DSNS Taper Question

[montebello]

Hi all,

At a recent visit to my Rheumy, he told me I'm ready to taper once again. At the time, I was at 7 MG PRED per day. I had been sick with Bronchitis for more than a month, and also had to care for my wife who contracted pneumonia a month before that, so I was not able to taper during that time.

He knows I use the DSNS method of tapering.

I told him I had planned on going from 7 mg to 6.5 mg per day, and he told me that was too small a taper when using DSNS. He suggested that I go from 7 to 6 mg per day instead, saying that with DSNS that would be equivalent to 6.5 mg per AVERAGE daily dosage.

I never thought of it that way. Does he have a point?

Thanks all.

[DorsetLady PMRGCAuk volunteer]

If you have been reducing by 0.5mg a time which many do once they get below 10mg and it works why change it now?

Plus as you get lower, that 0.5mg becomes a bigger percentage drop …. so sometimes it becomes more difficult.

Personally I’d stick to what suits you and you know works…. 😊

[montebello in reply to DorsetLady]

Thanks, DorsetLady, but to be honest I have NOT reduced by .5 mg at a time. I wasn't going to do that until I went from 7 to 6 (since 10% of 7 = .7). See what I mean?

[DorsetLady PMRGCAuk volunteer in reply to montebello]

Okay -can understand I didn’t reduce by 0.5mg until I got to 6mg -and that was mainly due to sluggish adrenals rather than GCA.

So it’s your choice - give it a go as Rheumy suggests - you won’t know until you try… if it works good, if it doesn’t return to 7mg and then try it your way.

[montebello in reply to DorsetLady]

Thanks so much.

[PMRpro Ambassador]

He might. But the lower the slower and by the time you get to 5mg it should be 1/2mg anyway. But it depends on the person and whether your body can tolerate it - some can't. And it isn't slow when it works.

[Sharitone]

As everyone says, stick to what suits you: no one can stop you anyway.

However, maybe I am being dense, but if he is suggesting an average daily dose of 6.5, then surely 6.5 per day would be just as good, and it is less than a 10% drop. All depends on your experience of reducing

[montebello in reply to Sharitone]

You're not being dense at all. Thanks for chiming in.

[DorsetLady PMRGCAuk volunteer in reply to Sharitone]

I think his point was 7/6mg would give an average of 6.5mg per day.. so on that basis 7/6.5mg would give a daily average of 6.75mg. Which to my mind is probably more helpful to his patient than he realises…

Not sure what his issue is ..😊 apart from over time it will take longer to get to zero -but so what. As we say, better than flaring…

[montebello in reply to DorsetLady]

Yeah, well you're right -- he's balancing the need to stay on the PRED with the need to reduce -- as he should I think. When I told him my wife had pneumonia, for example, he told me that at 5 MG of PRED, a patient is 100% more likely to contract pneumonia then someone who is not on PRED. Somehow, I bit the bullet and did not contract it.

[PMRpro Ambassador in reply to montebello]

Dear me - in 14+ years on pred I haven't had pneumonia!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Nor me….

[PMRpro Ambassador in reply to DorsetLady]

Don't think we've heard of many getting it have we?

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

No we haven’t…

[Sharitone in reply to DorsetLady]

I did.😧

[DorsetLady PMRGCAuk volunteer in reply to Sharitone]

☹️

[PMRpro Ambassador in reply to Sharitone]

Noted for the future ...

[proactive in reply to PMRpro]

A Doctor friend of mine who works in geriatric care told me she totally underestimated how much Prednisone compromises the immune system, and warned me to be very diligent about avoiding sick people, crowds and to use masks in public places.

[PMRpro Ambassador in reply to proactive]

Not for everyone - I used a mask all through Covid but not normally. Rarely "sick".

[DorsetLady PMRGCAuk volunteer in reply to proactive]

Can’t say it affected mine on GCA doses -narry a cough, cold etc -one bout of oral thrush very early days that’s all.

