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← Return to Trouble going below 3mg
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I had my markers tested on Monday. In April Sed rate was 5, CRP was 6.6. Monday Sed rate was 14, CRP was 14.5. At 2.5mg and 2mg I was feeling more than a "bit tired". I would call it fatigued. Fearing I could be flirting with adrenal insufficiency, I decided to go back to 3mg. I think I'm ok at 3mg. I'm going to finish this week with 3mg and start that taper next week.
My rheum was against splitting pills and this taper is whole pills, no splitting. My next appt isn't til Aug so I'll message him my plan.
That article talks about being at 3 mg forever as a choice.
Replies to "I had my markers tested on Monday. In April Sed rate was 5, CRP was 6.6...."
The other option my endocrinologist offered was for me to switch to hydrocortisone.
"The goal of glucocorticoid replacement in adrenally insufficient patients is to abolish symptoms of glucocorticoid deficiency and prevent adrenal crisis while avoiding over-replacement. The cornerstone of glucocorticoid replacement is oral hydrocortisone, typically 15–25 mg daily, taken in divided doses. Total daily hydrocortisone requirement is dependent on body surface area with normal cortisol production rate about 6 mg/m2/day.19 The first dose, generally 10 mg, should be taken immediately on wakening.20,21 A further one or two smaller doses should be taken at 4–6 hourly intervals, with the final dose taken more than 4 hours before bedtime."
https://pmc.ncbi.nlm.nih.gov/articles/PMC6297573/#:~:text=The%20goal%20of%20glucocorticoid%20replacement,daily%2C%20taken%20in%20divided%20doses.
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I have no experience with hydrocortisone. My endocrinologist said it was optional and I elected to stay on Prednisone.
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Either way, the total weekly dosage is the same whether or not pills are split. For example, in Week1 the total dose of the schedule you will follow is 20mg, and I'll get the same weekly dose of 20mg with two days of .5mg reduction in Week1 instead of one day of 1mg reduction. It might be just psychological, but I feel more comfortable with the smaller reductions. The end result should be the same.
Incidentally, I also noticed a distinct drop in energy while reducing to 3.5mg. I wouldn't call it fatigue but I've become more sluggish, moving more slowly and lacking the previous morning enthusiasm for tackling the daily to-do list. I've pushed through it so far with a recovery day every few days, but expect that could worsen at the next reduction.