Taper

[Januzzi]

I take 8mg Prednisone now .. I work night shift so I take 4mg at 4pm with evening meal and 4mg at 4am before going to sleep … I’m going to cut down to 7-1/2mg and wonder what dose should I cut 4 pm or 4am

Thanks for you help

[SnazzyD]

So, normally when doses starting creeping below 8mg we try to make sure there is a low level of Pred in the system around midnight or just after. This is the normal time that low cortisol is detected and the brain sets off cortisol production ready for the morning high. While you are on lots of Pred this doesn’t matter because the adrenal glands don’t need to work because there’s masses of the Pred taking the place of your natural cortisol. Once you drop somewhere below 8mg, your Pred level starts to become not enough, so you have to make some of your own. The lower you get the more of your own you have to make.

With that in mind, without night shifts it would be worth cutting the 4pm dose first. However, I was trying to look up cortisol production in night shift workers to see if there is any advantage one way or the other if your pattern is affected by being awake when the body normally sleeps. I found different answers. One said the process is swapped so you have your natural high when you get up at 4pm instead of 6am. Another said it’s the the same as a day worker but with stunted levels all round. It also depends on whether a person works permanent nights or on a rotation. So it isn’t obvious what natural cortisol level timing is in you as an individual. You could cut your 4am dose first so you don’t feel the lack during your night shift but you’ll have to bite that bullet at some point. If you are assuming you have a normal rhythm, cut your 4pm dose first. It’s a guess I suppose. I wouldn’t do more than 0.5mg. You may find that as you dip below 8mg now, that it becomes harder going with energy as many of us find.

I will be interested in what others here think.

[PMRpro Ambassador]

Are you on permanent night shift? Though even then - since you don't work at least 2 nights a week and presumably do something more aligned to the rest of the family, that must have some effect on your circadian rhythms. Difficult one!

I think I would be inclined to do not more than 1/2mg at a time on one and then the other dose so you reduce the two doses in parallel but alternating rather than doing both at the same time. And see how you get on.

[Januzzi in reply to PMRpro]

Work Full time 5 days week I try and stick to same schedule on my days off….Im not sure what you mean by alternate days .I was thinking 7-1/2mg … 3-1/2mg at 4am when I go to sleep and 4mg at 4pm when I have dinner for a month

Then the 4 pm and 4am dose at 3-1/2mg for another month ….then stick with The 7mg for another month…..I agree on going slow just not sure how to do it

Thanks for your advise I really appreciate it

[DorsetLady PMRGCAuk volunteer in reply to Januzzi]

If PMRpro means the same as I do, then reduce one dose at a time, not both at same time… So for example reduce the 4am dose by 0.5mg in your first taper, then second taper reduce to 4pm dose by 0.5mg…. and then carry on same routine for subsequent tapers…hence the alternate reference

But if she was thinking differently I sure she advise accordingly.

[PMRpro Ambassador in reply to Januzzi]

Exactly what DL said - not on alternate days, do one or other dose each month, first month work on the morning dose, the second month work on the afternoon dose. Then the morning dose again and so on.

[DorsetLady PMRGCAuk volunteer]

For the record, I agree with PMRpro -alternate doses -and most definitely only 0.5mg per time.-and certainly no rushing.