When and How to Taper Prednisone

Posted by vellen @vellen, Jun 24, 2023

I was started on 15mg for two weeks. I then was told to take 12.5mg for 30 days.
At day three of the 12.5, I woke in a lot of pain. I went back up to 15 by the doctor's assistant said that was fine, that was June 8 or so. I found out then that the doctor is out of the office until July 11. Yikes, right?
How do you know when to start tapering or is this something I was supposed to be doing already?
I have 5mg pills only and take 7.5 in the morning and at night 12 hours apart.
Any advice is appreciated.

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

I am in my 5th year of up and down prednisone dosing. I recently got my 1 mg tablets refilled and the tablets are orange. Thought they looked like St Joseph's aspirin for children. Checked the label to make sure it said these pills were small orange tablets. They are scored but do not break in half easily, I get 4 pieces most of the time.
After reading about blood pressure med recalls a while ago ( I take BP meds) I got curious about the companies supplying my pills. It's on the label, usually abbreviated. I checked all my bottles and researched the companies and how many recalls they had. I did complain to the pharmacy about one of the companies. It was overseas and imo had too many recalls. I started paying attention and reading everything printed on the labels.
When you take several meds it is definitely helpful having different shapes, colors and sizes.
suzanne

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@54pontiac

Yes, I filled a daily pill container for a trip and some of the pills spilled on the journey. Fortunately I had it in a bag, but I learned that the pills themselves don’t have the dosage on them. And the 10 mg and 1 mg have the same inscrutable number on them but are slightly different sizes. Glad I also brought the containers with me!

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I now take quite a few pills at three times a day (different maladies). I finally bought a pill
organizer and soo happy I did. The only hard thing about it is the day I fill it ha. Well and making certain I'm taking the right am/pm day.
Yeah, I scare myself at times! 😾

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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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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.

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You need to go to the pharmacy and buy a pill cutter they are about $4.00
I have had pmr for over 2 years now started at 40 mgs then tapered every couple of weeks 5 mgs then 2.5 mgs till got to 10. At that points was told to taper 1 mg per month. Was fine till 8 mg then had a flare. Started again at 14 reduced to 10 again but then reduced by 1/2 mg per month. I am now at 3 mgs you should not reduced more then 10% at a time. But once you are at 5 mgs just slow down. This disease affects people differently I am not a dr my thoughts here are only my own it may not be the best for you. I have done a lot of research on my own on the internet with Google. My Gp is great he agrees with what I am doing as he says I know how I am feeling
Go online and check out the different tapering plans
Read books about this disease and read different threads here. all the best

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If I understand correctly, Prednisone does nothing to cure PMR or make it go away. I'm 78, just starting to deal with Predisone on a continuing basis, and want to take the least amount possible due to its problematic side effects. My doctor has been very supportive of minimizing the Prednisone so I'm starting with 10 mg and tapering week by week, but taking it back up if I need to due to pain. I have also committed to following an anti-inflammatory diet and exercising. (When I was in such pain I would have committed to living the rest of my life on bread and water and running a daily marathon) I hope I can keep this commitment now that I'm feeling better. Do others find a good diet and exercise help as you taper? And what about taking daily doses of Ex-Strength Tylenol to help manage the pain (and keep Prednisone levels as low as possible).

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@barbsnow

If I understand correctly, Prednisone does nothing to cure PMR or make it go away. I'm 78, just starting to deal with Predisone on a continuing basis, and want to take the least amount possible due to its problematic side effects. My doctor has been very supportive of minimizing the Prednisone so I'm starting with 10 mg and tapering week by week, but taking it back up if I need to due to pain. I have also committed to following an anti-inflammatory diet and exercising. (When I was in such pain I would have committed to living the rest of my life on bread and water and running a daily marathon) I hope I can keep this commitment now that I'm feeling better. Do others find a good diet and exercise help as you taper? And what about taking daily doses of Ex-Strength Tylenol to help manage the pain (and keep Prednisone levels as low as possible).

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Hi @barbsnow, Not sure I could have made it through my 2 occurrences of PMR without prednisone but I made some major lifestyle changes when my PMR came out remission after 6 years and it really helped me to taper off of prednisone quicker, one and a half years vs three and a half years the first time. Here's some information that may help:

--- Polymyalgia Rheumatica Diet: Do's and Don'ts: https://www.healthline.com/health/polymyalgia-rheumatica-diet

Tylenol never helped me unless I had a headache but others may have a different experience.

