Reduction in prednisolone

[CathT]

I have been on pred since 2011. I have been on maintenance dose of 5mg for over a year and reducing by .5mg every month. Had a really bad reaction last time they reduced me. So now 3weeks into the reduction. Last week I started feeling fatigued and put it down to a slight cold. However I now struggle to do the slightest thing. I am sleeping for 2hrs every afternoon and sleep ing through the night which I normal do not do! My question is can it take 2weeks for a reaction to the reduction? Sorry it was a bit long winded.

[vivdunstan Volunteer]

Yes it can. Are your blood tests any use as a guide to disease activity, and if so are you due a blood test soon? I've been trying to taper steroids since a huge relapse in 2004 (I've been fighting this disease for 20 years), and although sometimes a small drop down (I typically try 1mg drops, though at a much higher dose than you are now) can react within 4 days, it often takes a couple of weeks before I go bad.

[CathT]

No they are usually fairly normal. Thinking about going to GP to ask for a blood test to check, I'm not due at hospital for a couple of months and it is 4hrs away!

[cazy-g]

I normally find that it can take about 1 month for my body to adjust .I am currently down to 5 mg after 4 years on varying doses .I have taken the reduction slowly and plan to wait another while before attempting a further drop .When I do drop I plan to reduce by 0.5 mg daily . I think the lethargy goes with the territory ,just go with the flow and rest if you can .Hope this helps .

[CathT in reply to cazy-g]

Thanks, I am slowing it down even more now and doing 5mg one day then 4.5mg the next for a couple of weeks then back to 4.5mg for 2weeks.

[AndrewT]

Yes CathT- VERY, VERY, VERY (unbelievably slow) reductions is the way to go. In answer to first question- emphatically yes- it takes time for the drugs, that you have already taken, to be used- your body now cannot produce more quickly at all (a common side effect of long term steroid use). Your system/metabolism will then start to 'notice' the lack of steroid- cue the symptoms you describe.

I would suggest that you do two days, at 5mg, then one at 4.5 mg- continue for two months then do as you suggest. I did say SLOWLY, didn't I? Doing the reduction, this slowly, SHOULD avoid any 'withdrawal' problems.

Please do let us all know how you get on, will you- our best wishes are, I'm quite sure, with you.

AndrewT

[PMRpro]

What you are describing could be due to your adrenal glands not yet functioning well enough for your body's needs - especially the extreme tiredness. Ask your GP to consider having a synacthen test done to check adrenal function - it CAN be done whilst still on pred - and if not get him to refer you to an endocrinologist asap.