what is the adrenal zone?

[musicalJ]

I've tried searching in FAQs but without success. What prednisolone doses constitute the adrenal zone? I am now down to 12.5 and notice a tendency to weepiness that I didn't have before. I went to 12.5 daily last Thursday, after 2 weeks of 15 mg and 12.5 mg on alternate days. At the start of the 2 weeks I had about a week of feeling rough, then improved dramatically - so I am hoping that the improvement will happen again once my body gets used to being on 12.5 mg daily. I knew that below 10 mg things were likely to get tougher, but might they already be getting tougher? Thanks for your help. I read the posts every day and often find helpful information; as so many other have said, it helps a lot reading what other people are going through and the advice they are given.

[DorsetLady PMRGCAuk volunteer]

Is this what you are looking for -

The body normally makes approximately 30mg of cortisol per day although that is not necessarily a constant level, measurements of 300mg have been measured in patients undergoing surgery. 30mg of cortisol is approximately equivalent to 7.5mg of prednisone.

Once you have been on steroids for more than 2-3 weeks and at a dose higher than 7.5mg (which is roughly equivalent to the normal cortisol production by your Adrenals [does vary between 5-10mg, sometimes higher, for individuals] known as the physiological level they temporary stop working because the artificial cortisol in your body (Pred) means they don’t have to.

Full post from the FAQs -

healthunlocked.com/pmrgcauk...

[musicalJ in reply to DorsetLady]

Thank you, yes - the note "does vary between 5-10mg, sometimes higher, for individuals" is what I was thinking of.

[DorsetLady PMRGCAuk volunteer in reply to musicalJ]

Agree with PMRpro’s reply… and as we’ve said many times don’t think the alternate days of dosing/tapering does a lot for people. Although it is mentioned in guidelines… experience doesn’t seem to support it - for many anyway…

[musicalJ in reply to DorsetLady]

That's interesting, because it seemed an improvement on the original instruction to go straight from 15 to 12.5

[PMRpro Ambassador in reply to musicalJ]

Superficially yes - bit in practice, while it may work for some patients, for others it doesn't suit them at all. Why not just tell the patient to do 15/14/12,5?

[DorsetLady PMRGCAuk volunteer in reply to musicalJ]

Well it is better than a single step down from 15-12.5, but not as good [for most] if you drop down in smaller steps… and I still think it’s more confusing on the body ..

[PMRpro Ambassador]

In your case I think it is more likely to be your body protesting at the rapid swinging about of the doses that is the problem. Some people DO start feel "adrenal-ish" above 10mg but it is very unusual and it is part of the reason we bang on so much about the size of steps down the dose and how often you do them, We also really don't like the idea of alternate days at such different doses - you do get there at some point on the slowed tapers but you build up to it more slowly rather than swinging about for 2 whole weeks. Your poor body has no idea where it is and as you get lower that change is a greater percentage. Gently does it!

[musicalJ in reply to PMRpro]

Thank you - sound advice, as usual!

[Missus835]

Hi musicalJ. I too am at 12.5 and very weepy lately. Only been at this dose a week and rheumy and also GP expect me to reduce to 10 mg tonight. I am going to try 11 or maybe only 11.5. Rheumy has threatened to cut off the pred if I don't comply with her schedule. Good thing I'd kept some 1 mg pills aside. Had been thinking of early adrenal thing as well. Thanks to DL and Pro for their wisdom. If I'm being honest, not ready for the Deathly Fatigue yet. Rheumy says "that doesn't happen to everyone".

[random901 in reply to Missus835]

What?! A threatening Rheumy? What a bully!

[ithurts1 in reply to Missus835]

No harm in slowing down and reducing by 1 mg or half a mg at a time. I did 1 mg every 3 weeks until I reached 10 then did 1/2 mg from there on. Fingers crossed it is working for me up to now. I made those decisions myself after reading the advice on here! My GP is fine with it as long as I am ok. I check in with her regularly. Rheumatologist tried to taper me more quickly but I said I wasn’t convinced. He is s seeing me in March to check how I am! Work with your own body

[Missus835 in reply to ithurts1]

Yes I have been listening to my body for 2 years and this rheumy has been on me for 18 months. Lol. Thanks for your reply. We'll keep one keeping on.

[musicalJ in reply to ithurts1]

Thanks. I haven't been given a plan for below 10mg, but certainly expect to have to go much more slowly

[musicalJ in reply to Missus835]

Thanks for the sympathy, Missus - I am improving, now that I've been on 12.5 a few more days; rheumatologist says stay on it for 4 weeks before going further. If I'm OK after 4 weeks I'll try the next reduction. I told her that quality of life is more important to me than length of life and she agreed, so if I can't cope with her tapering suggestions I shall argue.

[Missus835 in reply to musicalJ]

Yep I agree with you and have argued. QOL so much more important than reaching zero Pred at warp speed. I didn't reduce at all last night and may not until next week. Cheers!