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Is it ok to drop 5mg of pred was on 20mg for 10 weeks

Posted , 9 users are following.

pat38625
pat38625

Hi everyone, I had my first appointment today since diagnosis of PMR  in November and am currently on 20mg pred.  Was at endocrinology today and after taking some details and examination I have been referred to Reumatologist (which should have been in the first place).  Consultant I seen today suggested I go down from 20mg to 15mg but to work it out with my gp (who I have an appointment tomorrow afternoon) to tweak it up or down just to see how things go until I see Reumy.  Is reduction of 5mg too much at start.  I know everyone is different.  I shall just have to wait and see how I fair but am going to ask my gp tomorrow to prescribe me 1mgs of pred, so I can manage not to drastically.  Also gound out today that ESR rates also goes by age it does not have to be below 10.  Apparantly 19 is fine for my age, only turned 60.  Any enlightment will be welcome.  Also a thanks in advance.

2 likes, 30 replies

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  • tina-uk_cwall
    tina-uk_cwall pat38625

    Posted

    Hello pat, sorry to hear that you are now one of us, but this site is great for getting answers to the many questions posed by the twists and turns of PMR. I am not medically qualified, they'll set you right re the 5 mg drop very soon. Normally the tapering rate for prednisone is from 15 mg, 6 weeks, 12.5 mg, for 6 weeks, then 10 mgs for anything up to a year, ( read the PMR Bristol plan). But one thing we all advocate on this site is very slowly taper down to avoid flare ups. Eileen has written a reduction plan that we follow. I am following it but with a reduction of .5. So when reducing I do for example 10 mg one day 9 mg the next repeating this for 4-6 weeks then 4-6 weeks if 9 mg, then repeat the same formula for the next taper down.

    when taking prednisone if it is doing its job and keeping the inflamation under control both the ESR and CRP levels should be normal. Also once a level of prednisone is doing its job try and stick to that dosage. Upping and Downing the preds without good reason is not good clinical practice.

    good luck pat. Christina 

    • pat38625
      pat38625 tina-uk_cwall

      Posted

      Thank you Christina, I honestly don't know what I would do without this site, it's just so informative and with Eileen and her medical background.  I will google the PMR Bristol plan and read up and will look at Eileen's slow reduction plan (if I know where to find it).  I have been on 20mg pred for 10 weeks so am going to try the 15mg tomorrow for the first, fingers crossed.  I could not go back to the pain I was in, so easy does it for me until I see a Reumy.  Thanks again Christina.
    • tina-uk_cwall
      tina-uk_cwall pat38625

      Posted

      Hello pat, I'm on my iPad at the moment so cannot forward you Eileen's taper programme. If by tomorrow another member hasn't posted the details I'll access by big computer and copy and paste the details for you. I don't think you'll have any problems with the reduction. Some members have reduced from 40 mg to 20 mg. have a good nights sleep. Christina
    • pat38625
      pat38625 tina-uk_cwall

      Posted

      Thank you so much.  I really don't know what to expect but I do get reassurance from people like yourself and others.  Rest easy.
    • EileenH
      EileenH pat38625

      Posted

      https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316

      This is the link to the thread which has a link to the Bristol paper (I doubt you will find it with google just as the Bristol plan) in the first post and in posts 5 and 6 (or so) you will find my slow reduction plan.

      Basically, no reduction should really be more than 10% of the current dose. The way pred is used in other illnesses a 5mg drop is fine. PMR isn't other illnesses! You are looking for the lowest dose that controls the symptoms - it should be well below 20mg but there is also already the problem of steroid withdrawal after this sort of time - hence the suggestion of smaller drops. Smaller drops reduces the discomfort of that. I'd try 17.5mg first - you can get a pill cutter at any chemist. This is assuming you have white tablets - if they are coloured pills (red or brown) they must not be cut but you get 2.5mg pills.

      You may not need to be at 17.5mg for long, it is more a stepping stone to 15mg. Show your GP the Bristol paper - it's open access and you can print it off. MrsO has said most of it - but your GP doesn't appear to have much idea having sent you to endo first.  The paper is aimed at him to allow him to manage you without specialist advice if necessary.

    • pat38625
      pat38625 EileenH

      Posted

      Thank you Eileen, I have taken my 20mg and have appt. with my own gp at 3.30pm so will have a word with her.  She hasn't seen me yet it was another dr in the practice who sent me to endo.  I have no ink in my printer grrrrrr but will get some soon so as I can print the Bristol Plan and your own slow reduction plan and the relevant papers to give to my gp.  The only pred I have is 5mg but hope to have 2.5 and 1mg today.  Thanks again.
  • MrsO-UK_Surrey
    MrsO-UK_Surrey pat38625

    Posted

    Pat, after being on 20mg for as long as 10 weeks, and providing you feel comfortable, then you should by now definitely be making a reduction.  Although you might be successful in going straight from 20mg to 15mg, it might be wiser to just drop in the first instance to 17.5mg and see how you respond.

