Prednisone - how to tell when to reduce your dose

[ScreaminMeanie]

I started tapering pred 15 days ago from the 5 mg I'd been on for about 6 weeks, after an unsuccesful attempt to reduce from 5 to 2.5 mg back in November. The first day I went to 4 (as doc suggested), but I felt awful from about noon on. I went back up to 4.5 mg the next day and have been there ever since. This week, for the first time, I actually had three days in a row where I felt good, not just okay! I figured that would be a good time for me to drop the dose again, so I started today on 4 mg. So far, so good!

Does anyone have any type of signs or benchmarks that they use when tapering pred? My doc said I could do it however I liked, as long as I didn't drop faster than 1 mg/month.

[Sangye]

I get sudden afternoon sleepiness if I taper too fast. It's like someone has given me anaesthetic.

If you've gone too low, the key is increasing the dose quickly (within 2-3 days maximum). It's good to sit at a dose until you feel very good there, then drop a bit more.

[Wee Gerry]

Following a weekend spent in hospital with respiratory problems my prednisilone was increased rapidly. November 15th 80mg daily, November 29th 60mg daily, December 22nd 40mg daily, January 17th 30mg daily,January 31st 20mg daily. This is the 3rd time I have been down as low as 20mg, when I go lower all the pains return but I have not had any problems lowering the prednisilone until I reach 20mg. I am seeing my my Consultant next week and I will be asking for a more gradual reduction than previous. What reductions have you had and over what time scale, it may help me when I meet him.

[Sangye]

That's a typical taper from 80mg to 20mg. You can't stay on the ultra-high doses for longer without damage. Once you get to 20mg you need to slow down a bit. For example you can't go from 20mg to 10mg in one jump. Usually you go from 20mg to 10mg slowly, then 10mg to 5 mg even slower, and 5mg to 0mg very slowly.

If you're having Wegs symptoms once you get below 20mg pred, it sounds like the main immunosuppressant isn't controlling the Wegs as it should. That's exactly what happened to me when I was first dx'ed and treated with ctx and pred, but my rheumy was so lousy he ignored it and told me to keep tapering off pred. For the next 2.5 years I had active disease that was barely contained by cellcept. It was miserable.

Also, it's normal to get some joint pain when tapering pred. The way to differentiate it from Wegs joint pain is that pred pain goes away after a few days of a new dose. Wegs pain persists or gets worse.

[ScreaminMeanie]

Also, it's normal to get some joint pain when tapering pred. The way to differentiate it from Wegs joint pain is that pred pain goes away after a few days of a new dose. Wegs pain persists or gets worse.

As obvious as this seems, it's not something I'd thought about! Thanks for turning on a light bulb for me!

[Sangye]

I don't think any of us figured that out for ourselves.

[NicShaf]

Are any other Wegs symptoms common in the first few days of tapering down on Preds? I just started going from 60mg to 50mg per day, and I have noticed my nasal symptoms and some slight chest pain I was having have gotten a little worse, has anyone else experienced anything like this? I started tapering Tuesday morning.

[elephant]

You need to rule out why you are having chest pain/ nasal symptoms. Call you doctor now if your having chest pain. It could be heart trouble, infection, WG....ect

[Sangye]

Nicole, I agree with Elephant. Nasal symptoms are no big deal unless they get worse, but chest pain can't wait.

[NicShaf]

I've had this pain for about 3 weeks now. I've seen my GP and Rheumy since. My GP seemed concerned at first, but she took a chest x-ray and said it looked clear, she sent it to my pulmonary to take a look. I saw my Rheumy this past Monday and showed him exactly where the pain was, and he seemed unconcerned...I have been concerned with it for weeks, and they both made me feel like I was over reacting, now I'm second guessing. I will send all my docs an email and see if I can get in asap...I'm supposed to see my pulmonary doc on Monday morning too.