Alternative days taper

[Lynlea]

Hi all, I had an appointment with rheumi registrar yesterday. I have stayed on 5mg steroids for 3 months due to another flare.

I have been advised to taper 5mg one day then 4mg the day after for one month, then 4mg for a month then alternate days 4 mg and 3mg etc. She did say if this doesn’t work will look at methotrexate.

I do feel well at the moment fingers crossed 🤞the slow taper works.

[DorsetLady PMRGCAuk volunteer]

Personal opinion - think the alternate day approach is harder on the body... and you end up on same dose at the end as you did at the beginning of the month... so don't really see progress. which can be a bit demoralising.

I know it's in guidelines as a option, but most of us [having been there] think a slower taper - such as these below - are easier - and only 0.5mg a time is recommended once below 5mg. - plain white tablets can be cut easily - pill-cutter only a couple of ££s from local pharmacy or good old Amazon.

healthunlocked.com/pmrgcauk...

healthunlocked.com/pmrgcauk...

Hopefully will prevent a flare - and then no need for MTX..

[Lynlea in reply to DorsetLady]

Thanks for your reply and links, so many of us follow advice from rheumatologist tapering 1mg a month, doesn’t seem to work for a lot of us.

[DorsetLady PMRGCAuk volunteer in reply to Lynlea]

Certainly not as you get lower..

[SnazzyD]

Good luck with that. 1mg swings would have been too much for my body. 0.5mg was so much better over 6-14 weeks depending on how I felt once under 5mg. All you can do is go by how you feel and nobody can tell you otherwise us or the consultant.

[Lynlea in reply to SnazzyD]

Thanks for your reply, I am going to use DL taper plan and go down 0.5 mg.

[PMRpro Ambassador]

Personally I think that is a hard slow taper - DL's already dealt with that I see.

But I know quite a few rheumies who know a lot more about PMR than I bet she does, being as they are research bods, who would disagee about introducing MTX at this stage when you are already at a reasonably low dose. They also feel it is introducing a potential extra set of adverse effects without any guarantee you will get off pred. It does work very well for some but for the majority it either makes them feel awful or it only gets them a couple of mg lower.

[Hopelessatbest]

i have done an alternate days taper and so far it has worked for me but I did two weeks on alternate (drop by 1 mg) then dropped to the new dose for two weeks and then alternate again with another new dose. This served me well till I reached 4 mg dose. Then I found the complete drop to 3mg hard so I went back to alternate days tapering 4mg/3.5 mg and this has gone well. For the future on the lower doses I will taper at 0.5 mg. Started April 23 on 15 mg and now on 3.5 mg

[Lynlea in reply to Hopelessatbest]

Thanks for your reply, I am going to drop by 0.5mg after reading replies, I started on 40mg June 2022 did get down to 2.5mg but had to increase back to 5mg for 3 month due to a flare.

Hope all goes well with taper.