Still confused about tapering

Posted by michcan1 @michcan1, Nov 17 11:36am

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).

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

@ninadavis

There was someone on here who said that a nurse told her that tablets should not be cut unless there is a line to do so as the ingredients maynot be evenly dispersed in the pill. That is ridiculous, though it comes from a good-hearted person. But it defies common sense.

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From Drugs.com:
Pills with no line in the middle
In general, do NOT split tablets that are not scored unless your doctor or pharmacist has given you the okay to do this. Some tablets may be extended-release, enteric-coated or have other characteristics that might affect how the tablet is absorbed or works if you cut it in half.

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@art43

From Drugs.com:
Pills with no line in the middle
In general, do NOT split tablets that are not scored unless your doctor or pharmacist has given you the okay to do this. Some tablets may be extended-release, enteric-coated or have other characteristics that might affect how the tablet is absorbed or works if you cut it in half.

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I think this is good advice. I haven't looked at 1 mg tablets of Prednisone recently. From my memory, they can't be broken in half very easily. I don't know if they are scored or not.

I think it is okay to split 1 mg tablets in half if people want to. I don't know how useful that is though. I could couple a 2.5 mg tablet with the 1 mg tablets and get any dose I wanted except for 1.5 mg. I have split the 5 mg tablets in half because they were bigger than the 1 mg tablets. People just need to ask for different sized tablets as needed.

I'm not sure a 1 mg tablet split in half is feasible or not. I doubt the score mark is a cross mark (+) like this plus sign. I wouldn't ever cut a 1 mg tablet in fourths but I know people do this. Trying to cut a 1 mg tablet into fourths is too much work for me.

People should do what their own thing ... I guess.

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My 1’s are scored, and my taper is 0.5 per month from 5 to 0. Need to split the 1’s at 1.5 (current) and 0.5. No prob.

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@art43

My 1’s are scored, and my taper is 0.5 per month from 5 to 0. Need to split the 1’s at 1.5 (current) and 0.5. No prob.

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How do you feel??

I posted some new guidelines about how to deal with low cortisol levels when you are on low doses of Prednisone. I'm glad the medical community is starting to look at this problem more closely.

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@art43

My 1’s are scored, and my taper is 0.5 per month from 5 to 0. Need to split the 1’s at 1.5 (current) and 0.5. No prob.

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I have been splitting the 1 mg tabs for a couple of years now. As soon as I dropped below 8 mg I needed to taper .5 mg at a time. I use 5 mg and 1 mg tabs. My ones are scored down the middle and I use a pill cutter. It was hard to find one that did a good job. Even if the pill is split unevenly I get the whole 1 mg over 2 days. Unfortunately, my ones and fives are both orange, just a slightly different shade and size. My doctor thought a .5 mg drop was too small but I told him that was how I needed to do it.

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@dadcue

How do you feel??

I posted some new guidelines about how to deal with low cortisol levels when you are on low doses of Prednisone. I'm glad the medical community is starting to look at this problem more closely.

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Occasional fatigue, occasional right shoulder rotator cuff pains (but I think I strained it lifting bags of pellets). Low energy, but cannot really complain.

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My 1mg tablets are scored and split easily.
My rheumy however gave me a schedule tapering by 1mg even below 5mg. He does not believe in splitting pills.
I am supposed to be at 1mg now according to his schedule but alas I am at 4mg going to 3 (via 3.5 mg first).
Next appt in Feb. Hope I can get to 1 mg by then.

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@ninadavis

There was someone on here who said that a nurse told her that tablets should not be cut unless there is a line to do so as the ingredients maynot be evenly dispersed in the pill. That is ridiculous, though it comes from a good-hearted person. But it defies common sense.

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I don't think the reason is the even distribution of ingredients, no. But the rule of thumb is that a scored pill is fine to split and an unscored pill may not be.
For example, my 5mg Apixaban pills are not scored and a googlesearch said they can be split, but the second half has to be discarded if not used within 24 hours of cutting because the second half may lose strength after exposure to air.

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@mtr2601

Most of us can relate to your dilemma, there's the ideal world according to the treating Doctor and there's the harsh reality that each of us live everyday. Two different worlds in many cases! I am very sensitive to Prednisone and through lots of trial and error discovered that the only way I could reduce the dose and keep functioning was by a quarter of 1mg every week. I also had to split the dose, you'll find a lot of discussion on that and rely on paracetamol as needed. It has taken 14 mths to get to 2.5mg and I'm reducing a lot slower now, still living with pain but getting on with life. For me a gluten free diet and low stress lifestyle are very important

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Can you share your findings about using a gluten free diet? Did you start that before PMR?

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@dadcue

How do you feel??

I posted some new guidelines about how to deal with low cortisol levels when you are on low doses of Prednisone. I'm glad the medical community is starting to look at this problem more closely.

Jump to this post

I am new to this support group. Can you direct me to the location of the information you posted?

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