Connect
Still confused about tapering
Hi there, I was diagnosed with PMR about 4 months ago ... my rheumatologist gave me a "schedule" for tapering but I haven't been able to follow it because my symptoms return if I do. I understand tapering is variable but my question is this: How do I know when to go down in dose? Should I be completely symptom free before going down to next dose or 80% or 90% symptom free? Or 50%? And if I go down and symptoms worsen should I wait at that lower dose for a few days and hope the symptoms will settle or do I need to go back up? (I am on Prednisone only and currently 15mg daily and can't seem to go lower than that. I started at 20mg and was about 95% symptom free on my starting dose).
Like
Helpful
HugInterested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.
Connect
to pdxmac:
Please remember to remain alert for the possible side effects of taking prednisone with an NSAID such as meloxicam. Good luck.
-
Like -
Helpful -
Hug
2 ReactionsWhich is exactly why I resisted. Is there something specific you are referring to? I know about the gastro issues and am hoping that my need to take them both is not long-term. (I also know that you cannot always tell when the gastro issues are starting). To further protect myself, I even gave up my beloved alcohol (I was never a heavy drinker, but I certainly enjoyed my wine with dinner, sigh).
Please just Google “prednisone and NSAIDS”. That should tell you what to be alert for.
Tapering, I am at 2 mg of prednisone. I had level 3 rotator cuff pain a few times. I asked my doc about taking an NSAID while still on P. She said that infrequently might be ok, since I was on such a low dose, but that I should also take a Prilosec (antacid) as well if I did so.
Just trying to make sure you are alert for the possible bad interactions. Best of luck to you on this.
-
Like -
Helpful -
Hug
1 ReactionThe lower the dose of steroids the greater the percent of taper when you go down even 1mg. At 20mg a 1mg taper is 5%. At 10mg a 1mg taper is 10%. You may not realize the difference however your body does. Possibly try reducing by 0.5mg once you get low enough that your body reacts to a 1mg reduction adversely. Pill splitters are a great stocking stuffer!
Please read up on adrenal insufficiency since taking steroids long term can contribute to this problem. The oral steroids have taken over the work the adrenal glands normally do. Waking them back up is a big portion of PMR tapering. The symptoms of adrenal insufficiency are very easy to confuse with PMR pain. I'm not even sure they can be parsed by a medical professional. The body is complicated and complex. It is amazing what it does for us that we have taken for granted. I have learned so much about my body - I'm impressed.
-
Like -
Helpful -
Hug
3 Reactions"The symptoms of adrenal insufficiency are very easy to confuse with PMR pain. I'm not even sure they can be parsed by a medical professional. The body is complicated and complex"
---------------------------
This was true in my case. How ironic that the treatment for adrenal insufficiency was the same as the treatment for PMR.
https://www.endocrine-abstracts.org/ea/0056/ea0056p44
------------------------
I needed to take a maintenance dose of prednisone until my cortisol level improved. Staying on a dose of 3 mg or less was a low enough dose to allow some room for my adrenals to regain some function. My endocrinologist said to remain on low dose Prednisone "for as long as it takes" and possibly for the rest of my life.
After I stayed on 3 mg or less of prednisone for 6 months, my cortisol level improved. My endocrinologist said it was fortunate that my cortisol level improved after long term Prednisone use.
After my cortisol level improved, I was allowed to discontinue prednisone. My endocrinologist said 3 mg was such a low dose that I could simply stop taking Prednisone without a taper. As long as PMR was controlled AND my cortisol level was good there was no need to take prednisone anymore. PMR was controlled by a steroid sparing medication that didn't suppress my adrenal function.
So often in medicine ... the treatment for one problem creates a new problem.