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When and How to Taper Prednisone

Polymyalgia Rheumatica (PMR) | Last Active: Sep 20, 2023 | Replies (39)

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@johnbishop

@vellen I'm guessing 2 weeks was too soon to taper down. I've had 2 occurrences of PMR and I was started on 20 mg prednisone for both. The normal starting dose is 12.5 to 25 but sometimes higher depending on how well your pain is controlled with the starting dose. You might want to share this reference with your doctors assistant.

--- 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative:
https://ard.bmj.com/content/74/10/1799
I worked with my rheumatologist on the tapering. He had me keep a daily log with my level of pain on a scale of 1 to 10 when I first woke up in the morning along with my dose of prednisone for the day. I took 3-1/2 years to taper off the first time and 1-1/2 years the second time with PMR.

If the 15 mg starting dose got rid of all of the pain for you but the pain came back after 3 days at 12.5, it sounds like the taper was too much too fast. Everyone is different so it can be a challenge tapering. I think I would ask my doctor for a prescription for 1 mg and 2.5 mg prednisone tablets so that you can taper by smaller amounts when it's time to taper. Then if your pain goes up after dropping from 15 to 12.5, instead of going back to the previous dose, my rheumatologist had me bump up about half of the previous taper to see if the pain is controlled. So, for example, I would just go back to 13.5 and if my pain was gone the next morning I would stay at that level for a couple of weeks at a minimum until I tried another taper. I think that is why it's so important to keep a daily log and work with your doctor or rheumatologist.

Do you keep a daily log of your pain level and prednisone dosage?

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Replies to "@vellen I'm guessing 2 weeks was too soon to taper down. I've had 2 occurrences of..."

Thanks for the information John. No, I've not kept any logs but haven't had a problem (outside of side effects) unless I wait too long for the dose, either by sleeping late or like tonight, lost track of time and was an hour late, then it's a return of pain. I'll stay on this dosage until I see him next month. Perhaps the next prescription can be 1mg pills since my insurance wouldn't approve two different milligrams initially.

That is a great suggestion as far as getting 1 and 2.5 mg for tapering. I try cutting my 5mg in half but invariably, some still break apart.
I agree, tapering is a challenge and because everyone's body and reaction is so different, there is no Rx for how to do it other than trial and error. Glad to be part of this group (not really, but glad I found it LoL). Learning so much.