reducing prednisone with slow method

[Linny3]

I have been reducing for 2 months and have gone from 15mg daily to 12. Things are going pretty good. I have tweaked it a little and wonder what anyone thinks about it.

In the past I have flared doing this and thought what can I do differently to help myself.

I usually take my pred in the evening. Now I split up my daily amount (which is 12mg) I take 2-4 mg (depending on how I feel) first thing in the morning and I take the remaining mg. later in the day.

My thinking is maybe I need a little more pred. to begin the day just in case there is some inflammation building and trying not to let it gain a foothold.

Can’t think of any reason this would be bad for me?

All I know is; this has been the easiest and most successful decrease In over 6 years.🎉🤗😙

I could hope that the disease is waneing.🤗

[PMRpro Ambassador]

The usual thinking on splitting is about 2/3 first thing and the rest later enough to carry the effect over to next morning if it isn't quite lasting. The optimum time to take pred to control the morning dose of new inflammation (it only happens once a day at 4-4.30am) is 2-3am, earlier for prednisone, later for prednisolone which doesn't have to pass through the liver to be activated. This makes sure the pred is at a peak befor the inflammatory substances are shed and start their evil work.

[Linny3 in reply to PMRpro]

very interesting thanks for the info

[Exflex in reply to PMRpro]

On a slight but related tangent, why do some countries favour prednisone. Here in the U.K. it’s prednisolone?

[PMRpro Ambassador in reply to Exflex]

Prednisolone has the advantage of not needing to be activated by processing in the liver so it works even in patients with liver problems and is faster in onset of action. Other than that - probably tradition and what is cheaper - the UK has a massive bargaining power in the NHS for purchasing drugs unlike the USA where the insurers are all individual. It is certainly regional traditions here as far as I can tell.

[Linny3 in reply to PMRpro]

does it matter if I take it at 2-3:30am or 4-4:30 am

[PMRpro Ambassador in reply to Linny3]

Not really - except it takes 1 to 2 hours to get into your system and so the inflammation may have started up a bit before the pred gets there,

[PMRnewbie2017]

I see from your profile that you've been on this journey for a while now and you're still on a fairly high dose of Pred. Have you ever been able to get down to 7 or 8mg? Also does your PMR follow a typical presentation in that your blood results for ESR and CRP reflect how you are feeling? PMRpro has given a good explanation of why it's best to take the Pred very early in the day. I have always been a big advocate for this too. It is quite possible that the amount of inflammatory substance your body produces at 4am is decreasing which is why you have been able to reduce your Pred dose. However by taking the Pred so late in the day I fear you will be storing up difficulties when you do manage to get down to the lower doses. Typically PMR pains do wear off later in the day so it may not necessarily be your "later in the day" doses that are doing this?? Our bodies love the Pred which is synthetic cortisol. When we reduce our doses our muscles do complain and we can feel out of sorts and although your dose of 12mg is still way above the physiological equivalent of 7 or 8 mg, if you are ever going to significantly reduce your Pred dose (and hopefully get off it altogether) your body is going to have to make up the difference and start producing its own cortisol. In order for this to happen we have to have a very low amount of cortisol in our bodies (natural or from Pred tablets) at around midnight. By taking Pred much later than 9 or 10am there is a danger that we inhibit that process because there is too much synthetic cortisol in our system by midnight. I must stress you are still a long way from this, but I mention it to help you understand why your comment "Can’t think of any reason this would be bad for me?" is incorrect.

If I can give you a personal example: I am transitioning 2.5mg to 2.25mg using DSNS. I had tried taking my Pred at 7.30am to further minimise the inhibition of natural cortisol production. I would wake feeling a bit too stiff for my liking so have reverted back to 2am to 3.30am (whenever I wake - after 5+ years of this I just wake naturally at this time). There is a noticeable improvement in how I feel stiffness-wise. For the first two weeks of my taper I feel rather out of sorts. My muscles really complain but in my case I know it's not PMR as my bloods are OK (I am typical) and Paracetamol (Acetominophen) sorts it out.

The lesson here is not all aches and pains are from PMR and it's taken me a long time to get to grips with that!

[Linny3 in reply to PMRnewbie2017]

Thank you for your kind reply. I understand what you are saying and what pmr pro has said. I am definitely going to heed your suggestions. One time I got to 7 while on methotrexate. It didn’t last long as the dr decreased the pred too fast. This was in the early days of pmr and I didn’t know any better.

My blood markers were only high for the first few months after diagnosis. Ever since then they have been normal except when I had a bad case of Covid and then they went sky high. It took me months to come down from all the steroids they gave me for the Covid/pneumonia.

I have been fairly comfortable all these years on the higher pred. Though I paid a high price for it. The only time I would flare is when I tried to decrease the pred.

I am ecstatic that I have been able to lower it with minimal discomfort.

I start 11 mg tonite for 2 days and continue on with dsns method, and with taking a dose around 2-3:30 am

I am as sure as I can be that this is pmr. When I do get discomfort it is always in the same areas. Also my younger sister has just been diagnosed with pmr. She refuses to take the prednisone and is suffering horribly and is aching in the same place that I can.

[PMRpro Ambassador in reply to Linny3]

She is aware that untreated PMR is said to be 7 times more likely to progress to GCA? And if you get GCA the choice is much higher dose pred or risk going toally irreversibly blind? You can at least reduce the risk of that by taking a moderate dose of pred for PMR.

[Linny3 in reply to PMRpro]

thank you so much I had forgotten that. I will relay that to her now.