The affect of beta blockers on adrenaline and cortisol levels.
There's a fair bit of discussion on adrenal insufficiency or low adrenal levels being a reason for difficulty reducing prednisone. I wonder how many of us take beta blockers (Metoprolol in my case) for blood pressure control? They reduce the production of adrenaline, the precursor to the production of cortisone, the inflammation regulator. How does that medication affect our ability to get the adrenals and adrenaline going again as we reduce prednisone/prednisolone?
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@megz
All I know is my PCP said I could not take beta blockers for my high blood pressure because of my asthma. So I was put on cozaar and hydrodiurel for my BP. Later when I was diagnosed with SVT, I was put on a calcium channel blocker, Verapamil, which has a duel use for high blood pressure also.
This was all long before I was diagnosed with PMR. However, I was intermittently on prednisone short term for asthma and inflammatory arthritis.
I was on Losartin (Cozaar) and Hydrochlorothiazide (Hydrodiurel) also. My calcium channel blocker was Amlodipine (Norvasc). All of these medications were started after PMR was diagnosed. A cardiologist threatened me with starting a Beta Blocker if the above three medications didn't work. A cholesterol lowering medication was added at my next cardiology visit.
I took high doses (60-100 mg) of Prednisone intermittently and often but only on a short term basis before PMR was diagnosed. Usually I took the highest dose for a couple of days followed by a fast taper in a month for flares of uveitis and inflammatory arthritis. I didn't seem to have any other health related problems except for trigeminal neuralgia. I didn't have a PCP or a rheumatologist because my ophthalmologist prescribed all the prednisone for uveitis.
After PMR was diagnosed, I was on Prednisone daily and long term for more than 12 years starting with a dose of 40 mg. I was seen by my first rheumatologist and a PCP referred me to multiple specialists for a variety of health problems. I stopped seeing a neurologist because they wouldn't prescribe Prednisone so my PCP managed trigeminal neuralgia with more Prednisone when I needed it.
I never got much lower than 10 mg in 12 years until I started Actemra, Then it took a year for me to taper off prednisone.
I was able to have surgery for trigeminal neuralgia when I was still taking Prednisone. That was when I first saw an endocrinologist who was concerned about all the Prednisone I needed prior to having surgery. She watched me like a hawk until she was convinced I wasn't going to have an adrenal crisis. I just remember all the steroids that were being administered to me after brain surgery. A large vein was found to be compressing my trigeminal nerve and caused electrical problems.
When I started my blood pressure medications, a BP of 210/110 was discovered. I had no prior history of hypertension or any cardiovascular problems. All of a sudden I had left ventricular hypertrophy (LVH) and cardiac arrhythmias. A year or so later I had a massive and bilateral pulmonary embolism following a hospital acquired and work related enteric infection. I wound up in intensive care and warfarin for life was started.
All my blood pressure medication have been stopped when I was able to taper off Prednisone. I was getting dizzy and lightheaded all the time. Warfarin for life was stopped a few months ago. In fact, almost all my medications except for Actemra have been stopped since I discontinued Prednisone. My PCP likes to deprescribe medications. She said she likes that part of medicine.
I have heard about everyone trying to get off prednisone. I have been on and off prednisone for 30 + years and my rheumatologist just raised my P to 15 mg a day. I haven't felt better for two years. I am 78 yo and have normal bone density probably due to the amount of exercise I get. Please let me know what all the problems I am going to have? I was dx with PMR over 30 years ago. For about 15 years I would have yearly bouts of PMR and would take 10 mg of P and over 2 to three months taper to zero. When the PMR came more often I was on 2 mg P for about 10 years and that made it bearable then 5 mg P per day, 10 mg per day and just recently 15, which is the most I have ever been on and I feel it is over kill. Again, after been mainly on and off P what is going to happen to me? I feel great now.
"Please let me know what all the problems I am going to have?"
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You might not have any problems as long as you can still taper off. The higher the dose and the longer you take prednisone it becomes harder and harder to taper off.
I took prednisone for 30+ years too. High doses of 60-100 mg was okay as long I could taper off in a month the same as you. I did this for 20 years for flares but not for flares of PMR.
The flares I had would recur once ... maybe twice per year. I didn't have problems except for cataracts at the age of 40.
When PMR was diagnosed my starting dose was 40 mg. I was still on 30 mg after 5 years and 20 mg after 10 years. After 12 years I still needed 10 mg most of the time. I flared whenever I tapered down to 7 mg and had to go back to 15 mg every time. I don't know how many times I relapsed because I lost count.
The problem I had with tapering off prednisone was adrenal insufficiency. I didn't realize how much of a problem I had until I started a biologic and I could taper down to 3 mg of prednisone. When my cortisol level was checked I was told in no uncertain terms to stop tapering. I needed a referral to see an endocrinologist because of a very low cortisol level.
https://academic.oup.com/mr/article-abstract/32/5/891/6511018?redirectedFrom=fulltext
Adrenal insufficiency was just the last of a long list of prednisone related complications I had. Daily prednisone for 12 years to treat PMR was NOT good for me. I'm doing much better on the biologic that I have now been on for 5 years. I have been off Prednisone for almost 4 years. My quality of life wasn't very good on Prednisone compared to how I currently feel.
My PMR journey hasn't ended even though I am off prednisone