My first post here ... went ~ 6 weeks with symptoms before my diagnosis of PMR on November 6. Started on 40mg prednisone (after an 80mg shot!), and I gradually tapered to 12.5 mg several days ago. Started feeling some stiffness and then I had a total return of symptoms last night and this morning--as bad or worse than before starting steroids.
I took 12.5 mg this morning and plan to take another 7.5 early this evening to see if I can recover. What might others suggest for recovering and then returning to tapering?
THANK YOU to all those participate on this forum--I have found it to be very helpful.
P.S. My NP proposed tapering by 2.5 mg every 3-5 days which seems too fast to me. I was slowing by 1 1/4mg (half of a 2.5 pill) every 3-4 days.
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Trinka13
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- and you should be able to drop back to 12.5mg - but then a much slower taper…
… but I have to say a very strange approach… did the doctors suspect GCA - very high dose for PMR. And even though you can reduce quite quickly from a high dose is GCA is disproved, every 3-4 days is bonkers…
Usual advice from guidelines re the more common starting dose of 15mg for PMR is as follows -
The suggested regimen is:
. Daily prednisolone 15 mg for 3 weeks
. Then 12.5mg for 3 weeks
. Then 10mg for 4–6 weeks
. Then reduction by 1 mg every 4–8 weeks or alternate day reductions (e.g. 10/7.5mg alternate days, etc.)
**However, there is no consistent evidence for an ideal steroid regimen suitable for all patients.
Therefore, the approach to treatment must be flexible and tailored to the individual as there is heterogeneity in disease course.
Some benefit from a more gradual steroid taper.
Dose adjustment may be required for disease severity, comorbidity, side effects and patient wishes.
* note the comments - these are just guidelines, not everybody is able to conform.
"My NP proposed tapering by 2.5 mg every 3-5 days which seems too fast to me"
You are absolutely correct. You might get away with that with acute use of pred as in a chest infection - PMR is a chronic condition and 2.5mg per MONTH is the appropriate sort of rate although at 40 down to 20mg you might get away with 5mg every 3 weeks.
Was the 80mg shot as a diagnositic tool? It doesn't release all at once, 80mg would release slowly over about 3 weeks. To then taper from 40 to 12,5 in about a month is far too fast. You would have been better to start at 20mg for a monthe before then dropping to 17.5 or 15mg for a month - you just aren't ready for as low as 12.5mg yet. Doctors are in too much of a hurry to reduce pred - they are so unreasonably scared of it. I wish I understood why. Pred is the only drug that works for PMR - and it MUST be used properly. Then you can avoid the difficulties it can cause.
Instead of thinking about prednisone reduction in mg, I tried reducing in percentages. For example, a 1mg reduction from 10 to 9mg is a 10% reduction. A 1mg reduction from 5 to 4 mg is a 20% reduction. A 1mg reduction from 2 to 1 mg is a 50% reduction. Big percentage reductions are especially difficult when you get under 5mg a day. A method that I've been trying is a 3 day reduction of 2.5mg the first day, 2.0- mg the second day, and 1.5mg the third day. This is repeated 3 times, then 2.0-1.5-1.0mg repeated 3 times, then 1.5-1.0-0.5 and so forth.
I will stick to around 10% reduction at all stages of my taper - with each step 1 month or longer. I am absolutely convinced this suits me. Of course I carefully monitor my tapering and my stress situations on my journey.
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