Prednisone dosage lowered two days ago, feels like I got hit by a truck this morning.

[SpaceflightAddict]

Good morning everyone,

At my rhumey appointment on this past Tuesday, my doc wanted me to lower my prednisone dosage from 40mg to 30mg starting the next day (Wednesday 10/23). I felt fine at the lowered dosage all day Wednesday and Thursday, but this morning it feels like I got hit by a cold wet truck.

I woke up this morning around 4am with an actual headache (in addition to the usual sinus pain), my body felt stiff, and my back was drenched in sweat.

I am feeling better as of right now, about an hour after taking my morning medicine (prednisone, CTX, Bactrim), but it was a miserable couple of hours this morning.

I suspect that my body is not used to the lower dosage of prednisone yet, as I started feeling better after taking it this morning.

Has anyone else experienced this when tapering from 40mg to 30mg of prednisone? Should I give my doctor a call and let her know what happened this morning?

Thank you all for any input you have.
-Andy

[Dirty Don]

That large of a drop in pred reduction may have caused a minor drug withdrawal. Your reaction sounds like that. I'd tell the doc if for nothing else to let the person know that is too large of a reduction at once. 5mg would have been easier on you...2.5 would have been even easier. The tapering process is a bit different for everyone, but, nevertheless, a large reduction may be too fast for your body. Best of luck.

[pberggren1]

Go back up to 40 right now and call your doc, this is adrenal crisis.

[annekat]

At those higher doses, that doesn't sound like such a big drop, but everyone is different. I think docs are too casual about these tapers and should provide the patient with advice for regulating his own dose if this sort of thing should happen. Good idea to call your doc and let him know what is going on. It certainly will hurt nothing to go back to 40mg in the meantime, and probably will help a lot.

[drz]

I was given a lot leeway but some guidelines and advice on tapering and found for me going slowly seemed the best. I think most doctors will do so if you discuss it with them.

[annekat]

Andy, I'm thinking maybe you haven't been on pred all that long, since you were dx'ed fairly recently.... and maybe your adrenals wouldn't have fully shut down yet, if it's been 2 months or less.... so the doc might not have been as cautious. Or maybe I'm remembering it wrong. I my case, the doc tried to get me to go from 50mg. to 30mg. pretty early in the game.... I still felt lousy and felt it was too much of a drop, and don't remember whether I argued with him or just snuck some extra pred that I happened to have around. Of course, we are not supposed to do that, but I'd had enough previous experience with pred, from being treated for sinus infections and such, that I didn't think it was a big deal. I was already developing a sense of knowing the signs of what my body needed and how WG was reacting to the meds. That's what a lot of us end up having to do. These days, I argue with my doc about dosages and he always backs down, or if I vary from what we talked about, he doesn't get upset. With pred, anyway. Not so much with the immunosuppressant, which is currently MTX. I tend to go with what we agreed on for that and would just call him if I felt it was detrimental, like if I might be flaring.

[mzschaumkell]

Hi ya, my partner feels like that when he drops the pred, the bigger the drop, the larger the truck haha when he dropped from 60 to 40 he slept for two days....the one thing he does now, is when doctor says drop by 10mgs, he does 5 one week and 5 the next, seems to minimise the withdrawals....but doc says it's completely normal...

[Alysia]

I must say that all this issue of "adrenal crisis" scared me
I found this info helping to understand if it is so...
Acute adrenal crisis: MedlinePlus Medical Encyclopedia
and comparing to pred withdrawls symptoms:
http://www.medicinenet.com/steroid_withdrawal/page2.htm

[Rose]

Hi

I remember dropping 10mgs at time when reducing from 60mgs without too many problems. For me the problems came when reducing from 20mgs then I took it more slowly getting from 20 to 10 by dropping 2.5 mgs every few weeks. Should you go back to 40mgs as people have suggested and the symptoms you are experiencing disappear then you'll know the reduction was too fast for you...as others have said, we all respond differently. If the symptoms persist then it is probably not the pred reduction to blame.

I actually flared in the middle of my initial treatment protocol of 6xmonthly IV cyclophosphamide and 50 mgs of pred. My initial symptom of a constant runny nose returned and being Spring the doctor thought, as I was under treatment for the Wegs, it was an allergy ...until I pointed out that I never suffered allergies before so she did an anca and few other tests and sure enough I was flaring. Another round of 3xdays solumedrol and another 20lbs was soon added to 20lbs I already had gained!! This is one sneaky disease.

[annekat]

Those are interesting links, Alysia, especially the one on pred withdrawal where it talks about how alternating days , one with pred and one with no pred, can stimulate the adrenal glands and their related functions. This is what Phil is currently doing, as far as I know. My doc suggested an alternation of 10mg. one day and 5mg. the next, to get me down from 10mg. to 7.5mg., and I thought that was too radical, but in light of this info, there may be some wisdom to that kind of alternating. So I may try this pretty soon, probably not with a whole day off pred yet, but with a less extreme but still significant alternation.