How much Prednisone to increase?

Posted by aznurse58 @aznurse58, Aug 31 11:41am

Tapered from 10 mgm Prednisone to 7.5 mgm and it was too much. Increased to 10 mgm 10 days ago, but I'm still having pain and extreme fatigue.
Should I increase more?
NP not a big help

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

I dont know any of your particulars. But for my own case it seems the 10mg mark is about the minimum required to keep the PMR in check. I went 3 months before diagnosis but I started on steroids by self diagnosing myself. When I had my ESR and CRP checked they were in the normal range. I had found 10mg was the lest Prednisone i could do with some pain but able to function. It took 4 months for me to be able to reduce from 10mg. I tried several times and could not do it. However at 4 months I reduced to 5mg and had some pain but was manageable. Two months later I was off steroids. By the comments on this site my 6 months was fairly miraculous. There would be no sense in trying to taper from 10mg if your PMR is not burned out. It is called a self limiting disease and it appears to resolve itself but that is a difference for every patient. Many have other auto immunes show up as well. I think when your having trouble tapering from 10mg its usually the PMR is still active. About 7mg and below its usually adrenal insufficiency. Thats just my guess. I would check your blood markers and make sure. Unless they are like mine and not elevated. Then just go by your feeling.

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Thanks. Markers slightly elevated but consistent.

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Dropping from 10mg to 7.5mg per day is a 25% drop in steroids. This may be too much for your adrenal glands to manage. Adrenal insufficiency is a concern when titrating down. Adrenal insufficiency can be confused as a PMR flare. This topic has been discussed at length in other posts. Please do a Search on the PRM Support Group home page -
https://connect.mayoclinic.org/group/polymyalgia-rheumatica-pmr/
Possible search words would be tapering, titrating, adrenal, flare

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This is not an easy decision if you don’t have access
to an experienced physician. How is it affecting your
daily activities and sleep.? It may be time to consider adding a steroid sparing disease modifying drug or be
reevaluated by another specialist.
Are you taking measures to mitigate prednisone side effects? Have you tried an anti inflammatory diet.?
Advocate for the level of care you need if that requires a
second opinion.

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I had extreme fatigue in the beginning and started to take iron pills and that fixed me.

Also, I think you need to find a dosage where you don't have pain, and THEN taper down by .5mg (or less depending on the percentage drop) every two weeks. If you experience pain go back to the dosage that you took when you didn't have pain. That has been my path, 1 year and I'm at 2.25 (I break my pills into tiny pieces) and looking forward to seeing if I can take just 2mg. But if not I will go back to 2.25 for another two weeks. I started at 15 mg but was in agony after a few weeks and went to 20mg. We are all different but we can still try other's methods to see if they work for us.

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"Once a daily prednisone dosage of 10 mg is reached, tapering should be slowed to a rate of 1 mg every 1 to 2 months until discontinuation. Typical treatment lasts 1 to 2 years. Attempting to taper steroids before symptoms resolve or too quickly after symptoms have resolved may result in a higher rate of relapse and decreased success with treatment cessation."
https://www.ccjm.org/content/87/9/549
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According to the latest EULAR/ACR guidelines. Tapering should be individualized once remission is achieved.

Two things must happen:
#1 Remission of PMR must come first.
#2 The adrenals must be capable of producing cortisol. Prednisone causes adrenal suppression which is why a slower taper is needed after your prednisone dose gets into single digits.

Don't forget pain and extreme fatigue are symptoms of both adrenal insufficiency and prednisone withdrawal. It might not be a PMR flare.

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