Prednisolone tapering

[Seamab]

I was diagnosed with PMR in March of this year.My GP prescribed Prednisolone 20mg for 3 weeks,then 15mg for 4 weeks,12.5mg for 4 weeks,then 10mg for 4 weeks,then reducing by 1mg every 4 weeks.That has worked well for me,but I've now been on 6mg for 2 weeks and am getting slight shoulder/upper arm stiffness,nothing debilitating though.My thought was to either stay on 6mg,but for 8 weeks rather than 4,or increase to 7mg for 8 weeks,then to try reducing again.I would be grateful for any advice.

[DorsetLady PMRGCAuk volunteer]

You have probably gone just below the level you require... and 2 weeks after a reduction is just about right time to tell you that... as it's only just started I'd be inclined to go back to 7mg pronto and hope it sorts itself out. Then reduce as you suggested by 1mg every 8 weeks...

You are now entering in the level of Pred where your adrenals need to start thinking about working again - so the slower you taper the better for them as well as your PMR.

If the return to 7mg doesn't work then you may need to follow the advice in the link for dealing with a flare-

healthunlocked.com/pmrgcauk...

Also see this re all things adrenals -

healthunlocked.com/pmrgcauk...

[Seamab in reply to DorsetLady]

Thanks for the advice DorsetLady,I'll do exactly that.

[DorsetLady PMRGCAuk volunteer in reply to Seamab]

👍👍😊

[Rugger]

You could try reducing in 0.5mg steps - some of us do that from 10mg downwards. Use one of the dead slow tapers that you'll find in FAQs. I'm reducing by 0.5mg over 38 days!

All the best.

[Seamab in reply to Rugger]

Ok thanks for the advice.

[Polygolfer]

Every person is different… I would discuss any deviations from the plan with your gp… some stiffness or discomfort is normal!

[DorsetLady PMRGCAuk volunteer in reply to Polygolfer]

Yes it is, but coming on about 2 weeks after a reduction can be classic signs of a flare….

[Polygolfer in reply to DorsetLady]

Agreed! Still it’s so easy to swiftly reach for the steroids at the first hurdle - living with some stiffness and discomfort is part of ageing!!

[DorsetLady PMRGCAuk volunteer in reply to Polygolfer]

It is easy to reach for the Pred and blame the PMR [or GCA ]for every twinge, when it not, and having been on silly amounts of Pred I’d never say take it unnecessarily. A couple of paracetamol will quickly give the answer… but it they don’t help, then you have to consider it may be your illness, and act.

[Polygolfer in reply to DorsetLady]

Totally agree 100%!

[Seamab in reply to Polygolfer]

OK thanks for replying to my query.

[PMRpro Ambassador in reply to Polygolfer]

"some stiffness or discomfort is normal"

That is a very sweeping statement - and not necessarily true.

[Seamab in reply to PMRpro]

OK thanks for the advice PMRpro.

[alangg]

I would echo the advice about using a slow tapering plan to reduce the dose rather than a 'cliff edge' drop each time. And ask your prescriber for 1mg and 5mg pills and buy a pill cutter so that each time you start a reduction, the lower dose is only about 10% less than the higher dose.

By all accounts, Pred is a very powerful drug and so reducing the dose very slowly and gently is really important.

[Seamab in reply to alangg]

OK thanks for that, I have both 5mg and 1mg and a pill cutter, so I think a slow taper seems the best option.

[Mazxstitch]

There are also 2.5mg tablets. I have been tapering a quarter of a mg for some time and am on 4.25mg now.

[Seamab in reply to Mazxstitch]

Thanks for your advice. I would rather split a 5mg tablet.The 2.5mg are gastro resistant and I seem to remember reading that they didn't have the same bioavailability!

[Mazxstitch in reply to Seamab]

There are brown 2.5mg which are Gastro Resistant and there are plain 2.5mg coloured yellowish. Those are the ones I am cutting to get 1.25mg.

[Seamab in reply to Mazxstitch]

I didn't realise you got a 'plain' 2.5mg,are you posting from the UK?

[Mazxstitch in reply to Seamab]

Yes, in bonny Scotland!

[Seamab in reply to Mazxstitch]

Ditto! Good to know,I'll get the 'plain' one's when I need that strength,thanks for that.

[DorsetLady PMRGCAuk volunteer in reply to Seamab]

You can get both enteric coated and plain 2.5mg tablets in UK … but just be aware that the plain ones are more expensive than the enteric coated ones… which is at odds with all other doses where the reverse is true. So if you have an issue, stick with the 1mg… and cut in half as and when necessary.

[Seamab in reply to DorsetLady]

OK thanks

[cranberryt]

I agree, especially moving to 0.5mg decreases going forward. Doctors don’t believe it but half can make a big difference!

[Seamab in reply to cranberryt]

OK thanks for the advice cranberryt.