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How long to stay at higher dose of prednisone after a flare?

Posted , 8 users are following.

linda82701_USA
linda82701_USA

Whew!  I just remembered how to start a new discussion!  Really slow brain these days!! Have had a flare up of PMR.  Sooo my doc upped my prednisone from 13 mg to 20.  It has really helped.  How long should I stay at this start over dose before trying to reduce? I want to do it correctly this time.  Although, I have followed my docs recommendations thus far, he is reducing me too fast and I feel as though the yoyoing has never gotten my PMR under any kind of control. Thanks so much to all.... Linda

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  • sue-dorset
    sue-dorset linda82701_USA

    Posted

    Hi Linda,

    would suggest you stay at higher level for at least two weeks, longer if necessary. You need to get inflammation back under control, and then maintain that control before you start reducing again. Not sure what reductions you were doing previously, but obviously too fast. 

    You need to try and not drop more than 10% in any one go, so at 20 that equates to 2mg. However if you're on the 2.5mg coated tablets then that's a bit difficult! 

    You should also try a slow reduction plan, (there are various, or devise your own, I did) rather than an overnight drop, I found once I got down to 15mg that was the only successful way.

    if you can take the White uncoated tablets then you have much more flexibility with your reductions, unfortunately some people find they upset their stomachs. 

    So really the message is get yourself stable, then reduce slowly and little by little. Hope that helps.

     

    • linda82701_USA
      linda82701_USA sue-dorset

      Posted

      Hello, Sue, I will definitely stick at 20 mg. for at least 4 weeks and then go slowly and carefully! Thanks so much!
  • erika59785
    erika59785 linda82701_USA

    Posted

    Hi Linda USA.  American doctors will nearly always want to reduce too fast.  I had the same problem.  I was on 12 mg lateley with some pain and stiffness especially in the mornings.  I just had a flare last night and had to go back to 20 mg which took the pain away and I could walk well.

    I will try to go back to 15 tonight and see how I am going to feel in the morning.

    Hope, this goes well.

    All the best to you and good luck on your PMR journey. It is a tough one to manage.

    Greetings from Erika, USA :-)

    • linda82701_USA
      linda82701_USA erika59785

      Posted

      Hello, Erica, thanks for your reply. I, too, went back to 20 mg. but am going to stay there for 3-4 weeks then use the dead slow and nearly stop method to reduce! Good luck to you. Wishing you the best, Linda
    • EileenH
      EileenH erika59785

      Posted

      Beware of just shooting your dose up like that to deal with pain that suddenly appears. It is far more likely that you simply did too much on a good day - your muscles remain intolerant of exercise and will respond to even moderate extra activity as if you had run a couple of miles without training. Once you start yoyoing the dose you get into real problems with reducing the overall dose in the long term. 

      Management of PMR is not just the dose of pred you take - you have to do your part and pace yourself. Rest and exercise are important - even if that sounds contradictory. If you do things you need to do it in smaller bites with rest in between. By doing that you will find that you can achieve much more in a given time. 

      If you are doing that then you should be able to reduce your dose steadily and one would hope to under 12mg - but if you really struggle with that then maybe a rethink is needed as to whether there is something else going on that is making the PMR symptoms worse.

    • erika59785
      erika59785 EileenH

      Posted

      Eileen, thank you for your response.  I have moved in the meantime from a Townhouse of many steps to a one level apartment.  It was a busy month with some pain now and then when I had to take a couple of Tylenol.

      The flare I had 2 nights ago was in my left hip and it felt like an RA flare which I have had before...not often..... but so far no joint damage.  PMR is worse, and I don't think it was an PMR attack.  I went down to 15 mg today and I feel fine.

      My RA doctor did prescribe 15 mg for RA AND PMR which I like to lower, if possible.

      I appreciate your message.  I am happy that I don't have to climb staircases which were painful on my back especially when I would carry groceries. 

      With thanks for your caring guidance....viele Gruesse, Erika

       

    • EileenH
      EileenH erika59785

      Posted

      If it came and went then I think you are probably right about RA - but that needs investigating and treating too. 

      I think you will find things much easier without stairs - even in the days of PMR without pred I could manage well here in Italy in the flat where there is a lift to get up here, you don't have to climb stairs if it is painful. It meant I could do other things with the available "energy"

    • erika59785
      erika59785 EileenH

      Posted

      You are so right about the stairs.....and it is so much better not to have to climb them with PMR symptoms or other.......

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