I have recently had a full blown GCA relapse and after looking around the site I do not see any taper recommendations for GCA sized reduction doses.
Prior to my relapse I reduced from 60mg to 15mg in the standard taper listed on this site and recommended by my Dr.. The steps were 60,50,40,30,20,17.5 and finally 15. Each and every time that I reduced I would go through a new and different side affect for 4 or 5 days. I am aware of Eileen's recommendations; however, I do want to try them on the initial rates of reduction for GCA. The reduction from 40-30mg is 25% while a reduction from 30-20mg is 33%. Does anyone on this site know of a pointer to a medically approved taper for these sizes of reductions?
CC's 40mg to 30mg Taper Plan
Pill Combinations that I currently have.
DOSE. Days. % reduction. Pill Combination
40mg - 6.
37mg - 4. 7.5% 20+10+5+2
35mg - 4. 5% 20+10+5
34mg - 4. 3% 20+10+2+2
32mg - 4. 6% 20+10+2
30mg - 6. 6% 20+10
-----------
28 Days Total
CC's 30mg to 20mg Taper
Reduction starts after 6 days at 30mg
Cut two mg pills.
Dose. Days. % Reduction. Pill Combinations
28mg - 6. 7%. 20+5+2+1
26mg - 6. 7%. 20+5+1
24mg - 5. 7%. 20+2+2
22mg - 5. 8%. 20+2
20mg - 6. 9%. 20
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28 Days Total
There have been no properly monitored studies of any sort for "best practice" in reducing pred in either PMR or GCA. However, I'm sure I have already referred you to this post to get the link to the Quick and Kirwan paper:
https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316
On page 6 your will find the section "Treatment of Giant Cell Arteritis" with their usual tapering regimen for GCA. Any taper is only a recommendation - every patient is different and can tolerate different reductions depending on the activity of the underlying autoimmune disorder. The recommendations for a 10% maximum reduction also come from medically qualified contributors in the rheumatology field.
Every course of pred and its reduction for the patient is an exploration of the unknown - if the symptoms returned it is an indication that the previous attempt was either too fast or too far. That is about as much as can be said. A bit of "fingertip feeling" is required and close observation of how you feel and (if it applies) the blood levels.
When it comes to "medical approval" for reductions I'm afraid you are whistling in the wind - they can't even agree on the signs and symptoms of the illness, never mind the best way to treat it. I have offered you the best source we are aware of at the present time.
CC, In the absence of the "medically approved taper" you're looking for, it's very much a case of finding what works for you within the general guidelines.
I was very lucky in that I was able to reduce from my starting dose of 40mg for PMR and GCA in fairly textbook fashion until I reached the 5mg dose where things went pear-shaped as far as my PMR symptoms were concerned. This was long before the "no more than 10%" was mooted, and both I and my rheumy were guided by my blood tests which generally corresponded to my symptoms, but, unlike a very few lucky people, I wasn't so lucky as to become completely pain-free down through the doses.
It might help if you can recall at which dose you felt most comfortable before your relapse and then aim for a point just above that. It might then further help to remain there for a good deal longer than previously.
Eileen, I ran your recommendations through excel using my desired taper numbers. WOW, it is VERY gentle! Since prednisone can stay in the system for 36 hours it was not as jerky as it first appeared.
TT (Total Taper) / TD = mg/period
TT TT/#TD TD
Starting at 40.00 mg
1 day 30 and 3 days 40 150 37.60 4
1 day 30 and 2 days 40 110 36.67 3
1 day 30 and 1 days 40 70 35.00 2
1 day 40 and 2 days 30 100 33.33 3
1 day 40 and 3 days 30 120 30.00 4
Starting At 30.00
1 day 20 and 5 days 30 170.00 28.3
1 day 20 and 4 days 30 140.00 28
1 day 20 and 3 days 30 110.00 27.5
1 day 20 and 2 days 30 80.00 26.7
1 day 20 and 1 days 30 50.00 25
1 day 30 and 2 days 20 70.00 23
1 day 30 and 5 days 20 130.00 21.6
1 day 30 and 6 days 20
Total 32 days