Tapering question

[FreeWolf]

Does a person, while reducing their pred dose, disregard minor symptoms? I have gone fom 15 mgs to 12mgs and have some discomfort.

[DorsetLady PMRGCAuk volunteer]

The ideal scenerio is to have the same relief after a taper as you did before you tapered….

And can you just clarify how you got from 15mg to 12mg . That may well account for your discomfort now…

A day or so ago, you said you were feeling good… which makes me thing you have reduced in one step…

And this explains difference between steroid withdrawal and what may be a flare -

healthunlocked.com/pmrgcauk...

[FreeWolf in reply to DorsetLady]

The drop was on the advice of GP done within 24 hours. I have read the recommended article and I understand its content. Perhaps it is too much in one go.

[DorsetLady PMRGCAuk volunteer in reply to FreeWolf]

In that case could well be too big a drop..it is what is suggested in guidelines - but it doesn’t suit everybody.I’d give it a few days to see if it resolves - if so then it’s probably withdraw - but if it goes on longer than 5-6 days then it’s definitely too low.. and GP needs to be aware.

[FreeWolf in reply to DorsetLady]

Thank you so much. It is like a new country, this condition. Good to have the help this forum provides and much appreciated.

[DorsetLady PMRGCAuk volunteer in reply to FreeWolf]

Certainly is a new country… and not one you’d necessarily pay to visit… but the inhabitants are lovely and friendly..😊.. and rarely bite..🤣😂

[piglette]

You might have some discomfort for two or three days due to steroid withdrawal, but it should improve. If not perhaps you should have not dropped quite so much.

[FreeWolf in reply to piglette]

Thank you.

[Charlie1boy]

Well, I certainly never tapered down if I felt any symptoms. Just checked my treatment book, and I went from 15mg to 13mg, and then to 11.5mg, before down to 10mg. Achieved this reduction over a period of three months without having a flare.

From memory, I don’t think I was aware of steroid withdrawal issues at this stage!

[PMRpro Ambassador]

It is pretty likely when you drop in a big step all at once and 3mg at this stage is a 20% change in dose. Top experts suggest not dropping more than 10% of the current dose to reduce the risk of steroid withdrawal discomfort which can feel like a flare of PMR and can be very confusing.

The difference is that steroid withdrawal improves over the following week or so, PMR not being managed by the new lower dose results in increasing symptoms and pain. So if it worsens - go back to the previous dose and drop more slowly next time.

[FreeWolf in reply to PMRpro]

Thank you.

[winfong]

What's the difference between steroid withdrawal and adrenal insufficiency?

[PMRpro Ambassador in reply to winfong]

Steroid withdrawal is the body's reaction to the change in dose, especially if the reduction is large. It can happen at any dose, even high ones.

Adrenal insufficiency is due to the fact the adrenal glands stop producing cortisol when the pred dose is above about 10mg for a long time. This doesn't really matter when you are on higher doses of pred as the pred acts as a replacement for the natural corticosteroid that is essential for life. But when you get down to about 5mg, the pred isn't always enough for the body to function well and that gets more pronounced as the dose falls. Normally the adrenal glands would start to produce a top-up for the pred dose but that often lags behind and in a few patients doesn't manage to reestablish itself. And then you may suffer from adrenal insufficiency.

[winfong in reply to PMRpro]

Thanks. I was wondering in particular about the difference in symptoms.

[PMRpro Ambassador in reply to winfong]

Steroid withdrawal is often very similar to the disorder for which you are taking the pred. Some doctors confuse the issue by referring to the adrenal insufficiency effects as being "due to steroid withdrawal", which they are. But when it is steroid withdrawal in the sense of the body just adjusting to the change in dose, they will improve over a week or so. And the same will apply if it is also requiring an increase in cortisol as a result of that removal of exogenous pred.

If the adrenal insufficiency means there simply isn't enough pred for the body to function properly, then fatigue tends to be the primary effect, nausea and diarrhoea may occur too, And if it goes on, they tend to get worse, milder effects similar to those heralding an adrenal crisis - and you tend to feel very unwell that worsens.