Tapering
Posted , 8 users are following.
My recent labs are all in normal range im taking 25mg prednisone presently i was diagnosed in May 2019 and was as high as 40mg for a severe flare the end of August and early September my rheumy wants me to now cut down to 20mg for 5days and the 5days later cut to 15mg and then again in 5 weeks to 10mg My questionis, should K be tapering that quickly, 5 mg every 5days? im still not walking as i use to, i dont have much pain bit some stiffness mainly in left shoulder and upper arm and neck What would be a more sensible tapering?
0 likes, 8 replies
Anhaga ina0821
Posted
Are your symptoms now as controlled as they are likely to get? If you feel you still need some improvement you shouldn't be tapering at all yet. The minimum expected improvement is 70%.
Then the rule of thumb is to taper by no more than 10% of the dose which from 25 mg would be 2.5 mg, not 5 mg. It is also not a good idea to reduce so frequently as you have already had a serious flare. You want to avoid that happening again which can end up with you taking in far more pred than if you reduced at a much slower pace in smaller steps.
What kind of taper were you using when you had your major flare?
janet06653 ina0821
Posted
I started at 50 mg a day tapered to 25 at a 5 mg reduction per month getting blood work every 6 weeks then went to 23 for a month: 21 for a month etc.
until I was at 10 then tapered 1 mg per month the last 3 tapers were the hardest and I had a couple of flares during the process when the dosage was increased by 5 mg.
If you are getting regular blood tests every 6 weeks a rapid reduction to 10 mg can work as long as you have no flairs. From 10 down my dr had me take it very very slowly and even then when I was off it completely for 3 months I had a flair and had to go back on to 5 mg for 9 months.
Listen to your body and insist on the blood work.
Learn how to read your CRP, sed rate and platelet count so you know where you are. as soon as you feel pain you need to increase your dosage.
EileenH ina0821
Posted
No. Just because your numbers are in normal range that doesn't mean the autoimmune cause of the symptoms is in remission. All it means is that you are on enough pred to mop up all the inflammation being created daily.
25mg is a high dose for PMR and dropping to 20mg seems a good idea but then you need a couple of weeks before you drop again to make it more tolerable and to be sure it is still enough. Then trying a drop to 15mg might again be reasonable although I would go via 17.5mg - but then you need a month at 15mg, again to be sure.
According to the top experts in tapering no reduction step should be more than 10% of the current dose - now it shouldn't be more than 2.5mg at a time. Not just because it is more comfortable for the patient but also because they can't know how much YOU will need - everyone is different and PMR/GCA doesn't come with a rule book or crystal ball!
ina0821
Posted
fhank you for your replies they were helpful and backed up how i was rhinking ****
irene_88946 ina0821
Posted
Wired for sound!! Wow my pain management doc prescribed a 7 day taper pack, 1.8 mg. 7 days ago. I just finished the last pill. This dose pack is different than the medrol pack that you may have taken. I have had the shakes, can't sleep & certainly can't concentrate. Then I ended up with thrush in my mouth. He said he can get me off the daily dose of steroids & that this med doesn't cause you to gain weight. (We'll see about that because right now I am starving have been since I started the dose pack.) ** Sweets are my friends!!**
All I can say I hope this fixes my PMR & I can finally get off the prednisone!!
Has anyone else taken a dose pack like this? If so how did it work for you? Whoops I posted this on the reply instead of a new discussion. I hope someone reads this & has some answers for me.
EileenH irene_88946
Posted
It will NOT "fix your PMR". PMR is a chronic autoimmune illness that lasts between 1 year and as much as 10 years.
https://www.medpagetoday.org/rheumatology/generalrheumatology/66912?vpass=1
As long as the autoimmune part of PMR is active it will create new inflammation every morning which will cause symptoms. Just like rheumatoid arthritis, other forms of inflammatory arthritis or lupus. Would he claim to cure them with a 7 day taper pack of corticosteroids? If he does he is a charlatan and lying. And I would face him down with that - he is taking money under false pretences and is only creating problems in the long term for you.
irene_88946 EileenH
Posted
I was adamant about stopping the steroids. I've gained over 22 lbs. I have the moon face & starting to get a hump in back. He never said it would cure it, but rather help me get off the everyday steroid.s My Rhuemy knows about the taper pak. She told me if I start having problems again with the PMR to go back to 5 mgs. So far I don't feel like I am having a flare from stopping the steroids. I am sure the pain I am experiencing is coming from the iIiotibial band syndrome. I've already been involved with a pain management group who was just there for the money. I don't feel like this doctor fits in that category, I see him every 3 months the other doc had me coming every month. That was $50 for each visit. God forbid you would have a procedure. They charged for the facility plus the docs fee. It was nothing to drop over a $1,000 . If this doc does a procedure it normally cost about $50.00.
Thanks for comments.
EileenH irene_88946
Posted
It was adding to the pred dose - there is no logic in that at all for getting off pred. What is important is to learn what is PMR and what isn't.
But weight gain with pred is not inevitable - if you cut carbs, especially processed carbs and fruit, you can manage your weight, I lost 35lbs by doing that - and I am not the only one on the forums. That also reduces the risk of developing steroid-induced diabetes.