The lowest effective dose, how is it defined?

"She's a chemist, not a doctor."
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In the United States a Doctor of Pharmacy (PharmD) is considered to be comparable to an MD (Doctor of Medicine). The specialties are different but I would trust a PharmD to know more about medications than a medical doctor.

I have taken a couple of pharmacy courses. The beginning level for nurses blew me away. I think Dr. Megan has earned her title and should be called a Doctor. She provides valuable information about Prednisone free of charge.

"Dr. Megan Jolley Milne, PharmD, BCACP, earned her Doctor of Pharmacy degree at a Top Ten pharmacy school, the University of Utah College of Pharmacy, following in her father and grandfather’s footsteps."

and ... she has personal experience with Prednisone.

"Dr. Megan is a third-generation pharmacist who experienced a mysterious rash and nearly bled to death, starting a roller coaster medical journey. One day she was a normal, healthy young mother of four children, and the next she was forced to take a lifesaving drug, prednisone. The drug stole vital nutrients like calcium from her body. The miracle drug made her feel miserable."

She acknowledges that Prednisone saved her life.

The BCACP certification isn't given away.
https://bpsweb.org/ambulatory-care-pharmacy/

I hope you don't mind if I step in and list some of the dangers of taking prednisone. I've been taking it for the past 8 months to treat PMR and GCA. I have a few of these side effects. I'm just listing these off the top of my head. I'm sure there are lots more.

Prednisone can raise your blood sugar and can cause diabetes in some people
It can raise cholesterol
It can cause weight gain
It can cause the redistribution of fat with fat being deposited in the face (moon face), at the base of the neck, and in the belly
It can raise blood pressure
It can cause insomnia
It can cause mood changes, such as depression, anxiety, etc.
It can cause problems in your eyes, such as glaucoma and cataracts. It is important to monitor
the health of your eyes when you're taking prednisone.
It can cause hair loss
It causes your adrenal glands to stop producing cortisol, so when you stop taking prednisone, you have to do it gradually so that your adrenal glands can become active again.
It can cause problems with muscles and tendons and make them more prone to injury
It can cause lower bone density leading to osteoporosis and fractures

Most of these side effects can be counteracted with diet, exercise, and supplements. Also the side effects depend on your dose and how long you take prednisone.

G'day Jim,
I've been taking prednisolone for 21 months now, starting at 15mg in May 2023, and am now at 5.5mg. A flare last year at the 6.5mg/6mg reductions sent inflammation markers up and a return of PMR pain at 5-6/10 pain level. That required a rise in dose to control, and it set the tapering schedule back a bit. I believe the PMR was still active at that stage. Prednisone is not curative, it just holds the inflammation and pain at bay while the PMR runs its course, and that course is different for everyone.

The dangers of prednisone are different for each of us, and are best discussed with your new rheumatologist. I hope you get a good one who is experienced in PMR treatment. Ask questions and speak up for yourself. If a doctor didn't include me as a partner in treatment decisions and explain the risks and benefits of various treatment options, I'd run a mile. Good luck with the rheumatologist.

I was speaking to a fellow Australian, and here we don't call pharmacists doctors.

I'm just saying she is highly qualified.

You may have read my post where I reported being in my fourth year of taking prednisone (3 1/2 years). Chances are very good that you will not be on it that long. I would advise you to stay in the present moment, not worry about the future, and deal with symptoms of the disease and prednisone side effects as they arise. I try to have a problem-solving attitude. I read all my lab reports which are available online. I have been on prednisone doses of 20 mg down to 4.5 mg. From 20 down to 7.5 I had these side effects: white blood cell numbers out of whack, heart arrhythmias, bruising and skin tears, weight gain, insomnia and a slight rise in cholesterol. My blood pressure was fine all along and my blood glucose actually went down 10 points which is good. Under 7.5 mg most of the negative side effects went away. At 5.5 mg I have lost 5 of the 12 pounds I gained but I was never overweight. I still have some insomnia but it is much improved. I feel all right and have a good life, though I have scaled back my activity level. This is a survivable disease. You may or may not have a lot of prednisone side effects but there are ways to deal with most of them.

"Most of these side effects can be counteracted with diet, exercise, and supplements. Also the side effects depend on your dose and how long you take prednisone"
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After 12 years at Prednisone doses in excess of 20 mg most of the time ... I experienced most of the side effects you listed. I escaped lower bone density leading to osteoporosis. I'm not blaming Prednisone but I had a T-score of +5 in my lumbar spine which was called "normal" but not good. My problem was too much bone in places that it shouldn't exist. It was called heterotopic ossification (HO).

The following sums it up well:
" Myositis ossificans is the most common form of heterotopic ossification, usually within large muscles. Its importance stems in large part from its ability to mimic more aggressive pathological processes. Myositis ossificans is one of the skeletal “don’t touch” lesions."
https://radiopaedia.org/articles/myositis-ossificans-1?lang=us
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Heterotopic ossification (HO) is sometimes called a healing process gone awry or an "aberrant healing process."

"https://pubmed.ncbi.nlm.nih.gov/28315426/#:~:text=Heterotopic%20ossification%20(HO%2C%20also%20termed,processes%20of%20osteogenesis%20and%20angiogenesis..
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All I know is that my immune system has gone off the rails or sometimes my rheumatologist says it is "deranged."

Thanks @megzeng
Just curious for that month tapering, was that your month to taper to 5.5, and after week 4, you started the same schedule aiming to be at 5 mg? In other words, you seem to only have a full week during the 4 week period to be at the target mg? Thanks, I will be trying your formula effective March 1st.

Yes, that's right. I'm in week 3 of that tapering schedule with only two of the seven days being 6mg and the rest 5.5mg. Next week I'll stay on 5.5mg only to make sure it's all good before starting the same schedule to reduce to 5mg. So far, so good.

Thanks @megzeng
I’m all in with this, and hope it’s the final schedule for both of us!