Severe palpitations with prednisolone
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I have been on 40 mg of prednisone for 2weeks and consultant suggested I come down to 37.5 because all symptoms of PM had subsided That night I developed heart palpitations that lasted until 2 pm the next afternoon I was given an ecg and I was told it was a reaction I was told if it happened again to go to emergency It happened again Saturday morning and Sunday morning it was so awful Palpitations came on half hour after taking them My heart just has come back to normal now There is a suggestion I start on beta blockers I know I can't stop steroids but I am in a panic with what they can do Has anyone else hand this problem
0 likes, 25 replies
jan21306 robbo123
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Yes Robbo. I had severe palpitations every night but on a much lower dose. I Sympathise with you as I found it very frightening and uncomfortable and I went to A and E a couple of times. I had a 24 hr heart monitor, then a 7 day one. I was diagnosed with Atrial Tachycardia and SVT's. I was then put on a beta blocker which controls both my blood pressure and my palpitations. I still get them occasionally, but nothing like as fast and they dont last as long. The cardiologist has told me that I may be able to lower the dose of beta blockers as I reduce the steroids. I hope you are soon able to control yours too. Good luck !
3party robbo123
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cindy828 3party
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How long did it take you to get to 5mg. I started at 15mg 2 weeks ago, but I still have quite a bit of pain in the shoulders and neck in the morning. I asked my rheumy if I should go to 20 mg, she agreed, but I haven't done it because I've heard so much about how hard it is to taper. Not sure what I should do.
EileenH cindy828
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It is only difficult to taper if you go about it the wrong way - which is too fast. Do it slowly and tapering should be no real problem. What you MUST remember though is that however slowly your reduce you won't get below the dose that you are looking for as you reduce: the lowest dose that manages your symptoms as well as the starting dose did. It may be that your starting dose only reduces your symptoms by 70% or so overall - all stiffness may go but not all pain for example. Not everyone is totally pain-free and some parts of the pain may take a few months to fade at a lower dose - it took 5 or 6 months at 15/12.5mg for the bursitis I had to go but all of a sudden I realised it wasn't there any more. Maybe it would have gone faster if I had started at 20mg.
And don't concern yourself about how long - or how little time - anyone else needed to get to a given dose. You are you, Everyone is different in how they experience PMR and how they react to pred. Some people are pain-free with 10mg and never need more, other people struggle to reduce at 12mg - there are all sorts of reasons for that, not least the fact that you don't absorb and get the benefit of the entire dose. Some people absorb barely half, other absorb most of it. That's how biology and our bodies work.
If you still have a lot of pain, try 20mg. If it makes a difference take it until the symptoms are stable and as good as they appear to be going to get. Then start to reduce again - but not more than 2.5mg at a time and possibly even less. It isn't slow if it works.
robbo123 EileenH
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Daniel1143 robbo123
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Unless they suspect you have GCA or some other illness, 40mg is double what 90+% of Rheumatologists would advise. Virtually everyone starts at 15-20mg. Makes me suspect of your "consultant." At 40 mg, no surprise that you would have side effects
Anhaga Daniel1143
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I've been hearing of a number of people being started for PMR at this high dose lately. Why? I met a woman recently who was started at 40 because her doctor was afraid she would develop GCA, although she had no signs of GCA. It was a preventative measure. Unfortunately this was over six months ago and she is having trouble getting below 30. She's had a lot of side effects.
Anhaga robbo123
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I wonder why you were started at such a high dose? If you have had no signs of GCA I wonder if you should ask your doctor if you can reduce more quickly, to get down at least to 20 where you may need to slow down the reduction. That should reduce your side effects and as you've only been on pred for a couple of weeks maybe it won't be too hard to reduce a few mg per week for a few weeks. I don't really know, but it kind of makes sense to me. Just make sure your PMR symptoms are under control as you reduce.
robbo123
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Anhaga robbo123
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Oh I see. You were on pred for a while were you, at a lower dose? Maybe if the lower dose wasn't helping you have something else going on besides the PMR? Hope you get some good solutions soon!
robbo123
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3party robbo123
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dea13 robbo123
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I know it can be very scary when you get them, and it wipes you out for a few days also like you ran a marathon, so with the preds and having the heart palpitations must be very worrying.
I hope it settles for you soon.
EileenH robbo123
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Have you got PMR or GCA? You only mention PMR.
If you just have PMR you did not need to have been started on 40mg - that is the GCA dose. The recommended starting dose for PMR is "the lowest effective dose in the range 12.5 - 25mg, definitely not above 30mg" - that is from the "2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative"
and you will find a link here:
https://patient.info/forums/discuss/pmr-gca-website-addresses-and-resources-35316
Perhaps it is worth bringing it to the attention of your "specialist" - because he is far from up-to-date.
GCA needs high doses to reduce the risk of blindness, PMR does not and the only effect is to risk side-effects due to the high dose. Which you are finding and it does look conclusive that you are experiencing the problem soon after taking the pred. You could try taking the pred as a split dose - but really the best idea would be to bit the bullet and reduce rapidly to below 30mg. It won't affect the management of PMR, won't hurt you but could be a bit uncomfortable for a few days. But when using pred in other conditions, a 5mg or even 10mg reduction is normal. It is only after you have been on pred for any length of time and at lower doses that the slow reduction is required.
I also have similar symptoms and am on medication - but my atrial fibrillation is due to the autoimmune part of PMR which has damaged the electrical system that governs heart rate. It is well managed by the medication - but I still get the occasional episode.
robbo123
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EileenH robbo123
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That's fair enough - although there are no definitive tests for any of this except when you are "fortunate" enough to have a positive biopsy for GCA since even having a negative biopsy doesn't mean you don't have GCA - it just means they didn't find what they were looking for.
robbo123 EileenH
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EileenH robbo123
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This reduction scheme is copied from the BSR Guidelines for the management of GCA which I think were published in 2010. Our personal experience is that for patients with GCA it is possibly a bit fast but for PMR they would be no real problem - however, they are obviously perfectly safe or they wouldn't recommend them.
Suggested tapering regimen:
Start dose 40-60 mg prednisolone (not <0.75 mg/kg) continued for 4 weeks (until resolution of symptoms and laboratory abnormalities).
Then dose is reduced by 10 mg every 2 weeks to 20 mg.
Then by 2.5 mg every 2-4 weeks to 10 mg.
Then by 1 mg every 1-2 months provided there is no relapse,
So on the basis of that, there would appear to be no reason at all for not going to 30mg straight away and then do 5mg every 2 weeks to 20mg - they would do 10mg drops every 2 weeks which is even faster. At this level and after only 2 weeks there are no great adrenal insufficiency problems, it is just avoiding the discomfort of a biggish reduction. My daughter's asthma exacerbations are done with 10mg drops from the starting dose which are often 40mg for a couple of weeks.
(I can't give you the direct link here without it going for moderation but this is the title and authors if you want to check:
BSR and BHPR Guidelines for the management of giant cell arteritis Bhaskar Dasgupta , Frances A. Borg , Nada Hassan , Leslie Alexander , Kevin Barraclough , Brian Bourke , Joan Fulcher , Jane Hollywood , Andrew Hutchings , Pat James , Valerie Kyle , Jennifer Nott , Michael Power and Ash Samanta on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group )
robbo123 EileenH
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