I am 21 stone and have been on 15mg daily around 11am since end of April. I experience some pain twinges from mid evening.
I reduce to 12.5 this coming Saturday and have a tel consultation with my doctor next week.
At my weight, surely someone half my weight would have a much higher concentration of Pred than I have, on the same daily dose.
Is there any meaningful information available on this aspect?
Not necessarily -there are so many variables and weight is just one of them. I got an amazing result in 6 hours with 15mg, I am not very overweight but am borderline obese according to my BMI - but there are others who weigh a lot less and are slimly built who either took much longer or needed more to get a result. It depends on the version of PMR you have, what your pred receptors are like, other comorbidities, lifestyle and even diet possibly. The bottom line is, you need what you need although if you need an awful lot more it must be considered this may not be the PMR WE talk about since PMR isn't the disease, it is the name for a specific set of symptoms.
There IS a study where they established that 12.5mg as a starting dose achieved a result in a months with smaller women doing better than larger men - but one of the evidential criteria beloved by many doctors is a rapid response to a moderate dose of pred, up to 25mg or so. Slower or poor response may be a sign it isn't "our" PMR. More recent recommentations give the starting dose as the lowest effective dose in the range 12.5-25mg and 15mg is an accepted starting point. You appear to have had an acceptable response.
There is another point though and that is that the antiinflammatory effect of pred lasts 12 to 36 hours - depending on the person and I don't think weight has any bearing there. If you are at the low end of the range, then pain is likely to return before the next daily dose is due, In this situation, splitting the dose often solves the problem. Usual is 2/3 or so in the morning since the bulk of the inflammatory substances are released in the early morning and the rest later enough in the day to extend the antiinflammatory through to the next morning dose but not so late that it affects sleep and later, at lower doses, adrenal recovery.
excellent and comprehensive response, sincere thanks.
If 15mg is working for you that is fine. Big men sometimes start on 20mg rather than 15mg.
Read somewhere that people of 'normal' weight respond the best to steroids (sorry cannot recall source). I wrongly assumed my weight why I was started on 40mg (it was actually the jaw pain) but had a spectacular 90% improvement first week
I couldn’t agree more. I’m a petite 43kg female and was put on 15mg Pred. I asked my GP this exact question to be told‘It’s what the NICE guidelines tells us to prescribe!! How narrow minded!
There is no defined dose that is effective - there are far too many individual variables and it has been generally considered that dose is related to body surface are rather than weight and that varies less between adults than you might think!
Interesting. I guess we are all different. My first Rheumy was Italian and she started me on 5mg. I was told to come of my two hourly dose of painkillers the day before which I did very reluctantly. My response to 5mg was within half an hour! It was amazing. I could stand upright and walk in a normal way. Unfortunately 5m proved not quite enough and I was put up to 10mg by next Rheumy. First Rheumy went back to Italy at the start of the pandemic
Since then I have learnt that I react or over react to many drugs. I think one day they will be able to profile each person as to the right dose of any medication.
I was not over weight when I started the PMRGCA journey but I am now!! 5mg gave me all the known side effects of pred!
Do make sure you go on a low to almost zero carb diet to avoid putting on weight or becoming diabetic with the pred. Good luck.
I personally think so and it seems logical, but I am sure there are other factors also. I am what they called a "high metabolizer" (of any drug), so I always need more than most of any meds. I am on 27.5 mg currently and have been for 7 weeks now. I am overweight, but not obese.
I have no experience or knowledge re weight related effects on tapering prednisolone, but I believe that there are many kind, knowledgeable folk who offer good advice here.
However, I can offer my experience with tapering. For me, it must me done very slowly, ie 0.5 mg per month. (I juggle with the 2.5 mg dose rather than halve a pill). I am three months into my second year after being diagnosed with PMR and my initial, advised drop from 15 to 12.5 mg, then 10, put me right back up to 15 nearly a year ago.
I am now down to 9mg, but not without flare ups, which I tolerate, with pain relief.
I am currently enjoying, nearly pain free regular exercise (dancing, walking, table tennis) before the next drop to 8.5 mg prednisolone, when I'm sure there will be a flare up, which I will "tough out", following the usual pattern and my rheumatologist's advice.
I found that a call to the Rheumatology nurse, number found on hospital appointment letter, in berween six monthly rhematology appointments, to be helpful.
Good luck and best wishes to everyone.
I'm sorry but I don't have anything to add to the reply from Ambassador which seems to be very comprehensive. Good luck.
Hi there again, I have just noticed this post.In France the starting dose is 0.2 to 0.3 mgs per kilogram per day. So weight is taken onto account. OH is a big bunny, he always needs bigger doses of everything for the same therapeutic effect.
That makes sense to me!
Some doctors do, most don't in the UK. And in practice, it isn't always the case. The reason is probably that the dose needs to be tailored to the person, a process called titration and what you are doing with a slow taper. They start at a dose that is enough for most, if it doesn't quite work, they go up a bit, and then taper it. It used to be 30mg that was standard and then the panic about pred started and they dropped it to 15mg. A study found 75% of patients responded to a starting dose of 12,5mg. in a month, best results found in smaller and lighter females. But there are a lot of factors involved, not only weight: disease activity, delays in diagnosis, whether the PMR is actually a symptom of LVV or GCA which tend to need more.
The 2015 Recommendations say the lowest effective dose in the range 12.5 to 25 - covers most eventualities and if the first try doesn't work you go up a bit until it does. Once existing inflammation is cleared out - you taper the dose to find the right dose for that person, it isn;t as if the dose remains the same for the duration of treatment.
Absolutely, but as you study shows, best result in smaller lighter females, ie greater dose per kg body weight. It is our experience that a big person gets undertreated due to lack of individualisation of medicine doses, in OH case by body weight. Done routinely in kids, so why not ditto in adults.
OH?
Other Half, what the American call SO, SIgnificant Other
True, but in GCA, the dose recommendation based on weight is up to a maximum total and to some extent that is what the fairly standard dose does and goes to the higher end. It also depends on the medication, most of which are designed for adults. Children are frequently half the weight or less. Unless your husband is a VERY big boy, he's unlikely to be double me.
Wouldn't dream of risking an indelicate comment! 🤭🙂
Other Half.
Back on Prednisolone
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