Yet Another Tapering Question

[Donna5658]

I had been doing well after tapering from original 15mg dose (start date 08/03/22) using DL’s slow taper. I got down to 5 and stayed there for the next two and a half months. After some extra stress and very cold weather this past winter, I had a major flare and ended up back at 12.5 for a week, followed by 10 for another week and finally down to 7.5 where I have been for 10 days.

Since I did fine for almost three months on 5, I wondered if I could drop to 6mg starting tomorrow and see how I do? I would stay there for another month before I resumed slow taper. Or is 7.5 where I should sit for awhile? My side effects were mostly gone at 5, including my elevated A1C, so I hope to get back to that dosage eventually.

Thanks!

[DorsetLady PMRGCAuk volunteer]

Really depends how you feel at 7.5mg…. And to be honest, you won’t know how you are at 6mg until you have tried…so it’s always a bit of a risk.

For the sake of 1.5mg and only 2 years into PMR, and also into the adrenal nudging zone, I’d think I’d err on the side of caution.

[Donna5658 in reply to DorsetLady]

If I’m honest, I have to admit I really don’t feel that great even at 7.5. I think I’ll just sit here for awhile and see if things settle.

[PMRpro Ambassador]

Also depends on whether the reason for the flare was actually that 5mg was slightly too low and allowed a build up of inflammation or whether the stress nudged the underlying autoimmune part of PMR into greater activity. Above all though - I think your reduction steps are far too large at this stage, absolutely shouldn't be more than 1mg and under the circumstances 1/2mg would be better. It may sound slow - but it isn't slow when it works.

[AyJayBass in reply to PMRpro]

I 100% agree that it is slow that works! My Rheumy has me on a taper of 1mg over 4 months and I have successfully reduced from 8mg last August to 6mg now. I'll be on 5mg in August and then go even more slowly at 1mg per 6 months. This is after yo-yoing quite a bit earlier last year so that my GP referred me to a Rheumy to see whether I needed MTX. In effect I referred myself to a private Rheumy (in Oxford) of whom I had heard very good reports and my GP wrote the referral letter. I didn't need MTX, just a much slower taper regime.

[Donna5658 in reply to AyJayBass]

Thanks for your reply! I think it was hard for me to believe (once I successfully got down to 5mg and stayed there for 2.5 months) that I would have such a spectacular flare this winter. It was almost as bad as in the beginning. Thanks for the reminder to always proceed slowly. No point in self-sabotage due to impatience.

[Donna5658 in reply to PMRpro]

Thanks PMRpro. I had tapered by 1mg every 5 weeks when I reached 10mg. Then I did 1/2 mg down to 5. I guess I should just do 1/2 mg from my current 7.5. I’ll stay at 7.5 for another couple of weeks before going back to DL’s slow taper.