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Altering pred dosage

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philoso4
philoso4

This might be a question of enough general interest to post it. 

Is there guidance on altering dosage of prednisone in order to test whether you're on the correct dose or not?

Let me make it specific. I am on 7.5mg a day of medrol. I've had that dosage for 3 months. I feel that my PMR is not under sufficient control. I am mobile and functional but stiffness and pain are a bit more than I would like. Could I, eg, bump up to 10 mg for a week (say), gauge my symptoms at that level and then drop to 9 mg after the first week and see how that felt? Or is there a suggested process for trying to optimize the dosage?

What I do NOT want to do is change the dosage too much or too quickly.

Does anyone have any experience or have you found any guidance in the literature?

0 likes, 5 replies

5 Replies

  • EileenH
    EileenH philoso4

    Posted

    The only guidance I know of is what we churn out over and over with the slow reduction schemes. A lot of doctors are in cloud cuckoo land about it - they hand you the prescription and a reduction scheme and leave you to it, believing that by the time you get to the end of their recommended approach the PMR will have gone away. Yeah, right!

    The very slow reduction is the first approach to finding the right dose - reduce in small steps until the symptoms reappear - and go back to the previous dose where you were OK. That is the fundamental approach to any drug titration - where there is no fixed dose related to body weight for example but an empirically identifed dose is used.

    From what you say in your post - I'd say you are perhaps looking at too big intervals with 1mg,  I do appreciate that Medrol makes it difficult with the smallest tablet size being 2mg - but 1/2mg can make a BIG difference. I have the same problem as you though, I use tablets which can't be broken and the smallest dose available is 1mg. To make the interval smaller means alternating doses - which I do when required. You don't have to take the same dose every day and the supposed top GCA guru in the UK suggests reducing from 8mg by starting with 8/8/7 repeat and then 8/7 and 7/7/8.

    But if you are basically pretty well at 7.5mg why not try a week at 8mg and see if you feel better? If that doesn't feel significantly better, up it to the next step.

    • philoso4
      philoso4 EileenH

      Posted

      Thanks, Eileen, I may try that. But what if I did jump to 10 mg for a week and got really good results. If it were only for a week, could I drop a whole mg for the next week? Or should I be slower?
    • EileenH
      EileenH philoso4

      Posted

      No - I think that would be fine, it all depends on how sensitive your body is to sudden changes but really there is no reason why it shouldn't work OK. It's only not going to work if 9,5mg is your ideal dose!

  • dboza
    dboza philoso4

    Posted

    I was diagnosed last November 2015. I was started on 40mgs. and tapered off and finally finished meds in September. So far, so good. I went in for blood tests before each dosage change to check my sed. rate. My doctor an internist was very good and informative. She concluded my first flare up of PMR was 24 years ago, when I was 35 years old. She did not know what it was then, nor the rheumatologist she sent me too. Doing much better now.
  • sophiesu20099
    sophiesu20099 philoso4

    Posted

    My experience is that as long as you are consistent in your dosage do not jump around with the dosage, (I know, I forget at times), try to speak to the Chemist pharmacist. They will advise you, but unfortunately we get

    into trouble playing with dosage.

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