Is fatigue associated with Prednisone reduction in PMR?

Hi shelly, I was diagnosed in March and I'm 54. I'm no expert but fatigue has been a constant problem for me. And from my understanding at 10 mg you should only Reduce by 1 mg or 1/2 mg at a time at this point. I'm currently doing the dead slow method and reducing from 10 to 9 mg, on my first nine day I was very fatigued so considering changing it to 9 1/2. But I'm going to try 9 again tomorrow and see how it goes. I hope this helps

Be careful not to reduce to quickly. I was diagnosed last dec. I am 61 years old. I I was put on 20 mg took pain away + easy to reduce until I hit 7 mg then it has been tough to get body to make cortisol again symptoms and fatigue came back. My dr. Had me take 6 days at 7mg and 1 day 6mg. Next week 5 days 6 mg 2 days 5mg adding 1 day new dose each week. At 6mg trying to get to 5mg now but it is working.  This slow reduction really works. I so want to be off the prednisone so I have previously tried to rush it and symptoms came back. Active but stiff in morning. Fatigue is gone.  I do Pilates's one day, walk next day, Pilates etc. I feel the exercise really helps and a really healthy diet. Best of luck. It is tough.

HI Shelley,  I think the problem is that you have reduced prednisone dose too fast. The rule is not to reduce dose more then 10%, which means that when you get to 10mg, reduction should be in 1mg steps. In addition, search the PMR site for DSNS method of reduction ( slow method with alternating days of now and old dose).  This gradual reduction takes 4-5 weeks. 

When you get to 7mg, it is better if your reduction is done in 0.5mg steps.  The goal is to find the lowest dose of pred that manages your symptoms as well as first does did ( 20 or 25mg).  You can only reduce IF PMR activity is slowing down. If  you reduce too much too soon, pain and stiffness will be back. 

H

Hi shelleysinclair, I flared reducing from 8 mg to 7 mg. This time I am going to reducing using DSNS in smaller step. I am enclosing a link to DSNS, if you have questions just ask. Good luck on your journey, I doing my journey with a smile on my face and a positive attitude.

https://patient.info/forums/discuss/reducing-pred-dead-slow-and-nearly-stop-method-531439

Once you get to 10mg you are much better to taper your dose by 1mg steps. As you get lower you are obviously getting closer to the dose you are looking for: the lowest dose that manages your symptoms as well as the starting dose did. You aren't tapering relentlessly to zero remember.

Below 10mg you are in the realms of your adrenal glands having to wake up and start to produce cortisol again - if they are lagging behind in that you will start to experience the symptoms of adrenal insufficiency and the cardinal effect is fatigue. The smaller the reduction steps the easier your adrenal glands and the complicated feedback system that govern them will have.  And the more likely that you won't miss your end point dose - if you overshoot you run the risk of developing a flare of the PMR and needing to go back to a higher dose to manage it.

My gosh, 2.5mg in one go to 7.5mg, why so fast? Under 10mg I was told reduce .5mg a month and things should go well. At around 7mg your adrenal glands have to start doing some work again which can make you very tired as the steroids are no longer producing enough cortisol for the adrenal glands to stay on their holiday.