To much pred for my size?

I was a bit surprised to read that a 50kg. patient would start on 10 mgs. I'm 53 Kgs and first time I had PMR I was started on 30 mgs. and the second, when my GP said we would " be a little less aggressive this time, " (  no explanation given. Nowadays I would ask but I must have been shy in those days! ) and  started on 15 but I have to say that the second episode gave me far more reduction problems than the first. No idea whether the starting dose was significant.

I'll be very interested in the responses as I was in the same boat as you, but put on 20 mg pred. Which ended me up in ER having almost an anaphylaxic reaction.  I felt it was too much pred for my body to handle, especially after I had read online that low weight women could be started at 12.5 mg.  however, neither my gp nor the rheumy had ever heard of such a thing--although as I recall, it's on the mayo website too.  

I dont know know about the source you mentioned, however, I do believe that weight is a consideration.  Hang in there; good advice on this forum.  

MhairiP, how do you feel? Do you have any PMR pain? I personally don't believe in tapering if you have any PMR pain. ??

Kate Gilbert's book is basically wrong on this point - she isn't a scientist and doesn't know a lot about pharmacology. The rest is pretty good about how she lived with PMR - though it is HER journey and in my experience of 9 years on the forums and thousands of patients it really isn't that typical.

The patient is started on a dose that is plenty to manage the inflammation - and that has nothing to do with your size. It also has to do with the activity of the underlying autoimmune disorder - if it is more active it will need more pred - and the amount of the medication you absorb. In the case of pred, although it is quoted as 70% it actually ranges from 50% to 90% - a small woman may only absorb 50% while their large male neighbour absorbs 90% So the basic dose they need will be different and the woman might need more.There are also other considerations with regard to the way the receptors on your cells that make the pred work link up to the pred.

The most recent Recommendations say "Use the lowest effective dose in the range 12.5 to 25mg/day". Then you taper the dose to find the lowest dose that manages the symptoms as effectively as the starting dose. This process is called titration and is the way that the dose of all these medications that vary in their bioavailabilty and how they work from patient to patient are adjusted.

You start on a fairly standard dose - if it doesn't work well you add a bit. If it does work well you take it or 4 to 6 weeks which clears out all the existing inflammation and allows inflamed tissues to heal and then you start to reduce the dose SLOWLY to find the lowest dose that works for you. If you try to reduce too soon or too quickly/in too large steps down you run the risk of a return of symptoms, either because of something called steroid withdrawal (the body protesting at you changing its status too much for comfort) or because you have gone to a dose that isn't enough to manage the daily dose of inflammatory substances shed in the body in the early morning and which cause inflammation and so pain and stiffness.

To add to what Betty has said - they used to use higher doses and then got worried they were giving patients too much over the time they had the PMR. So they had a look at what dose they needed to get a result - and cut the recommendations down to 15mg. Now they have realised that actually they probably cut it a bit too far for some people - and have increased the amount again. 

Don't worry - if you had started at a lower dose it would have taken longer to get relief and down to a non-inflamed baseline. If you have any problems speak to your doctor - or ask on here. 

And while I think about it: you cannot go back to normal duties just because you feel better. The pred only mops up the inflammation that is coursing around your body - it does nothing to the actual underlying disease process, and autoimmune disorder that causes your immune system to attack your body in error because it doesn't recognise it as self, and that chugs away in the background, attacking your body as if it were a foreign invader. This is what causes the fatigue and flu feeling. Your body is intolerant of acute exercise as a result and that you have to manage by pacing and resting appropriately. 

This is a link to a post on another forum which explains it in a more lighthearted way:

https://healthunlocked.com/pmrgcauk/posts/135650532/fatigue-pacing-spoons-and-a-gorilla...