When and How to Taper Prednisone

@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?

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.

FYI, for those needing more information and/or experiences tapering, I found a helpful thread from 2017 under the PMR support group. "Tapering off of Prednisone".

@vellen, I thought I would share a direct link to the discussion you found helpful so that others that haven't seen it can check out.
--- Tapering off of Prednisone: https://connect.mayoclinic.org/discussion/prednisone/

Thank you! ❤

Hi again- Echoing the others here and sending support.

We worked with my dad’s rheumatologist on the tapering, following general guidelines but honestly it’s more guided by his symptoms. As she puts it: “We have to listen to what his body says.”

He was on his initial prednisone dose of 20 mg for at least a month, but sadly this was because he has a stroke two weeks after diagnosis of PMR was diagnosed and we didn’t want to rock the boat while he was recovering. He was eventually out on 30 mg for at least another two weeks because it wasn’t enough; after an initial drop in his ESR and symptoms, it spiked again.

His rheumatologist has him take a new dose for at least 2 weeks and if his pain and fatigue are stable and no sign of a flare, plus labs look ok, he reduced by 2.5 mg. (We tried dropping by 5 mg, and that was too fast, so again, she was deferring to how his body responded).

We continued that way. If after a reduction in dose, there was a flare or an initial increase in symptoms didn’t resolve after 2-3 days, we went back up to the previous dose for another 2 weeks and would try again to drop the dose.

After getting to 10 mg, we’re going even slower. He took 10 mg for 4 weeks. Then alternated 10 of and 7.5 mg for 2 weeks. Now he alternates 7.5 mg and 6.25 (it’s a 5 mg tablet + half of a 2.5 mg tablet—so crazy).

Why all the craziness with the numbers? We tried to put him on alternating 7.5 and 5 mg and he had a flare!

I guess we’re lucky in that his insurance will cover the different denominations of tablets. We need to get 1’s. I’m planning to ask his rheumatologist for those this week because he just had new labs drawn.

I think I mentioned this in the other thread you cited, but you might be able to try getting your entire prescription in the smaller denomination of pills i.e. I take 112.5 mg of a different medication.

However, the script is written that I should take 5, 25 mg tablets every morning (I take 4.5 tablets). My doctor did it that way because 25 mg is the smallest denomination of these tablets, and we wanted to titrate slowly. 112.5 mg was where we landed.

Hope that helps!

@emo, yes that helps a lot! It sounds like your dad is in the same boat as I with needing to spread out the dosage each day and yes, I plan to ask for the next rx to be all 1mg. The taste is awful for sure but... soldier on.
Light and love to your dad and you.

I am looking for a creative taper that I read on here somewhere. New dose for a day and then old for six. And the new for two days and old for five, or something like that. I am stuck at 9.5mg of prednisone. Trying not to do too much yo yoing

Was it this one?
Dead slow and nearly stop reduction plan (Tapering)
https://healthunlocked.com/pmrgcauk/posts/131189593/dead-slow-and-nearly-stop-reduction-plan

That’s it! Thank you so much. Gonna give it a whirl!

Melissa