How to go from a 7 day 50 mg prednisone to the previous 14 mg

Yikes. I’m sorry to hear this, but glad it sounds like you’re on the mend.

Hopefully another member may have a similar experience to share. But I thought I’d just reach out to offer support. That would make me very nervous too… I thought prednisone almost always had to be tapered, but my family doesn’t have personal experience with this.

It does seem best to consult a rheumatologist. Do you think you could tell your temporary doctor or the one treating you for the lung condition about your concerns related to the prednisone and PMR specifically, and then ask if either of them might be able to consult a rheumatologist to weigh in on your case?

That might be a workaround and if they’re not aware of how debilitating PMR can be and how prednisone is tapered slowly, maybe if they could understand that they’d be more motivated to confirm if that’s okay with another specialist.

Two weeks (3 weeks tops) is the maximum window in which you can raise prednisone quite high for a particular purpose then drop it again. Any longer and the reduction must be done slowly. If 14mg is your dose to keep PMR under control, I don't know why it wouldn't be okay to drop back to that? I can understand the nervousness, but if 14mg worked okay before it should stay that way. That's my understanding of it.

Thanks for your advice.
When I’d had to do a short course of high dose prednisone in previous years when I didn’t have PMR my adrenal glands only had the interruption of added cortisol for 5 days so when I stopped after the five days I’m sure it wasn’t too hard for the adrenals to kick back in. I never had a problem with it.

This time since I’ve been on prednisone for about 9 months starting at 24 mg and now down to 14 who knows how my adrenal glands are going to respond with the temporary high dose and then an immediate drop to 14.
I don’t want to deal with adrenal insufficiency problems so trying not to make an error.
I’m hoping someone might have had this situation and can tell me how it went for them.

I did a "prednisone burst" many times for other conditions unrelated to PMR.

You are wise to be concerned about your adrenal function. However, going back to 14 mg of prednisone is enough to manage your need for cortisol.

Approximate Prednisone Dose Ranges:
Physiologic: 5 mg (usual average adrenal output)
Supra-physiologic: 10-20 mg
High supra-physiologic: 50-250 mg (max adrenal output)

Your need for cortisol varies considerably depending on the day. However, 14 mg of Prednisone is an adequate replacement dose for most days.

According to my endocrinologist, problems with adrenal insufficiency begin to surface when your prednisone dose is tapered down to less than 10 mg. Not everyone will have a problem. It depends on dose and duration of time you have been on Prednisone.

Hello.
From my past experience working the ER, there would usually be a recomended follow up consult which in your case would be a Pulmonologist. And hopefully a collaboration with whoever is managing your PMR To keep you safer with the prednisone issues and establish an objective care plan. Hope your health and circumstances begin to improve soon.
Ernie

Thanks. There is no follow-up. A GP is all I have to work with. He doesn’t know much about the disease so I have to research carefully and lead him.
He will work with me because I’m diligent in what I do. It took almost a year to get the diagnosis of PMR while I lived and worked in terrible pain. The GP I had at the time just kept telling me it was arthritis and to take Tylenol.
I found another GP after my cardiologist and an emergency doc both clued into the fact that I had PMR.
I’m on a wait list for a rheumatologist but it could be a long wait here in Canada where there are such shortages of doctors.

Thank you!
I’d read just last night about the physiologic outputs etc but I’m presently quite unwell so hadn’t delved into it any further.
I appreciate your post. This is exactly what I need right now to give me a little confidence in going right back to 14 mg.
I’m almost 77 yrs old but must work a lot still so I can’t afford downtime.

Adrenal insufficiency isn't usually a problem till around 5mg dose when the dose normally produced by our body is reached. Steroid withdrawal is a different thing, and it can be the problem with moving too fast on reductions at higher doses - except in the case of a very short term rise and drop of prednisone.

I hope someone who has had your current experience replies.