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Withdrawal or Flare-up ?

Posted , 14 users are following.

rocketman42
rocketman42

Each time I try to go from 11mg to 10.5mg I will have an increase in my PMR symptoms within 24 hours.

Is this considered withdrawal symptoms in which case I should maintain the lower dose and put up with the symtoms until it eventually resolves ?

Or, is this considered a flare-up in which case I should go back up to the 11mg since it will not resolve ?

Obviously this is important to know since the "solution" is very different.

Thanks

 

0 likes, 16 replies

16 Replies

  • Oregonjohn-UK
    Oregonjohn-UK rocketman42

    Posted

    Are you lowering down for just one day and going back to old dose the next?

     

    • rocketman42
      rocketman42 Oregonjohn-UK

      Posted

      Yes ....thus the question I am posing.

      I thought I once read if the increase in symptoms is rapid then it is one thing and if the increase in symptoms takes a while to appear then it is something else. If it is withdrawl then I will stick with it ....if it is a flare-up then it makes sense to raise it again.

    • maid_mariane
      maid_mariane rocketman42

      Posted

      what we are asking is what method of tapper are you using. iIs it the dead slow method and if so is it after the 1st. week or 1st. day on a new dose. we need more info.

    • Sheilamac_Fife
      Sheilamac_Fife rocketman42

      Posted

      So days 2,3,4,5, 6 are back at 11mg?

      if yes, then it sounds like steroid withdrawal, so it should go as the week goes on at 11mg

  • Anhaga
    Anhaga rocketman42

    Posted

    Generally speaking, and as you know we are all different, pred withdrawal can happen quite quickly and is worth sticking out the discomfort.  If pain gradually eases, then you know you are safe to continue with the taper.  If it starts to increase, then it is more likely to be PMR creeping in, and you immediately go back to your last effective dose, which is why DSNS method is so good because by tapering in such tiny steps it's relatively easy to find that last safe level.  This happened to me a few weeks ago as I was attempting a taper to 2.5 from 3.  The first half of the DSNS taper was fine.  At every step I've had a stage where I felt pain and wondered whether I'd be able to push through, and every time I had been able to, and was either the same or better at the lower dose when taper ended.  Not this time.  One morning I woke up with pain in shoulders, which I hadn't had for many months, so that told me to go back up.  I went back up to 3.5 for a few days, and then settled back at 3 where I've been for a while, feeling fine, and am now planning to try the taper again in November, same cautious way.  In my experience at other sticking points, I've had a few, it's worth trying fairly regularly to try the taper until the time it will properly take, but I may just have been lucky, others may find it more beneficial to stay longer at a given dose without kicking the tires, so to speak.  

  • joey_12298
    joey_12298 rocketman42

    Posted

    Scott42 - Be careful not to see-saw back and forth while attempting to adjust your own pill scheduling. It can make the symptoms so much harder to control. If you are having problems with your Prednisone reduction plan, it was found that many flares are not necessarily the PMR returning but problems with steroid withdrawal pain. Some PMR patients may be especially sensitive to the steroid withdrawal. I am. That pain is very similar to the regular PMR pain. If there are underlying familiar aches and stiffness that are not getting better with a particular reduction dose over a couple days to a week, then yes - it is still there. You will have to go back on the dosage that worked best before (in your case 11mg) and reduce even slower. It is all about getting your body use to the new dosage. You can cut 1 Mg tablets into half or quarters. I know this will be a bother with those tiny 1 mg pills but it is what it is. If after a couple days if your withdrawal pain does not ease up then try reducing from 11mg to 10 & 3/4mg prednisone on the Dead Slow Nearly Stop Method. After you complete the DSNS method for that 10 & 3/4mg dosage go to 10 & 1/2mg then finally try 10& 1/4mg. So far it has worked for me. 

     Dead Slow Nearly Stop Method:

    1 day new dose - (10 & 3/4mg, 6 days old dosage - 11mg)

    1 day new dose, 5 days old dosage

    1 day new dose, 4 days old dosage

    1 day new dose, 3 days old dosage

    1 day new dose, 2 days old dosage

    1 day new dose, 1 day old dosage

    1 day old dose, 2 days new dosage

    1 day old dose, 3 days new dosage

    1 day old dose, 4 days new dosage

    1 day old dose, 5 days new dosage

    1 day old dose, 6 days new dosage

    GOOD LUCK!

     

    • linda17563
      linda17563 joey_12298

      Posted

      How do you cut such small 1mg?, I have a snipper but they break up, and almost go to powder....they must be more expensive as well, because my surgery is strict on prescribing them compared to 5mg!
    • joey_12298
      joey_12298 linda17563

      Posted

      I bought a pill cutter that had a razor blade at pharmacy store. It works if you guide the pill in with the middle indented area of pill in first. Then the blade goes through more or less giving two equal parts. Turn the two separate halves & cut each one which will give you quarters. It is a delicate process & most of the time it works. Wish I could offer a better suggestion.

  • barbara75814
    barbara75814 rocketman42

    Posted

    Me, I had symptoms with every reduction I made, and I decided to ignore them during the year it took me to get off pred. Finally, when I reached 3 mg, I switched to the "slow-slow-almost stopped" method until the end, at zero.

    After an initial consultation with a rheumatologist, I never considered or asked for advice from him thereafter, and sort of became my own doc. It all worked out. Good  luck to you--Barbara  

  • anapp
    anapp rocketman42

    Posted

    The solutions are different but you may have to do both.  My Rheumy for PMR said to try to work through the symptoms but if they became too strong, to go back to the last dose at which I felt good.  I did both.  Sometimes I worked through it and the next dose was better, and sometimes I went back up.  As Anhaga said, we are all different.  Took me between 1.5 and 2 get down and off for the PMR.  Lots of good advice on here.  Hopefully you'll find what works for you.

  • tpaggs
    tpaggs rocketman42

    Posted

    Why don't you try 11 mg one day and 10.5 mg the next; alternating for a couple of weeks and see if you can tolerate that.

    • sophiesu20099
      sophiesu20099 tpaggs

      Posted

      If you can tolerate the withdrawal try, I can't tried to do 10mg every second day, but pain was not tolerable in my legs. Back to daily first thing upon waking, as I forget. Weight gain, will it continue after we stop entirely

    • Sheilamac_Fife
      Sheilamac_Fife sophiesu20099

      Posted

      Sophie you would be better following dead slow nearly stop method instead of alternating doses. It's a much gentler way and works for most of us. 10mg is nearly always the dose where problems start, but this regime will help you find the lowest dose that keeps the inflammation at bay

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