the absence of symptoms is to have the CRP checked a week to 10 days later to see if there is a rising trend.

Matua profile image
Matua in reply to PMRpro

Thank you...I guess that I am impatient to get off Pred as I really hated the side effects when I was on higher dose (25mgs)....now that I am down to 5 I have no real side effects so I just want to get back to normal. ie No Prednione.

PMRpro profile image
PMRproAmbassador in reply to Matua

You will get off when the PMR is gone - but that may be a while ...

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