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Safe dose and tapering on Glucocorticoid therapy.
British Medical Journal article. This is the most informative article i have read so far and answers questions about tapering schedules, split dosing and why its not a great idea, risk benefit ratios etc. Probably should be required reading for anyone thinking of starting Prednisone therapy.
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Your article is well written and informative as you say. Thank-you for posting this information.
When I was 10 years into my PMR journey and on prednisone, a person who had personal experience with an adrenal crisis explained things to me. Her experience was invaluable to me but also sad.
The following link should also be required reading . It is a dialog that happened on a chronic pain forum rather than a PMR forum. Nevertheless, this dialog changed the way I thought about being on long term prednisone. This discussion is on a personal nonscientific level but supports what your article is saying. I'm no expert but I'm capable of learning. I read as much as I can and I ask questions. Everyone's personal experience is informative and sharing information is useful.
https://www.healingwell.com/community/default.aspx?f=16&m=4073463
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1 Reaction@mtr2601 Wow ! OUR very astute @dadcue noticed that you had linked to this article just before i did yesterday!! Not that it is just recently published but it popped up in a search of "prednisone tapering" -something like that
My (new) PT was the one who seemed to be trying to incorporate the issue of steroid-withdrawl with a care plan for me !
BTW -- i am just getting ready to decrease to 4.5 mg from 5 mg . I will reread to look for mention of [not] splitting dose, as you suggest -
what about you ? are you still taking. Prednisone ?
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1 ReactionHi, yes I am 7 months in with classic PMR and bad arthritis in both hands. Currently on 7.5mg Pred (5mg am and 2.5mg pm) plus 5mg Methotrexate. Disease is poorly controlled but I don't want to increase the Pred and the Mtx is just horrible so I'm coping as best I can, hoping things will improve.
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2 ReactionsBoth you and @nyxygirl are getting close to "adrenal territory." The tapering will get harder as you progress through this difficult to navigate territory. I think it is less about tapering and more about "holding your ground." The only time, I was advised to stop tapering was when I reached my 3 mg dose of prednisone when my cortisol level was low.
At or near a 3 mg dose of prednisone, your cortisol level can be checked. If your cortisol level is low ... you ain't going nowhere! Except for trying to hold your ground, there isn't much you can do until your adrenals "wake-up" ---"reboot" --- or "start to work." Your adrenals need to produce reliable amounts of cortisol again and that takes time.
Cortisol is what prednisone has replaced. Perhaps prednisone "competes" with cortisol is another way of saying it. You have to get cortisol from somewhere. If your adrenals aren't up to the task quite yet, you need to supplement your cortisol need with prednisone or some other corticosteroid.
Cortisol and/or prednisone is what "regulates" inflammation in the body. The HPA axis does a better job regulating inflammation then we can ever do with a daily dose of prednisone.
In the absence of anything else that helps to keep inflammation in check, it is difficult to taper without having a flare. In my case, Actemra made a huge difference because it keeps my inflammation in check and didn't suppress my adrenal function. I think methotrexate might help some too.
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3 ReactionsI also couldn’t tolerate methotrexate and I have been on lefluodomide 20 mg which helped suppress my symptoms and 5 mg prednisone. Good luck PMR is a bitch.