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Pred and/or Beta-blocker causing problems ?

Posted , 9 users are following.

jan21306
jan21306

I have been on 6.5mg Pred for 3 weeks now.   Two and a half years with PMR.    I occasionally have a reasonable day, but more usually either fatigue, an inner trembling, pins and needles in my legs and feet, sometimes dizziness and sluggish brain, sometimes agitation.   I rarely have the energy or inclination to go out.

I dont have much pain, unless I carry shopping thats too heavy, or overdo the exercise, (which isnt often as I dont have the energy).  Or, as I found out a couple of days ago, after a gentle massage of my legs, feet, arms and hands. The next morning it was quite achy and painful.  

My question is:  does anyone else have these other side effects from Pred, or could it be that my Beta-blocker, Metoprolol, that is causing some of them?  

My quality of life is really not good at the moment.   Any comments or advice would be very helpful.   

0 likes, 16 replies

16 Replies

  • EileenH
    EileenH jan21306

    Posted

    I'm assuming this has all happened relatively recently? Those are classical signs that your adrenal glands haven't quite caught up with your reduction in pred dose. Were you OK while on the higher doses of pred? 

    I'm on pred and a beta-blocker, bisoprolol, and it hasn't caused any problems for me. I am on a very low dose though, and take a very low dose of losartan as well, Have you had your BP checked? I was on a slightly higher dose of BP/atrial fibrillation meds and my BP was too low which made me feel fairly rubbish. We tweaked them a bit and everything was fine again.

    • jan21306
      jan21306 EileenH

      Posted

      Thanks for replying Eileen.  I have always had side effects from Pred, but since 8.5/8 have had the shaking, trembling, lack of energy etc and generally feeling unwell.   It seems to get worse the lower I go.  

      Could the adrenals have been affecting me since then ?  My BP tends to be on the high rather than the low side.

    • EileenH
      EileenH jan21306

      Posted

      Yup - really sounds like your adrenal glands are being a bit slow on the uptake. Those are typical signs/symptoms, especially if they are worsening as you reduce dose.

      Some people only absorb about 50% of the pred dose they take, others up to 90% - if you are a 50% person then you are getting well below the "physiological dose" which is about 8mg for normal function. I don't think doctors stop to think about that side of things, they always quote 70% as the bioavailability of pred (the average) but 50% is far less and there must be a fair number of people down that end of the scale.

      Do you see what I'm saying? I don't seem to have put it very well. I think most doctors wouldn't expect a problem until about 5mg but I've always thought it could happen earlier.

      You need to discuss it with your doctor. I wouldn't reduce any further for the moment - and if you are really unwell you may have to go back up a bit, not to 8mg maybe but maybe 7.5mg until these symptoms reduce and preferably go away. And do keep an eye out for an adrenal crisis if you are under any excessive stress - don't hesitate to call 999 if you feel worse (I'm assuming you are in the UK?).

      Some doctors suggest switching to hydrocortisone instead of pred as they think it stimulates the adrenal function better. It may even be worth asking for a synacthen test now and even a referral to an endocrinologist.

    • jan21306
      jan21306 EileenH

      Posted

      Thank you Eileen.   I think I will go up to 7.5 tomorrow morning and speak to the doctor on Monday about having the test.   Yes I am in the UK.   I feel stressed all the time, have to make myself stop fidgeting my fingers or feet constantly and relax my muscles.   I thought it was a side effect or withdrawal of Pred, but it never goes away.    How would I know if I had an adrenal crisis ?
    • jan21306
      jan21306 EileenH

      Posted

      Another thought Eileen.   Could I take an extra 1 mg of Pred tonight?
    • EileenH
      EileenH jan21306

      Posted

      No real reason why not.  I would.

      You would feel very poorly!

      "If the level of cortisol falls to become very low you can become very ill in a short time. This is called an Addisonian crisis. In this situation symptoms include:

      Severe vomiting and diarrhoea.

      Pains in the back and abdomen.

      Lack of fluid in the body (dehydration).

      Low blood pressure.

      Collapse."

      You might only have some, not all.

      https://patient.info/health/addisons-disease-leaflet

      If you feel any of that - dial 999, the paramedics carry injections for possible adrenal crises. It is because of the risk of this that we are meant to carry steroid cards, it is a risk even when on higher doses of pred.

    • jan21306
      jan21306 EileenH

      Posted

      Thanks again Eileen.  I will let you know what happens.
    • dea13
      dea13 EileenH

      Posted

      Hi EileenH, That's interesting that some people only take 50%  why is that? I think I am one of those people as even on 40mg my pain never really went to more than 70% away, and now on 22mg it's worse, I am tapering 1mg every 2 to 3 weeks, depending on how I feel: last 1mg was a hard one, so went up just a .5 and it helped. This taper I will stay for 3 weeks at least, I'm in no hurry :

      Thanks Dea 

    • EileenH
      EileenH dea13

      Posted

      Not "take", "absorb". It's the same with many drugs and one of the studies they do during drug development is to find out how much people absorb of the drug. 

      But you know, if you didn't respond well to doses well above the usual - it really is a sign to look for other potential causes for the PMR symptoms.

    • jan21306
      jan21306 EileenH

      Posted

      Hello Eileen.   I saw the endocrinologist last week and had the short Synacthen test and he also did thorough Thyroid tests.   The Thyroid tests were fine.  He said there was the minutest trace of adrenals beginning to come to life, but he would like to do another test if I can get down to 5 mg Pred.    

      I have now reduced back to 6.5 and will see how I get on with it this time.   If it is still problematical I will go back up to 7 or 7.5.

  • Oregonjohn-UK
    Oregonjohn-UK jan21306

    Posted

    I agree with Eileen - it was one of the reasons I stayed a 5 mg for some time.  I found I had to be patience and wait until the body was ready.  I am now at zero and have been for 2 months - like you, it took me 2.5 years to get there - best of luck - it will happen!
    • jan21306
      jan21306 Oregonjohn-UK

      Posted

      Thank you Oregonjohn-UK.    I am so pleased for you.  It must be wonderful to be off Pred.  I do hope you are able to stay in remission.   Good luck

      Interesting about the blood pressure.    I shall keep an eye on it.  Thank you

    • Elijo
      Elijo Oregonjohn-UK

      Posted

      Good for you being off of pred!  Quite an accomplishment!  Stay well!

  • Oregonjohn-UK
    Oregonjohn-UK jan21306

    Posted

    I forgot to add the BP 'problem'.  I take BP meds and had to reduce shortly after starting as the pred seemed to reduce my BP but when I dot to 4 mg it started to rise again so had to up the dosage again back to pre pred levels.  It has now stabilised and I feel so much better.

  • dea13
    dea13 jan21306

    Posted

    Hi, sorry i can't give any advice: But I am sorry you are going through so much: Hang in there :  

    • jan21306
      jan21306 dea13

      Posted

      Thank you Dea.   Good luck to you
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