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AsTimeGoesBy AsTimeGoesBy

Down to 4mg Pred - but suddenly up to 80mg

My first post was in August 2017 under the heading "Is this just a blip?"

To explain my alarming new title: I'd been gradually reducing and had reached 4mg per day. All was well and I had a blood test before seeing the French rheumatologist again last month. He told me to stay on 4mg and come to see him again in August. All being well, I would then drop by 1mg per month.

However, from time to time (perhaps once a year) I get an asthma flare-up, often associated with bronchitis. Such a flare-up occurred at the end of last week and I wheezed and coughed my way to a GP, who has put me on 4/5 days of 80mg plus a short course of antibiotics. As is nearly always the case, this high dose is sorting out the asthmatic / bronchitis coughing and I'm confident it will have gone away within the 4/5 days.

I have stopped my daily 4mg (for the PMR) during this period but am wondering whether this sudden surge up to 80mg will mess up my gradual reduction programme. I mean, will it be a shock to the system if, in a couple of days, I suddenly drop back to 4mg?

I have plenty of Pred available so should I cut back to, say, 40mg or 20mg before dropping back to 4mg? If so, for how long?

It really is Sod's Law that I should get this asthma fit just as my pred was decreasing so nicely!

Comments and advice greatly appreciated.


6 Replies

  • Anhaga AsTimeGoesBy

    My daughter in law's father has been on pred for PMR for several years.  I think he was at something like 5 or maybe a bit more when he had a serious issue which required a massive dose.  The doctor had him wean quickly off completely - obviously oblivious to the fact that he still needed a small dose for PMR.  Very quickly he went back on, but only at the level he'd been on for the PMR control.  

  • EileenH AsTimeGoesBy

    It shouldn't do if you are only on the very high dose for a few days. If you weren't on pred at all then you would take the course (though it does seem high, my daughter has never had that high a dose I don't think, 40mg is the usual) and stop.

    Some people get a bit wobbly even after that short sort of course - but I don't think that going via 40 and 20 would make any significant difference apart from extending the time you are on pred at a high dose. Above 20mg is considered high dose and is enough to upset adrenal function which is the crux.

  • AsTimeGoesBy

    Thanks for the replies ... especially to EileenH. Well, in the event, I dropped day-by-day from 80mg: to 40mg, then to 20mg and finally back to 4mg again. I've been on 4mg for some days and am glad to report that the asthma/bronchitis has cleared up and that I don't have any PMR pains. So I'll press on with the 4mg till the end of August and take things from there. One thing I forgot to mention: the French rheumatologist prescribed a gastro-resistant variety of the once-weekly Risedonate 35mg, which means I don't have to take it on an empty stomach. The local chemist had to make a special order for these.


    • EileenH AsTimeGoesBy

      Good! How interesting about the gastro-resistant version. Is your French good enough to get more details? I imagine you could get it here in Italy - my husband used to get custom-made warfarin doses from the chemist but somehow I can't imagine many UK chemists being able to compound in the shop.

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