I notice that the Bristol Method of prednisolone reduction has rather large reductions of 2.5mg between 20mg and 10mg , albeit that they take place after 4 weeks. Since many on this forum talk of not reducing by more than 10% at a time, I wonder what experience others have had in following the Bristol Method between 20mg and 10mg. (I have GCA and am just now on 20mg and would like to follow a reduction programme further).
I have just come home from a check up with my GP and discussed this very thing with him! I have GCA/PMR and have just reduced to 20mg this past Saturday. I told him about the 10% and he said that I should reduce 2.5mg every 8 weeks instead of every 4 weeks to slow it down. I think I am happy with that......! However, if I have a flare up I shall do the 10%.
Hello Audrey, I don't know if the tapering process for GCA is different than for PMR, but I have PMR and experienced no problems at all reducing from 15, 12.5, 10mgs. I was kept on each dose for 6 weeks and on 10mgs for 6 months. I then reduced to 9mgs, no problem but when I attempted to reduce from 9 to 8 mgs had a flare. I put myself back up to 10mgs and reduced only by .5 every 6 weeks. I am now on 8.5 and currently experiencing no problems.
many patients do have problems with the 2.5 drops so although I am not medically trained I'd suggest 1mgs drops and stay on each dose for 6 weeks. Then when you get to 10mgs definately follow Eileen's slow and almost stop method. I follow this method, sort of, but as I said only reduce by .5 each time and so far I'm doing ok. All the best, christina
Hello rapha, if you experience any problems with the new suggested regime you could always try the regime I have suggested to Audrey. Remember I am not medically qualified. All the best, christina
Experience of 3 different forums and people reducing has resulted in some of us on the support groups realising that while some people can cope well with 2.5mg steps, others find the change in dose overnight upsets their body. That is why we started suggesting 1mg at time, even at doses about 20mg, when people were struggling and apparently having flares in their PMR. One of the signs of "steroid withdrawal" in any patient is signs of rheumatism and in PMR it was being confused with a flare and the patient went back to the higher dose - which worked whether it was PMR flaring or steroid withdrawal. In PMR you are reducing the dose to find the lowest dose that manages the symptoms and if you go in too large steps you are likely to miss that end point - 10mg is fine, 7.5mg isn't so you go back to 10mg, not realising that actually 8mg would have done the job but you missed it. Half a mg can make a big difference!
In GCA, on the other hand, by the time you are getting to 20mg you should be clear of GCA and merely aiming for tapering your dose and eventually getting off pred altogether. Our experiences have been that many people with GCA have fewer problems getting off pred altogether than PMR patients. Then the size of the steps is less important providing YOUR body can cope with that - and as I say some can. some can't. This is a slightly different cacse than just PMR - unless of course you are a GCA patient who has PMR as one of their symptoms.
The 10% is nothing to do with slowing the reduction down - it is purely a percentage that has been found to result in fewer problems for the majority of patients in terms of the change in dose. At 30mg 10% is 3mg, at 20mg is already down to 2mg, less than 2.5mg. By 10mg it is 1mg - the 2.5mg steps are big changes when you have been used to pred for months, or even years. Saying "10%" is far quicker than explaining the changing dose.
One of the acknowledged top experts in the UK now tells his patients to take 3 months to reduce 1mg once they are going below 8mg - over three days progressing from 8/8/8 repeated to 8/8/7/8/8/7 and 8/7/7/8/7/7 repeated to get to 7 every day and the same for all following doses. This is the same sort of pattern the support groups have been advcating for the last few years - at this level it is to give the adrenal glands a fighting chance of being able to adust to the changes they are faced with.
We suggested it below 10mg at first - and then realised that there were patients at even higher doses who struggled with the step down and several of us tried it ourselves - and it worked. If you can drop 2.5mg at a time with no problems that is great - but when you can't and find yourself yoyoing between 15 and 12.5mg because that 2.5mg drop is too much to cope with you need another approach.
So the result became the "Dead slow and nearly stop" reduction plan which you will find in the replies section of this thread:
https://patient.info/forums/discuss/pmr-gca-website-addresses-and-resources-35316
You will notice if you get to a dose that is too low - and find the right dose far more easily than reducing by 2.5mg or even 1mg at a time from one day to the next without smoothing out the drop. A slope is far easier to walk up or down than steps!
Thank you Eileen. That is most helpful. Although the GCA has left me very poorly sighted and very deaf I have not suffered recently from any PMR flares, so will try 2.5mg reduction, reverting to 1mg if necessary. Thanks.
Hello audrey. I have used the reduction plan reccomend by ElieenH & a few of the other girls,and after 15months i am on my first week of trying on zero pred; TOUCH WOOD so far so good.i have PMR so started on lower dose than you.One thing i learnt with good advice from the 3 main forums is not to be tempted to rush and learn to get to know your body.just to add Slowy does it. All the Best for your journy.Dave
Hi David,
I love to hear when someone has a successful reduction and especially to "0"👏👏. I hope you are in remission forever!!
Hugs, Diana🌸
It didn't work for me. I went from 20 to 17.5 to 15 over an 8 week period and the joint pains came back strong. I am now at 19 from 20 and will try reductions of 1mg every 6 weeks.
Thanks Diana,I owe it all to you & all the other girls off the 3 forums,wot would us blokes do with out you. I will keep every thing x x that can be crossed & hope for the best.I now have to get used to every day owd mon aches & pains.I am on holiday with the family kids + dogs.and football.next week so i will be packing my trusty pred.I will still log onto the forums i feel i have got to know so many of you.I owe you all so much.A massive thanks to one & all and take care.Dave
All the best David - and don't go nuts next week on holiday. Others who have got off pred reckoned it took them a year of being off pred to being back to "normal"!
Thank you EileenH.i am pretty sure you were one of the first to wellcome me on board,telling me supply more info to my first post, after i had gone nuts after being pain free after first day.Yourself & the other volunteers etc.deserve a medle.but i am afraid a massive thank you is all i can offer.I will give it a few weeks? then i will apply for the zero club.on the up north forum.PLEASE keep up the good work & I will say it again thank you all&take care Dave
Audrey,
I went from 20mg to 12,5mg over 4 months doing 2,5 mg decreases. I tried to go to 10mg in one jump and my body did not like it. I went back to 12.5 mg for a couple of weeks and then did a slow (month) reduction to 11.25mg and feel good. In another 10 days I am going to start for 10mg again over a month.
Charlie 44644
Thank you Charlie, that is a useful report. I'll see how I get on.