    Yes, they do allow for a higher ESR with age, and women can have a slightly higher reading than men.  Normal levels can be considered as anything between 0 and 20, and can be slightly more elevated in the elderly.  It can also rise in the case of any infection or virus.

    So stock up with some 1mg tablets and some 2.5mg if you haven't already got them.  If you are on coated pills, they shouldn't be cut, but the 1mg are always uncoated and can be cut in half - as you get lower on the steroids, you may find you need to cut the pills to give you the correct dose.  Pill cutters are available from pharmacies. Meanwhile, good luck with that first reduction.

    • pat38625
      pat38625 MrsO-UK_Surrey

      Posted

      Oh Mrs. O thank you so much.  I mentioned to the dr who seen me at the hospital to day about reducing 10% of what I am on but she said that the consultant said 15mg and she did, she came into see me.  So gonna go for the 15mg and then when I see my own gp tomorrow afternoon will ask her for 2.5 and 1s, so that I can adjust.  There is still some residue of muscle pain/weakness in my right upper arm and my right thigh (my dominat side) but I am not going to be watching and waiting for pain.  I will handle it as and when.  Also want to reduce as I think my moon face has appeared.  I shall see how it goes but thanks for your input, much appreciated.
  • Bababoyd
    Bababoyd pat38625

    Posted

    I have never had good results for me dropping so fast.  I find a slow SMALL drop woks better for me, I wish you luck.

     

    • pat38625
      pat38625 Bababoyd

      Posted

      Thank you so much, I am keeping my fingers crossed, I would rather have  reduced at a much slower rate but like a good girl lol I am going to do as the consultant suggests but I will have my back-up plan ready that is why I would like to get 1mg and 2.5mg so as I can adjust when needed, just until I see the Reuematologist and I don't know what the waiting list is like so heres hoping.  Regards    

      Pat

    • MrsO-UK_Surrey
      MrsO-UK_Surrey pat38625

      Posted

      Pat, I still think you would be wise to try 17.5mg initially. With a 5mg drop if your symptoms worsen, it will be impossible to tell at which level the inflammation resurfaced.  If your pains worsen on reducing as far as 15mg, and you then decide to increase back up to 17.5mg, you will be getting into a yo-yo situation and we have seen people struggle from then on.  Far better to test the water with a smaller drop to 17.5mg, and less shock for the body.
    • pat38625
      pat38625 MrsO-UK_Surrey

      Posted

      I think what you are saying is so correct.  I don't want this yo yo effect, especially when I am so new to this PMR.  I am seeing my own gp tomorrow and will discuss it with her.  I think it is more sensible to reduce by 2.5 and see how I fair and if I do alright then how long would I stay on 17.5?  All I have is pred 5mg, I have no others but will ask my dr. tomorrow afternoon can I have 2.5 and 1mg ones so that I can reduce slowly.  Thanks for the information Mrs. O it really is much appreciated.
    • MrsO-UK_Surrey
      MrsO-UK_Surrey pat38625

      Posted

      If you're fine on 17.5 then you should be able to try reducing to 15mg after about 3 weeks, perhaps having your ESR repeated before the reduction. I was never completely pain-free down through the doses but if my symptoms worsened, my ESR and CRP blood tests alsways corresponded with raised markers, so my rheumy and I were able to use these tests as a helpful guide before each reduction.  
    • pat38625
      pat38625 MrsO-UK_Surrey

      Posted

      I am going to take my normal 20mg in the morning, then when I see my own dr will explain to her what I would like to do.  Slow tapering and I don't think she will argue with that.  It's just that I don't know how long it will be before my first Reumy appointment, so am gonna have to reduce it very slowly.  So Saturday morning will be the start of me on 17.5mg.   Endocrinology did my bloods today so I don't even know what my ESR or CRP is.  They will forward them on to my gp.  I know I should have been sent to a Reumy and not Endocrinology there is more time wasted.  Not to worry, will get there in the end.  Thanks for your good sound advice.  
    • erika59785
      erika59785 MrsO-UK_Surrey

      Posted

      I agree with MrsO.  Slow reduction is best.....1 mg or 2 1/2.  I am reducing right now from 20 mg. and I reduce by 1 mg to be on the safe side.  I had too many yo-yo events.
    • pat38625
      pat38625 erika59785

      Posted

      Thanks Erika, all comments and inputs are greatly appreciated.  Am seeing my gp later today so hopefully will get my meds sorted out.  
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