Fatigue and Tapering

[craighead72]

As my previous posts say I had gradually tapered down to 11mg a day about two weeks ago. I have now tapered to 10mg and have started to feel very tired, weak and drowsy during the day although I cannot say I am feeling any PMR symptoms. Is this likely to be caused by low cortisol because my adrenals are not yet working enough and if so do I stick it out at 10mg for a couple of weeks and hope the tiredness improves or increase the Pred again?

[DorsetLady PMRGCAuk volunteer]

Could be adrenals stuttering -although we usually quote around 7- 8mg Pred, it can and does start at higher doses for some.

But with timing after reduction would say maybe PMR -2weeks is about the time your body says -“whoa, not enough Pred”, even though you may not be experiencing any typical symptoms as such. Which is why we always say 4weeks at any dose before you reduce.

I’d be inclined to go back to 11mg -hope that works -and then stay there for 4 weeks before attempting 10mg again.

[SnazzyD]

Although 10mg is usually still a bit high to be suffering from needing the adrenal glands to work, some people do notice it. It might be down to how much each person absorbs. So it sounds like it’s has been only 2 weeks since you got to 11mg and already you are on 10mg. Each time you drop it is by a larger % of your dose so you may be starting to get Pred withdrawal as your body isn’t being given enough time to adjust to the new dose before you’re off reducing again. On higher doses 1mg drop isn’t as big a proportion of your dose you’ve reduced from.

So if it is adrenal function needing to start up and it isn’t, staying put is the only way for it to catch up instead of going back up. However, on the face of it being 10mg still and too fast a reduction (for you) the second possibility is where I’d put my money. If you felt ok on 11mg in all ways and you go back up and feel much better, that might help the detective work. Perhaps stabilise yourself there for 2 weeks or more and then drop by 0.5mg drops over a minimum of 2 weeks. The lower you get the slower you get to ease the adrenal glands in and make the the reducing plan look more like a gentle slope rather than a staircase.

Alternatively you’re ill with something else low grade in which case reducing isn’t ideal.

[PMRpro Ambassador]

For some people it can start to be felt as high as this sort of dose but as DL says, this is also the sort of time you discover the new dose isn't quite enough for PMR purposes. Tapering 1mg every 2 weeks is quite fast by our standards. The 11 may not have been a generous level - going to 10mg may well have been too much, too soon.

I'd go back to 11mg for now and if that works so you feel good again, I'd taper in smaller steps and slow down.

[BabyRuby1]

I thought I was a zombie while going from 8 mg to 4 mg. So tired all day and napping constantly. I thought it would never go away but once I reached 1.5 mg it was gone. No more naps and my strength came back. It seemed like forever but finally I feel almost normal again. Be patient it will get better

[Merryfield]

Funny but not. It’s 9:45 am and I am drowsy. Am down to 6 mgs methylpred. Because am flexible and mostly strong, am going to keep going down on steroids. They, weight and genetics gave me diabetes. 😵‍💫