update: tapering, nausea, steroid withdrawal, adrenal glands

[LucilleG]

Three weeks ago, I wrote about having nausea and dizziness at the beginning of my taper from 6 mg to 5.5 mg. I had just taken 5.5 mg for the first time on the Wednesday and on Saturday, was very nauseous and dizzy, with a sore neck later in the day. Both the dizziness and nausea went away within a day, and I took Tylenol and the sore neck also disappeared.

It is now 3 weeks later and I've been feeling fine until yesterday (Using the DSNS tapering plan, I took 5.5 mg yesterday and today, back to 6 mg tomorrow, and then 5.5 mg for three days, etc.). I woke up with a sore neck, which is always where I feel PMR symptoms first. I also felt a bit nauseous, but not like 3 week ago. I was not dizzy and just ate bland food for the day, with the nausea going away quickly. I took my Prednisone at 7.30 am before my morning walk and also took a Tylenol, and the neck pain was gone 3 hours later.

This morning, the neck pain was there again. I decided not to take a Tylenol and just took the Prednisone. Three hours later, no neck pain.

At the beginning of this taper, I believe the neck pain was from steroid withdrawal as the pain started several hours after I took the Prednisone, and of course, it was at the very beginning of the taper. Over three weeks into this taper, could it still be steroid withdrawal? I don't think it is as the pain went away within three hours of taking Prednisone, regardless of taking Tylenol. Perhaps I'm at the level that is needed to mop up the inflammation? I was hoping to start a taper to 5 mg in mid to late February, but I'm thinking that I might need to stay at 5.5 mg for a while longer. Would do you all think?

So grateful for this amazing group!

[PMRpro Ambassador]

It is perfectly normal to have a return of pain in the morning which then goes away after taking the pred. The inflammatory substances are shed in the body at about 4-4.30am and can cause symptoms due to the new inflammation in the early morning if you are amongst the people for whom the anti-inflammatory effect of pred doesn't last the full 24 hours until the next daily dose is due. Not steroid withdrawal - just waiting for the steroid-effect to ramp up again.

[LucilleG in reply to PMRpro]

Thank you, PMRpro. That's what I thought. Until now - well, except for the very fast taper last year on the recommendation of my Rheumatologist! - I guess I've always had enough prednisone in my body to not have any pain. Do you think I should stay at 5.5 mg for a while before I start to taper to 5 mg?

[PMRpro Ambassador in reply to LucilleG]

I would! No hurry, it isn't slow when it works and you feel OK in the process.

[Sharitone]

When you do move on from 5.5mg, would you want to consider reducing in smaller drops, ie to 5.25mg? I find that easier when it starts to get difficult.

[LucilleG in reply to Sharitone]

I’ll definitely do that if I have to. I have both 5 mg and 1 mg pills. I could cut the 5 mg into 4 pieces (never tried that before!) and then add four 1 mg pills to make 5.25 mg. Thanks for the suggestion!

[Sharitone]

And if you can persuade someone to prescribe you 2.5mg tablets, you can reduce by 1/8mg at a time. That's what I do.