Reduce or Not Reduce Prednisone

[RaisinBran]

I have had a very difficult time over the past two years to get below 1.5 mg. Using the dead slow method for the past year i have been able to drop from 3mg to 1.5mg. While still feeling very fatigued, I'm experiencing my leg muscles while sleeping, wanting to develop into a full blown cramp, but not doing so. Would it be wise to drop now from 1 1/2mg to 1 (as I am over scheduled to do) to challenge my adrenals and see what happens or remain on 1 1/2mg for a bit longer? Thank you all that have so much experience with this.

[PMRpro Ambassador]

What makes you think it is the lower pred that is causing it> Have you tried magnesium?

I see no reason to force yourself lower if it makes you feel worse, Advancing age also affects adrenal function - at the dose you are at I would be in no hurry at all.

[RaisinBran in reply to PMRpro]

The only reason I have, is that I did not have these possible cramps at all in my legs previously until I tapered from 2 to 1 1/2. Yes, I also take 450mg of magnesium daily. TY

[PMRpro Ambassador in reply to RaisinBran]

Just wondered. But yes, they can be a symptom of adrenal insufficiency - so that gives you an extra reason to slow down, not speed the taper up. If you slow down - maybe the adrenal function will catch up.

[RaisinBran in reply to PMRpro]

Is it at all possible to challenge the adrenals to produce more cortisol by lowering the dose of Prednisone that you are currently taking?

[PMRpro Ambassador in reply to RaisinBran]

Well yes - that is exactly what you are doing. But it means achieving a balance between being able to function and low enough to challenge the HPA axis (hypothalamus. pituitary, adrenals). Below about 4 or 5mg you should be low enough to poke things into life and the lower you go, the better. Except it isn't very clever to get into adrenal crisis territory or a total zombie state.

[RaisinBran in reply to PMRpro]

My Rheumatologist just looked at my new blood work. Sed Rate was 2, C-Reactive Protein is 1.2 and my Cortisol level is 16. He suggested I no longer have to be on Prednisone. I can stop it immediately. I currently am tapering from 1 1/2 to 1 and have always been very sensitive at this level twice before. Would you please offer and insights you may have? TY

[PMRpro Ambassador in reply to RaisinBran]

In theory yes, you may be able to stop - the cortisol is OK, but the markers remain low as long as you are on enough pred so are really not a guide as to whether the underlying autoimmune disorder that creates the inflammation is gone into remission . As little as 1/2mg can be plenty to stop the inflammation building up until symptoms return so we don't recommend stopping suddenly - whatever rheumies say. Enough people taper off their pred carefully and still discover a few months later that the PMR is still there and have to restart pred. Leave it long enough and you can end up back where you were before - with considerably more pred required to sort it out.

[RaisinBran in reply to PMRpro]

Thank you for your excellent advice. I will continue to taper at the dead slow method.

[DorsetLady PMRGCAuk volunteer in reply to RaisinBran]

I can stop it immediately.

Maybe, but not a good idea, and PMRpro has said even 0.5mg can make a vast difference…..as has been proven many a time on here.

[RaisinBran]

I'll take your advice and continue cautiously tapering. TY