Posted , 10 users are following.
Have wavered from the path of dsns recently due to pressure from both gp and rheumatologist to reduce more quickly. However, have seen the error of my ways (increased symptoms) and have just finished a successful taper from 9 to 8.5 with dsns, and feeling well on it. I took my last 9mg dose yesterday. When should I start to taper to 8mg? Thank you.
0 likes, 10 replies
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susan43406 lbh
Posted
I would wait a month if I were you before starting the next taper. Just to make sure you are ok. For me it took a few weeks before I realised symptoms were gradually increasing. I'm back to 9mg and waiting a couple of months this time before I try again. I realise this might be my maintainance dose for a while.
nick67069 lbh
Posted
You can only reduce if PMR ( or CGA) has slowed down. PMR controls what dose you need, not the other way around. Thinking that PMR would go into remission if you reduce quicker is wrong way to look at the reduction. You are looking for lowest dose that controls your symptoms - as simple as that. Your gp/rheumi can pressure you as much as they want, PMR does not care and only you will suffer, not them. Best to politely explain that you need to go slower. How slow? Minimum is 2 weeks pause to make sure that your body /symptoms are under control. 4 weeks is preferred.
I am not sure how long you had PMR, but keep in mind that average treatment with prednisone is about 6 years ( not 2 as many gs and rheumis tend to believe. Only 25 % of patient have treatment under 2 years and half of us stay on prednoisone longer then 6 years. No reason to rush.
Twopies lbh
Posted
duh! i didnt think you had to go to 8 1/2 from 9 because its a drop of only 11%--so i thought you could go directly to 8. anybody else do that or am i wrong? i just dropped from 10 to 9 (broke my heart to go back up to 10); was thinking when i was able to reduce, i would go to 8, not 8 1/2. i didnt think you needed to reduce by 1/2 until you got below 7. thamks.
ptolemy Twopies
Posted
It seems that dropping .5mg seems to work better than dropping 1mg under 10mg. I suppose it depends on you. The general rule of thumb is do not drop more than 10 per cent at one go. Although this is difficult at low doses.
EileenH ptolemy
Posted
Which is where the slowed tapers come in spreading the drop over several days so it has less impact.
EileenH lbh
Posted
I say in the original that it is possible to just continue with the next step - one lady even switched at the halfway point when reducing 1/2mg at a time so that she achieved 1mg over the entire course but was never having more than a 1/2mg difference in consecutive days doses.
How much you can manage and how fast you can manage it depends on the person - 10% is the basic rule in any tapering but even that is too much for some people and they shift to 1/2mg steps much sooner than others.
Nick has it in a nutshell. Remind your doctors that it is YOUR pain and disability, not theirs. Forcing a reduction often just adds to the cumulative dose as you fail and have to go to a higher dose again.
karenfizz lbh
Posted
I reduced by 1mg a time using DSNS over 7weeks successfully from 10 to 4mg, starting the next taper immediately after the first as Eileen points out. However, when I got to 3mg I had a flare; am now on 4mg for a week till things settle down and will then go to 1/2mg drops to be more cautious.
Good luck
Anhaga lbh
Posted
I'd say it very much depends on how you feel. If the taper went well with only the bare minimum of "niggles" at the beginning, and you feel at least as well at the end of the taper as you did before you started the taper, I would even suggest that a ten day wait is enough. But it is true that for some people, and certainly at the doses lower than you are now, it is sometimes hard to know if your dose is quite enough. Hence the advice to wait longer, two to four weeks, which makes it much more certain that you haven't overshot the mark.
ptolemy lbh
Posted
Don't let them bully you. They have not got PMR. It always amazes me that doctors give us pred and then immediately they want us to reduce it to zero.
lbh
Posted
Thank you to each of you for your answers and advice. It is very much appreciated.