Tapering the Pred with DSNS
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I made what I now believe to be a mistake in tapering too slowly at the beginning of Pred treatment. With the benefit of hindsight, I misread the enthusiastic endorsements of the DSNS method, and sought to apply a version of it from the starting dose, which in my case was 20mg. I presume the correct advice is that the DSNS method really comes into its own when dose reduction has reached about 10mg and below? If so, may I suggest that this point be given more prominence?
Does it matter? Although many of us will be on the Pred for years, some will get off earlier. The adrenals reportedly shutdown progressively over the first year or so. The earlier we can challenge, preempt or reverse this the better. DSNS is the way to go, but I presume it is best at doses below 10 mg. In my case, I think that I tapered too slowly for nearly a year during which time I offered no "challenge" to detect for disease remission and/or stimulate the adrenals.
0 likes, 5 replies
EileenH dmart7
Posted
No - that isn't the case. You can use the DSNS way to reduce 2.5mg at a time down to 15mg but from there many people do it 1mg anyway. The DSNS is an add-on - and even allows the 2.5mg steps which patients couldn't manage easily otherwise.
You are only ever a month behind using the DSNS. The drop should never be more than 10% of the current dose. The original DSNS was worked out to reduce below 5mg - and Ragnar the Swede was the person who started it all off, managing to get to zero where before he had failed to get to 4mg. Then we said from 10mg - and then realised there were people who struggled even at 20mg, especially after a too fast reduction had led to a flare. That is a common reason for people having problems - go too low too fast and let a flare happen - even doctors acknowledge it.
The adrenals will not need to function for the entire time you are at a dose above about 8mg/day, there will be no challenge to their shutdown until you are well below 8mg in most cases. Even with DSNS, if you start with 2.5mg steps and switch to 1mg steps later you will be below 10mg well within a year. The people who are able to reduce the way their GPs suggest don't find a need for DSNS so soon - but a lot of them struggle to start with and then head for DSNS.
nick67069 dmart7
Posted
just to add to Eileen's comments, your adrenal glands went dormant within first 2-3 weeks; not a year or so as you commented. Body is smart enough that when it detects prednisone (actually cortisol) level in the blood above 7-8mg, it shuts it's production immediately. One can get away with short course of steroids, but as soon as you take them longer then 2-3 weeks, taper is necessary to restart adrenal glands gradually.
Anhaga dmart7
Posted
In other words, no harm done. But I take your point that DSNS may not be needed by the majority of people above 10 mg. I followed my doctor's advice to taper by 1 mg per week from 15 to 10 with no issues, but getting to 9 was a step too far. That's when I introduced DSNS and was at 3 mg by the end of the first year. On the other hand I read often of people who have been told to drop by more than 1 mg, usually 2.5 sometimes as much as 5 mg at a time from 20 or 15 and this is a big drop (well over 10% even from 20) and can cause problems, especially when the reduction happens overnight rather than being introduced slowly.
As a matter of interest, have you in fact found that your taper has gone well?
dmart7
Posted
Anhaga - My taper went very well and without incident from 20 to below 10. Not surprising as I did it in 1mg steps or less with DSNS, even at the start. That is the bit I would do differently. I could have gone a bit faster in the early stages. Anyway, since then (still DSNS), I've relapsed twice at about 8.5mg. First time, I had to go back up to 12. Second time back to 10. I guess that is not untypical of many on this forum.
Michdonn dmart7
Posted
Well Dmart, I don't believe you can taper too slowly. When tapering from my crippling flare I used a modified version of DSNS from 30 mg but at no time ever reduced by more than 10%. My flare start at 7 mg and I end up on 30 mg to get relief, the flare was caused by rushing my reductions. Now on 5 reducing to 4.5 first reductions over 10%. Take your time you will end up taking less Prednisone. Try to stay active, positive and smile. 🙂