Questions about tapering MTX and pred

[annekat]

My doctor is talking about having me start reducing dosages of my meds, which are 15mg./wk methotrexate and 10mg./day prednisone (and Bactrim). He said he was leaning toward me reducing the MTX first, to 5 pills a week, or 12.5mg./wk. I said I was more in favor of tapering the pred, since 15mg. MTX is a pretty low dose. He said, OK, but wanted me to taper the pred faster than what many people here typically do, to get down to 5mg. in a month or so. I argued that I only wanted to go 1mg. at a time, based on experiences I've read here. He thought it was unnecessary to go that slow, but agreed to let me do it however I wanted, and wrote me a prescription for 100 1mg. pred pills which I can combine with 5mg. gotten by splitting a 10mg. pill.

I know there are threads in the archives about tapering pred, but I'm curious what those currently reading the forum think. Do people typically try to get off the MTX first or the pred, or do they do both at the same time? And do they typically taper the MTX, possibly to sub-therapeutic doses, or do they just quit it all at once, or what?

[Pete]

Hi Anne,

I don't have any words of wisdom about tapering mtx. I tapered off pred at 1 mg every two weeks. I've been off for almost six months, but am concerned about transient pain in my hands and upper thighs/hips. Will call wegs doc tomorrow.

[Dirty Don]

Anne, Mayo chose to get me off pred first, then, perhaps next year, they will/may start reducing mtx if my numbers remain good. They want to make sure the mtx is doing what it's supposed to do w/o the assistance of pred...that is considered progress. You are right in controlling how fast you reduce drugs.

[annekat]

Thanks, Pete, and Don. I value what both of you have to say. And it pretty much fits with my intuition. Honestly, I feel I know more about the use of Wegs drugs, and weaning off them, than my doc does, because I have been reading this forum every day since March of 2011. I consider it a small victory that he is letting me decide how to manage it at this point. I think I'll try your regimen of 1mg. less every two weeks, Pete, and see how it goes. At that rate, I will be down to about 6mg. when I see him in two months, and I don't see how he could argue with that. I'll also keep in mind and possibly try to repeat what you said, Don, about why people go off pred before MTX.

[drz]

When I tapered pred from 10 to 5 mg, I went down 1/2 mg every two or three weeks and had little trouble while going that slow. i used 5 mg, 2.5 mg and 1 mg tablets which were scored for easy cutting in half. My long term maintenance dosage is the 5 mg that I have been on for past year and half and expect this will continue for a very long time. My doctors say at this level I should not have many adverse side effects and I also seem to be tolerating the AZA OK too. I probably can't afford a major flare given extent of my kidney and lung damage i already have from Wegs so they plan to leave things as they are for long time since 80% of Weggies flare within two years once they quit all meds and that risk is too high for me.

[mishb]

Mine also want to keep me on the higher MTX (20mg) whilst tapering the pred.

My Aunty's specialist for RA told her to decrease 1mg every two weeks and she had a terrible time and basically went in to adrenal shock.
Then she had to go back on to pred again - therefore I reduced even slower.

My rheumy had me doing it crazy - I was advised to print out a 30 day calender and marked it this way
15mg, 15mg, 15mg, 14mg, 14mg, 15mg, 15mg
15mg, 14mg, 14mg, 15mg, 15mg, 15mg, 14mg
14mg, 15mg, 15mg, 14mg, 14mg, 15mg, 15mg
14mg, 14mg, 14mg, 15mg, 15mg, 14mg, 14mg
14mg, 14mg

So 3x15's then 2x14's then 3x15's for two weeks
then 2x15's then 3x14's etc for two weeks
then 4x14's then 1x15 for two weeks
and then two weeks of 14's
then 3x14's then 2x13's and so on.

It was really slow- it worked out to be a drop of 1 or 1 1/2mg per month - and now I am at 3mg's and that is it I'm afraid.

She wanted me to do it really slow, but I also have other AI issues, so that could be why.
Everyone is totally different and you may be able to just go to 14 straight away and not have a problem.......and then 13 etc.
If at any time, you start to feel that 13 or 12 or 10 or whatever number, doesn't feel right - then go back up to where it did feel comfortable and try again.
I don't think there is any fast or slow rule - my GP said that he didn't even realise that 1mg every two weeks to zero, could send you into adrenal shock
- and maybe it doesn't for some people, for some illnesses.

Just do what you think is right, for you

Good luck and I hope you can get completely off them, one day

[annekat]

Thanks, you guys. Wow, Michelle, that is some tapering schedule. I did have trouble going from 15 to 10 and ended up hovering around 12.5 for while. I just did it by feel and it was slower than the doc suggested, but I finally did it and he didn't argue. I will start with 9mg. and see how it goes. If I feel terrible, I'll bump it back up to 9.5 or 10 and take it from there.

[whatthewhat]

Anne, that is so great that you are aware of your body &able to speak up to your doc like that.

Our teenage daughter is tapering & is doing so much faster than I was familiar with. But her funny rheumy just grinned and said "That's so 80's" when I said I tapered from Pred more slowly as a kid. Made me laugh. He is a ped weggie expert, and I trust his wisdom & experience.