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@barbsnow

If I understand correctly, Prednisone does nothing to cure PMR or make it go away. I'm 78, just starting to deal with Predisone on a continuing basis, and want to take the least amount possible due to its problematic side effects. My doctor has been very supportive of minimizing the Prednisone so I'm starting with 10 mg and tapering week by week, but taking it back up if I need to due to pain. I have also committed to following an anti-inflammatory diet and exercising. (When I was in such pain I would have committed to living the rest of my life on bread and water and running a daily marathon) I hope I can keep this commitment now that I'm feeling better. Do others find a good diet and exercise help as you taper? And what about taking daily doses of Ex-Strength Tylenol to help manage the pain (and keep Prednisone levels as low as possible).

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Tylenol helps me a great deal on bad days. I try not to take too much of it. And yes exercise is important. I have to say it is hard to make my butt move some days. Fatigue and pain but I feel better overall if I do. Also changed my diet but I haven’t completely eliminated all the “bad stuff,”. Had a chocolate Sunday last night.

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Hi Folks, I am new to PMR, just over 2 months on Prednisone (had symptoms 6 months before Prednisone) Started on 20, to 15 to 10, split dose. I am reading all these stories and am very discouraged that people are on prednisone for years to treat this disorder. I do not want to be on prednisone and am trying to learn tapering schedules and responses to such. I have learned everyone has different experiences.
But what I really need to know is if anyone out there has a story of quickly getting off this medication? What is the shortest taper schedule possible? I do realize the importance of a slow taper in relationship to the adrenal gland but I can't comprehend being on it more than year. Is this possible or is it wishful thinking?

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@jj8431

Hi Folks, I am new to PMR, just over 2 months on Prednisone (had symptoms 6 months before Prednisone) Started on 20, to 15 to 10, split dose. I am reading all these stories and am very discouraged that people are on prednisone for years to treat this disorder. I do not want to be on prednisone and am trying to learn tapering schedules and responses to such. I have learned everyone has different experiences.
But what I really need to know is if anyone out there has a story of quickly getting off this medication? What is the shortest taper schedule possible? I do realize the importance of a slow taper in relationship to the adrenal gland but I can't comprehend being on it more than year. Is this possible or is it wishful thinking?

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Was on prednisone for 12 years. Took me a year working with an endocrinologist to get off it. We substituted my medrol dose for hydrocortisone tablets in an amount equal to the one medrol pill. Every few months, I took one less pill as long as my blood work showed it was safe to do so.

Finally took my last hydrocortisone tablet last February when my cortisol blood work came back as normal. I think anyone going off long term steroid treatment needs to work with an endocrinologist to make sure you don't go into an adrenal crisis. I had to carry extra pills and a hypodermic in case I had any trauma. Good luck to everyone trying to get off. I will say I felt better on medrol but the risk of diabetes which I avoided but the fact I now have osteoporosis made it essential to get off it. No good deed goes unpunished.

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@tarmansbks

Was on prednisone for 12 years. Took me a year working with an endocrinologist to get off it. We substituted my medrol dose for hydrocortisone tablets in an amount equal to the one medrol pill. Every few months, I took one less pill as long as my blood work showed it was safe to do so.

Finally took my last hydrocortisone tablet last February when my cortisol blood work came back as normal. I think anyone going off long term steroid treatment needs to work with an endocrinologist to make sure you don't go into an adrenal crisis. I had to carry extra pills and a hypodermic in case I had any trauma. Good luck to everyone trying to get off. I will say I felt better on medrol but the risk of diabetes which I avoided but the fact I now have osteoporosis made it essential to get off it. No good deed goes unpunished.

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Omg, 12years! I have to figure out what to do so that doesn't happen to me. I wonder if the longer you are on steroids, makes it more difficult to come off. That is part of my impatience. I want to taper quick so that it doesn't destroy my body or make me dependent on them. Thanks for your story. Glad you eventually got off before you sustained any more damage. Good point about the endocrinologist. I will keep that in mind. I am hoping there is somebody out there that has a better outcome, like a year, not 12, ugh!

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