Whoops! I made a boo-boo.

[HarmonyGranny]

A week ago I visited the rheumatologist, who prescribed reducing Prednisone from 5mg to 4g daily and adding 20mg hydrocortisone. All part of the wean-off steroids.Stupidly, and because I was massively distracted by life circumstances, I didn't take in her instructions properly and reduced overnight from 5mg Prednisone to just 1mg!!!!

I've been doing this for a week now, with attendant aches and pains, but nothing like I would have imagined, coming down so suddenly.

My question is: should I go back up to the 4mg she prescribed, or could I continue my self imposed reduction? (Still taking the 20mg of hydrocortisone daily).

Thank you to anyone more knowledgeable and sensible than I.....❤

[PMRpro Ambassador]

I am a bit confused as to her thinking to be honest. 20mg hydrocortisone is equivalent to 5mg pred so I don;t see how that plays in weaning OFF steroids. She had almost DOUBLED your dose of steroid - which if your PMR is very quiescent would probably leave you in the same situation as being on the 5mg pred. You are taking slightly more steroid in total. No wonder you don't feel as bad as you expected.

I don't really know what you should do though. As far as adrenal replacement is concerned you are on about the same. If the PMR symptoms don't flare up you could stay on the 1mg plus the HC and see how you get on. If you flare up though - you will know why!

[HarmonyGranny in reply to PMRpro]

Thank you so much PMRpro. I didn't realise that 20mg of hydrocortisone equals 5mg Pred! My gut feeling is that "if it ain't broke don't fix it". Meaning that if I seem to be coping OK with 1mg of Pred plus the 20mg of hydrocortisone, I'll keep going with that. (She didn't really explain how the two medications differ).....Hopefully I won't get a flare up, but if I do, perhaps I should just increase the dose of Pred to 4mg. Thank you again for taking the time to help me make sense of things.

[PMRpro Ambassador in reply to HarmonyGranny]

The difference is in how long they remain in the body - HC is excreted in a couple of hours and the antiinflammatory effect is lower and shorter than pred. But both are corticosteroids.

[AtopicGuy in reply to PMRpro]

Indeed. As I understand it, the relative potency of steroids is judged on how much vasoconstriction they cause (which is obviously a proxy); but molecular shape and the rate (half-life) of breakdown (metabolism) are important, too. Their efficacy will surely vary somewhat according to the disease. The choice of prednisolone/prednisone as the frontline treatment for PMR was made empirically (based on results by trial & error) many years ago. Changing to hydrocortisone seems bizarre.

[Polygolfer]

Dear Harmony, experience from this forum would indicate it’s more prudent to reduce gradually, but everyone is different, so who knows, it might work for you? At the end of the day, it’s a call you and your Rheumatologist need to make together so I would ask for her views before deciding!

[Polygolfer in reply to Polygolfer]

There are also some good insights on Google on tapering and replacing prednisolone with hydrocortisone… worth checking it out!

[HarmonyGranny]

Thanks for your advice Polygolfer. Much appreciated.