[Rugger]

Using any of the DSNS lengths of taper, for half the days we will have been on the higher dose and half the days on the lower dose, so yes, the average dose is between the two doses. However, the taper slowly eases us into the lower dose so we have a chance to tell if it is suiting us.

All the best.

[montebello in reply to Rugger]

Yes, this is exactly as I see it. Thank you

[TheMoaningViolet]

I think this is a personal choice based on what you can tolerate and you should do what feels comfortable for you. You can try reducing by 1 mg, but extend the taper if it feels uncomfortable. I changed from 1 mg drops to 0.5 mg drops just below 7 mg. Then I changed from DL taper to DSNS taper half way through dropping from 5 mg to 4.5 mg, because I found it difficult. My tapers after that became longer as I repeated various steps. Could I have tapered faster, who knows, perhaps I could have. But I had no flares and I was not in too much discomfort. 7 mg is the mark when the adrenals need to start working, so the experience of the taper becomes more complicated.

[Flivoless]

Only you know when you are "ready" to reduce Pred not your Rheumy. Personally I reduced by 0.5 from 10mg down and have not had a problem save for a slight hitch going from 7.5 to 7 resulting staying at 7.5 for longer than my usual. Now at 2.5.

[Seamab in reply to Flivoless]

Can I just ask you,I'm now on 8mg after having a slight flare when I was down to 6mg and going back up to 12mg-- is your reduction a straight 0.5mg ie half a 1mg tablet each time,and how long do you stick on each dose?

[DorsetLady PMRGCAuk volunteer in reply to Seamab]

If you are doing an “overnight” reduction - then you need to stay at each dose for at least 4 weeks….if you are using one of the slow tapers we talk about on here they usually take around 5 weeks to get from old dose to new dose.

I found once I’d completed one taper, I could usually embark on the next one without an issue… if I wasn’t sure I stayed on that dose for a week or so, and then off I went again.

As we are always saying, you need to adjust any tapering plan to suit you…

[Seamab in reply to DorsetLady]

👍thanks

[Flivoless in reply to Seamab]

Yes, just 0.5 Mg steps with the duration of 5/6 weeks. Easier to cut 5mg pills than 1mg so only 6.5, 5.5 and 1.5 are a pain.

[Seamab in reply to Flivoless]

👍thanks for that.

[Flivoless in reply to Seamab]

You're very welcome

[cranberryt]

I will add that around 7mg is the point where adrenals need to kick in. So it’s a point where many struggle to reduce. I think .5 drops u der 7mg even while doing dead slow method is wise.

[montebello]

Another question came to mind last night regarding these taper routines.

I'm wondering if it's more important to limit any reduction to no more than 10% PER DOSE,

or

to limit any reduction to no more than 10% PER MONTH.

For example, if I use the DSNS taper and go from 5 to 4 mg over a period of one month, the AVERAGE mg usage for that month would be 4.5 -- which is equivalent to less than a 10% decrease FOR THE MONTH but MORE THAN a 10% increase PER DOSE.

So I'm thinking that the 10% "rule" might best be applied to a MONTHLY DECREASE?

If so, then when I finish going from 5 to 4 mg in DEC (an average of 4.5 mg for the month), then for JAN I ought to take an AVERAGE of 4.0 mg, which would require me to go from 4.5 to 3.5 instead of 4.0 to 3.0.

All this is to say that I think PMRPro's original suggestion for her DSNS taper routine is "right-on," and the best, simplest, safest way to go. For example,

DEC: 5 to 4.5 over 30 days (AVG - 4.75 mg/day)

JAN: 4.5 to 4.0 over 30 days (AVG = 4.25 mg/day)

Then again, maybe I'm just too "anal."

[DorsetLady PMRGCAuk volunteer in reply to montebello]

Then again, maybe I'm just too "anal."

Couldn’t possibly comment! 😉