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Smallest amount of prednisone for adrenal glands to work again?
I was diagnosed with PMR in May 2025. After 7 months of being on prednisone, I was able to taper off completely, but then had a flare on 12/15 after being completely off of prednisone one week. My rheumatologist had me go back on 20 mg and taper down again, 5mg every 3 days. I'm completely off now, but am having major issues with adrenal insufficiency, especially fatigue and night sweats. Is there a minimal amount of prednisone that I can take to alleviate these symptoms, while still allowing my adrenal glands to kick back in naturally in the next 6-12 months?
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@laura1970 Spacing out your prednisone does not mimic what your adrenal glands do naturally. Adrenal gland release based on the circadian pattern with the highest being between 6am and 8am. My understanding that spacing them out can actually encourage adrenal suppression, so it is definitely something that should be discussed with your doctor before doing it. I am sure there are some good reasons to split a dose, I am not a doctor so I don't know what they might be.
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1 Reaction@dadcue I believe what linda7 is trying to tell you is your experience is your experience and does not apply to everyone. None of us are medical professionals, we are the victims of this horrid PMR and everyone's journey is a little different from the next person. Simply explaining what you understand is enough. We need to all respect that we each struggle to decide what is right for us.
I have recently been diagnosed with Giant Cell vasculitis, asymptomatic, all very rare and I suspect that there is not another member of this Group that has walked the road I am on. They are still trying to evaluate where I am on the Giant Cell journey while I live with the threat of a possible aortic aneurism. It is scary, both my short-term future and my long-term future are unknown. I am determined to play the hand I was delt with maturity and optimism. Plus, I have a three-week vacation planned to start the first of Feb. We need to find out if I should cancel. We never know what someone else is dealing with.
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6 Reactions@dadcue Thank you for sharing your experience. Everybody is different, for the rate of metabolize the prednisone varies. Mine is slow one. Just 10 mg in the morning could cause me sleepless during night. After initial tree days of dosing at 10 mg/day, I had to drop it to 5mg/day. That was the dose I took for the next three months. Of cause it was not very comfortable, there were some bearable pain and stiffness, especially in the morning. It was still better than sleepless night. After that, it took 15 months to completely off prednisone. Thinking back, I realized my Adrenal system was compromised, but never stop working. That made the journey back to prednisone-free life easier.
PS. I was medicinal chemist before retirement, I have habit of doing literature search before starting any medication. Eg. prescription was 15 mg/day. After search/calculation, I knew the correct dose was 9.8 mg/day for my body weight. Also, I asked to check my cortisone level before I took off prednisone. My PMR was more and less related to the Covid vaccine boost shots. I stopped taking vaccine shots during recovery. That was my personal decision. Everyone should consider their own priority.
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2 Reactions@bluebird25, That’s exactly where I am! For the past 2 weeks I alternated 3.5/3 mg. This is my first week with 3 mg daily. In another 6 weeks or so, I’ll do the 3/2.5 mg alternating dosages. Good luck!!
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3 Reactions@dadcue , I don’t have PRM. I have secondary adrenal insufficiency from being on prednisone for asthma. Every time I have to stress dose it’s harder and harder to wean back down. I was finally down to 6 mg then had to stress dose for broken ribs and after being on 7 mg for 9 days (I was decreasing by 0.5 mg every 2 weeks), I passed out twice which earned me a 4 day stay in the hospital. There no one could figure out why I passed out. I was seemingly doing okay back up at 7.5 mg when the day of discharge I got a message from my long distance endocrinologist’s muse saying to go up to 9.5 mg. I did that and was supposed to decrease by 0.5 mg every few days which I didn’t tolerate at all so the Endo said okay decrease by 0.5 mg every week or 2. I haven’t been able to get below 9.5 mg since. When I dropped to 9 mg after being at 9.5 for 15 days, I started with all of the same symptoms again, headaches, dizziness, extreme fatigue, cold clammy sweats, feeling like I was going to collapse, so just tonight I increase back to 9.5 for the day by taking an additional 0.5 mg this evening when I couldn’t take feeling this bad any longer. I don’t know if this increase is even going to be enough to bring me out of this. Even after passing out twice my endo doesn’t think this had anything to do with adrenal insufficiency yet she increased my dose which seems strange to me. She says I look good on paper and I therefore shouldn’t really need more than 5 mg daily. At this point I don’t even know which way to turn. I feel like this stuff which I now call poison is going to kill me. I’m trying to get to Mayo to be be evaluated but have hit a road block with my insurance so I’m working on that. Prednisone has completely taken over my life and I couldn’t hate it more.
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3 Reactions@staylorrn2000 ‘You look good on paper’! That comment would send me running to another doctor. Bloodwork is a very blunt and inexact instrument. If a doctor discounts how you feel in preference to numbers on a page, they are not a good doctor, in my opinion.
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4 Reactions@staylorrn2000
It isn’t easy to manage adrenal insufficiency. When adrenal insufficiency is caused by prednisone, the only way to manage the symptoms is more prednisone. The only way for the adrenals to recover is less prednisone. This situation is a classic Catch-22.
The situation is also known as the prednisone trap. I was caught in this trap but I got lucky when I escaped in the words of an endocrinologist.
Isn't hydrocortisone pills an option when prednisone is only used because of adrenal insufficiency?
@kjoed53
Yes … I was offered hydrocortisone for adrenal insufficiency but it is just another corticosteroid. The endocrinologist that I saw gave me the option of staying on prednisone. She didn’t think hydrocortisone would make much difference for adrenal insufficiency. It probably isn’t as good for PMR either because I would have had to take hydrocortisone three times per day.
@dadcue
Both are corticosteroids, but they differ in potency, duration, and side-effect profile. Hydrocortisone more closely mimics our natural cortisol and causes less adrenal suppression than prednisone. It also has less effect on bone density. It's not supposed to treat PMR as it should only be used to treat the adrenal insufficiency that can occur with long term prednisone use, and as a means of ending prednisone use. For some people, the bone loss from prednisone use is a serious concern and hydrocortisone would be preferable for them. It's an option that should be considered if bone loss is a concern or if elimination of prednisone is preferred.