Flare at low dose

[Booboos171]

Hi, I'm looking for some advice again please. I was really pleased to be at 2.5mgs (after 4 years) and felt great, I naively thought I may no longer have PMR as I felt so 'normal'. I dropped to 2mg (1 day the first week and 2 on the following week) then started to feel the symptoms again. I thought it could have been withdrawal so ignored but the last few days have almost been back to when I first had PMR in terms of stiffness and pain. I have read through the advice on what to do with a flare and yesterday took 7mg. By the evening I felt great with almost no stiffness 🙂 my question is, do I stay on 7mg for 7 days then go back to 2.5mg? Is this drop too much? It does feel a big drop! Any advice would be welcomed, thank you 🙏

[DorsetLady PMRGCAuk volunteer]

You can stay on the increased dose for up to 14 days without impacting on drop down - usual recommendation is 7-10 days.

After then, drop back down to just about previous dose, so in your case I would try 3mg…. If you are feeling nervous about that, then do it in 2 stages - firstly down to 5mg for about a week, and then to 3mg.

Stay at 3mg for a few weeks, and then try tapering again…..but as such low doses there is no rush, and as you have discovered 0.5mg really does make a difference…..

[Booboos171 in reply to DorsetLady]

Thank you Dorset Lady and PMRPro for your quick responses, that's very reassuring and I will do as you suggest. Thank you again 🙏 x

[PMRpro Ambassador]

For a flare due to overshooting the dose you need that is fine - the higher dose mops up any accumulated inflammation and it isn't for long enough to upset adrenal function so it is fine to drop that much. It is the same as if you weren't on pred and given pred for a chest infection or something just your baseline is higher,