I was diagnosed with PMR and GCA in February last year and put on 60 mg prednisolone. I am now down to 12.5 mg and was supposed to reduce today, but this morning I awoke with a sore throat and wondering whether I might be going to develop the nasty chest infection that my niece got while I was staying with her over Easter. Thinking that if I got the nasty cough that she got I would not be able to visit the pharmacy I went there this morning to buy whatever the pharmacist said I could take. The answer was that I mustn't take something bought over the counter but must speak to a doctor. The pharmacist also said I should go ahead and reduce my prednisolone dose, but my feeling is that I should wait until I have stopped fighting an infection; what does anyone else think? If I don't do it now it will be another 2 weeks, as I have something planned for the 18th April that I don't want to miss and the last 2 reductions have caused me problems. I've been on 12.5 for 7 weeks, because when I was supposed to reduce I had only been feeling well for 6 days so decided to wait until after my Easter break. The rheumatologist said my next reduction should be to alternate 12.5 with 10 mg, but after the problems with the last 2 reductions I intend to alternate 12.5 with 11 mg.
to reduce or not?: I was diagnosed with PMR and GCA... - PMRGCAuk
to reduce or not?
What a load of whatever - better not say what I'm thinking! Do NOT reduce the dose if you are hatching an infection. Wait until you are over it properly. And as for the cough medicine - the best I can say is he saved you spending money on something probably totally useless. Not that I have the slightest idea how long he thinks hacking coughs with colds last given it will take you weeks to see a doctor ... I thought pharmacists were to take over from GPs and save the world?
And do use one of our slowed tapers rather than the alternating idea. Is it plain white pred you are on? If so, indulge the pharmacist's profits and get a pill cutter to get a single dose to take daily and not confuse your poor body!
What were you hoping for for the cough? Honey and lemon won't do any harm, honey is highly recommended, preferably proper honey (doesn't have to be Manuka), not supermarket stuff. Lots of fluids, inhaling steam, with or without additive likes Friars balsam or menthol, sucking a hard cough sweet.
Thank you. I had forgotten about Friar's Balsam, the remedy of my childhood which I used for many years but have been lucky enough not to need for ages. What a good idea. With a bit of luck I won't get the cough, but I certainly feel that I am getting something. I have 1 mg, 2.5 mg and 5 mg of prednisolone, so at present don't need to cut tablets. I will reread the slow taper details - I've read them several times already but my memory is not what it once was.
I've been thinking about how I shall taper my prednisolone once I am free from infection. The rheumatologist said the next reduction should be from 12.5 to 10, but I was proposing to make it 12.5 to 11. Now I'm wondering if I should do 12.5, 11.5, 10.5, 9.5, 9. What do you think? I've also been thinking about the dead slow taper that starts with 1 day on the lower dose followed by 6 on the higher. The plan I was using meant I could make allowances for holidays etc, but I can't see how I would do that on the dead slow plan - or is the theory that I wouldn't need to make allowances for special events because I wouldn't go through the rough patches? What would be meant by a) staying on the same dose [eg 1 day on low dose followed by 4 on high?] and b) reducing the dose [start afresh at 1/6 on a lower dose, or go from 1 day low followed eg by 5 days high to 1 day low followed by 4 days high]? I had thought the alternate doses sounded sensible, but presumably your experience shows that it doesn't work for a lot of people.
I would certainly reduce in smaller steps - 1mg is fine by our experience, The theory is that the slower tapers, however you do them, remove the experiences of a dramatic change in dose. At this level you may not need the DSNS or DorsetLady's version if you are only doing 1mg at a time.
I used to find that after 3 trials of the new lower dose I actually felt worse on the higher dose days do then went straight to every day new dose. But sorry - not clear what you are asking. Must be feeling dense this morning!
I don't think you are being dense, there was rather a lot in my last post and I tried to make it shorter by not spelling out all the detail. Anyway, thanks to both you and Dorset Lady for your advice, I think I will do 12.5 to 12 and then two 1mg increments to reach 10. I'm expecting the rheumatologist to contact me this month because if I had done exactly what she said I would now be on 10mg and she would need to give me a fresh plan. I have several holidays coming up and want to be well for them.
Well sorry, but your Rheumy needs to realise that just because she has given you plan it’s doesn’t always work out as she expected… if she does, then she’s either very naive or not very observant.
You are not an automaton - and life has a habit of the throwing the best laid plans of mice and men [and women] into the rubbish bin… apologies to Rabbie Burns for paraphrasing.
Agree with PMRpro - what a load of twaddle from said pharmacist.. and if you’re going to buy a pill-cutter boycott that one.
Definitely steer clear of alternate days… and go for slower taper -choices here- but not yet!
healthunlocked.com/pmrgcauk...
… and plenty of home remedies for coughs.
Thank you. I have reminded myself of the taper plan, but will not reduce again until I am clear of infection.
From your comment to PMRpro re slower tapering plan and holidays etc - I think you are muddying the waters,.. as well as overthinking things. My response is Keep It Simple... and if you have a holiday or something stressful on the horizon - then don't start a taper beforehand. Odd days of stress are another thing, but deal with those as and when.
As for Rheumy's suggestion of 12.5mg to 10mg... forget it and do 0.5mg initially and then 1mg a time.
All the leaflets and posters say that for mild illnesses like coughs etc go to the pharmacy first to reduce the load on other services. Perhaps they panicked and worried about immunosuppression, though 12.5mg is not huge. Perhaps they didn’t want the responsibility of deciding you didn’t need antibiotics in this circumstance. Nothing they can sell you will change the course of your infection.
I do wonder about this new initiative to have pharmacists performing GP type consultations. Knowing your way around pharmacology isn’t the same as having examination and diagnostic skills that have been practiced daily for years. But to then advise you to reduce with an infection….I know some doctors would say the same possibly because they don’t understand the issues with withdrawal from the point of view of the patient. If they did they would be wary of telling you to make your body deal with large swings of 20% of the dose. The trouble with alternate dosing is that if you have a flare you don’t know what your ideal dose was, only that it was somewhere between and including 10mg and 12.5mg. You might then have to go back up to 12.5mg when you might have got away with 11mg. Following a smaller drop longer plan also allows you to more easily distinguish between withdrawal and flare. Withdrawal symptoms are more likely if your body keeps being faced with large changes. It probably looks feasible on paper though.
Thanks SnazzyD. I always feel that doctors don't understand about possible drug interactions, whereas a pharmacist should, but the pharmacists are rushed off their feet the same as doctors. When I came out of the consulting room the shop was full of people waiting to be dealt with. I agree that maybe the pharmacist didn't want to risk me not getting an antibiotic if I needed one.
I agree with your instincts and would start sick day rules to support your system until this blows over. When it does I think I would reduce more slowly by smaller decrements in future. They do seem to be whizzing you off and you are heading for the sticky part with adrenals and all.
thanks for your support
Please don’t taper until you feel better. You have enough on. X
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