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Are There Guidelines for Prednisone Tapers
I am new to PMR: Diagnosed 1 month ago. I really want to learn more about reasoning, professional opinions, and guidelines to prednisone tapers schedules. I am taking a high level, tapering down every 2 weeks it seems excessive. How can you evaluate this? My sed rate is now down to a normal level
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1 day new dose, 6 days old dose
1 day new dose, 5 days old dose
1 day new dose, 4 days old dose
1 day new dose, 3 days old dose
1 day new dose, 2 days old dose
1 day new dose, 1 day old dose
1 day old dose, 2 days new dose
1 day old dose, 3 days new dose
1 day old dose, 4 days new dose
1 day old dose, 5 days new dose
1 day old dose, 6 days new dose
I’ve used as a tapering plan for 12 years. Adjusted for flares, etc.
Under 10mg reduce by no more than 10% +\-. Sometimes I shortcut by starting at 1 day/ 4 days.
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1 Reaction@rlstonejr When I got to 7.5 mgs my doctor had me taper alternate days 7.5, 5, 7.5, 5 for a month and it tapered me right into a flare and I had to go back up to 20 mgs. Now when I got to 7.5 I'm tapering 1/2 mg every 6 wks. Currently at 6mgs and fine except for fatigue which I'm sure is the adrenal glands trying to wake up. Everyone is different but I can't do the alternating schedule.
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3 Reactions@pah17 I found a diagram with from the and back views of the body with the upper "girdle" (shoulders upper back) and the lower "girdle" (hips, upper thighs) highlighted in light red shading.
It was on: https://my.clevelandclinic.org/health/diseases/25215-polymyalgia-rheumatica
Scroll down to see the body diagram
Good article all around.
@kobellava
My doctor suggested 1mg decrease per month. I am about to start on that. I am at 10mg Prednisone right now.
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3 Reactions@betsyhase The doctor that caused the flare was my ophthalmologist my other doctor suggested 1 mg a month once I got to 7 1/2 but I'm taking it slow basically for the adrenal glands when you get to the lower dose. My Aunt has been on 4 mgs for 20 years for PMR, she's 90 and doing well. My doctor said people take maintenance doses of 5 mgs for life. Everyone is different I just don't want another flare. It was horrible. Wishing you all the best.
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2 Reactions@gwl I’ve been blessed that only the hands in particular one or two joints on left hand are the most painful. Especially if golfing. I take Aleve or Advil occasionally for the pain. At 70 I accept the pains as a “passage of rite” into this stage of life.
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1 Reaction@kobellava
My doctor has suggested decreasing 1mg per month. Originally I thought that was too slow but after reading all the setbacks from going faster, I will be patient and hope for the best.
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2 Reactions@betsyhase
Prednisone is commonly tapered by 1 mg per month after you reach 10 mg. After that, "setbacks" might be inevitable no matter how slowly a person tapers while on lower doses of prednisone.
I had many setbacks during my 12 years of being on prednisone. My doctors were very patient with me most of the time. Eventually a doctor said 12 years was "too long" to be on prednisone and wanted me to try something different. I'm very grateful to the doctor who wanted me to try a biologic called Actemra which was introduced to me as my "best hope" of ever getting off prednisone.
Funny thing happened after I started Actemra. I was told that I tapered "too fast" when I went from 7mg to 3 mg in a couple of weeks.. I had to stay on 3 mg for a long time until my cortisol level improved. A setback of PMR pain wasn't ever a problem while I took Actemra and stayed on 3 mg of prednisone. After my cortisol level improved AND while PMR pain was still controlled with Actemra, I was told to discontinue prednisone. After my cortisol level improved, going from 3 mg to zero didn't involve a long and slow taper. I would not say "no taper" because that wasn't how I discontiued prednisone.
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2 ReactionsThere are guidelines. See image for UK NICE guidelines. But Note; these are under review. Here’s a link to EU guidelines. https://ard.eular.org/article/S0003-4967(26)00357-2/fulltext
But there’s also a lot of research around the high %age of people who ‘fail’ during tapering. My experience with GP Nutritionist and Pharmacist is that tapering needs to be personalised. And run in parallel with changes - nutrition, activity, sleep, lifestyle - to eradicate the underlying inflammatory/autoimmune problems that provoked the onset of PMR. Otherwise the chances of tapering failure and/or return of PMR seem quite high. Lots of great online info on Inflammation and PMR, Diet and PMR. Cytokine production and PMR. Healing the HPA Axis and PMR. It’s the endocrine background to PMR.
Happy to share my tapering schedule but it is my personalised schedule.
Good Luck!
@dadcue There are no guarantees with GCA or PMR as far as treatment. My Aunt has PMR, she's 90 and has been on a maintenance dose of Prednisone of 4 mgs for over 20 years. Very active person. I have GCA and tried 1 injection of Actemra and ended up in emergency room with breathing issues. It works for some but not everyone. I don't think people necessarily need to be off Prednisone. My bloodwork has been stable and the side affects right now I'm sure has to do with reawakening my adrenal glands. Happy your treatment has worked out well for you, wishing you continued success!