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Prednisone Taper Trap

Prednisone Taper Trap

 Are you stuck in the prednisone taper trap? I know, I was stuck in the prednisone taper trap. You might be wondering what it is the prednisone taper trap. I’m Dr. Megan, the prednisone pharmacist, and I took prednisone for a long time. And the taper trap is the reason why we need to taper.

What happens if you taper prednisone too quickly?

  • Tapering too quickly may be risky but still, it depends on your body on how it copes during the changes of your prednisone dosage. It is still best to contact your doctor when you are choosing your prednisone schedule.

What is a normal prednisone taper?

  • There are different types of taper schedules and your body’s reaction will determine if that schedule works for you.

How Taper affects your White Blood Cells

 So prednisone was a miracle for me. I took prednisone and it allowed me to not bleed to death from a condition called ITP. My immune system was attacking my own platelets and I could have bled to death if I didn’t take prednisone.

ITP

So what my doctors would do is give me a high dose, say 40 milligrams. My platelets would be down here at five or something really super low. So, as they kept me on a high dose, my platelets would go up.

They would try to decrease my dose of prednisone. Then my platelets would go down and then they would taper my prednisone down so that I didn’t have so many side effects.

And then my platelets would go down and then they’d try a little bit lower. Yeah. And then my platelets would crash so I was stuck in this taper trap.

how prednisone affects neutrophils

And we do it again. They go back up to 40 milligrams and try to get me back down and back down. And my platelets would go up and then they would crash and then they’d have to go back up.

 I just went on this rollercoaster doses from 40 down, down, down, down, and then my platelets following high, then low, low crash rollercoaster. So,

the taper trap is when you are stuck when you can’t get any lower.

For me, that was okay. And somewhere around 15 milligrams where my platelets might stay at the high, but I was suffering so many side effects. For other people, it might be that their rheumatoid arthritis, they can actually use their hands, but, and the side effects aren’t too bad.

But if they get any lower than that, the side effects come back or they’re not able to use their hands. It’s a really tough situation.

The Prednisone Taper story

So I want to tell you the story of a guy named Matt. That’s what we’re going to call him. It’s not really his name, but we’ll call him that because I want to protect his privacy.

So Matt is an important person. He owns a business where he supervises 30 people and he can’t just be sick. He needs to be there to run his business. So when he came down with a sinus problem where he’s tried everything from no sprays to nasal flushes to prednisone. And the last resort is surgery!

surgery and prednisone

He can’t take 2 weeks to have surgery. So he’s taking prednisone as the alternative to keep him able to breathe at night. If he doesn’t take it, he gets so congested that he can’t sleep.

So the prednisone for most people like me doesn’t let me sleep because it causes racing thoughts, but for him, the prednisone caused decongestion and he could actually breathe.

So with Matt, it’s this really tough situation. He has to be on pretty high doses to get all of that decongestion, but it’s causing moon face and weight gain and all sorts of other side effects. And I had to go through this with him. Where is the dose that you find the best balance of being able to breathe?

Not having too much congestion but not too many side effects. It’s a really tough spot to find for every person it’s different. For me, it was around 15 milligrams for him. It might be around 25 milligrams for a lot of people with rheumatoid arthritis, it’s often closer to five milligrams or 10 milligrams. It’s really dependent on your condition, your body, the level of inhalation that you have tapering is so essential.

How Your Body Reacts to Taper

Based on the research I’ve done, it’s not really a science. Like they’ve tried to do studies to find a perfect tapering schedule and they couldn’t find one. And so it’s more of an art than a science and fun fact of the day.

Tapering is the #1 reason people contact me for a side effect consultation as the prednisone pharmacist because it’s so hard to do. It’s so hard to have a doctor who has the time to be able to help you find what doses to take one.

So there are websites that can help you navigate this. That will, you can link to it in my article, or you can use a taper chart.

Prednisone Taper Chart

As mentioned there are different types of prednisone taper charts depending on each patient’s dose prescribed by their doctors. There’s this short-term one there’s, long-term, and there’s even slower.

As shown below there’s one that takes a year and a half. It’s really dependent on you and your condition where the withdrawal syndrome kicks in and what is withdrawal syndrome?

Prednisone Taper Chart

 

 

So withdrawal syndrome is where your body is going through withdrawals from prednisone and it feels awful. It’s really hard to diagnose because it looks like everything else. It looks like the flu. You might get a fever. You might feel totally exhausted. Fatigue, achy like muscle aches, joint aches, like you would.

If you had the flu, you got run over the bus by a bus, you might get sweats. You might get all sorts of really weird nonspecific symptoms that could even be confused for COVID. It’s just crazy!

HPA Axis

So when that withdrawal kicks in that’s your adrenal system has to recover from taking prednisone. Your adrenal hypothalamic, pituitary-adrenal system, your HPA axis have to kick back in so that you start making cortisol again your body has been not making cortisol while you’ve been taking prednisone.

HPA axis

It’s been replacing it. And so you have to be able to allow your pituitary gland, your hypothalamus, and your adrenal gland to get that system re-engaged. So it can actually start excruciating cortisol. And then the rest of your body has to get out of prednisone withdrawal.

It’s a really unique patient-specific art of finding that balance that speed that you can go down in doses. So knowing that we’re trying to balance prednisone, withdrawal, and your condition, those are the two things we’re trying to find a balance.

Finding balance for Tapering

  • When is your condition going to get out of whack?
  • When is your prednisone withdrawal gonna kick in?

The taper trap is when you can’t go any lower and you have to go so super slow or go through the pure misery of adrenal withdrawal syndrome. It’s neve. There’s never a good answer. Okay? Like, I can help you find the best balance, but there’s never a black and white, like, this is for sure what you should do is always a, okay, let’s find the lightest gray that we can find. It’s really a tough thing.

So based on this, I give you a whole bunch of things on my website, and then you can print it out. And by when you print it out, you can just go here to the printer button and I’ll just do it right now.

Using the Prednisone Taper Chart

  • Always ask for advice from your doctor on your tapering
  • Tapering Charts are different. You need to follow the milligrams and schedules for taking it.

So, there are the days of the week and what dose you should take. So if your doctor said, “Okay, I’m going to taper you down from 40 milligrams”. Here’s one way to do it.

Now. I want to make it perfectly clear that I am not replacing your doctor. I am not your medical provider and am all the legal things. This is just an example you can follow, okay. Not medical advice and just a service I’m trying to provide because I get asked so often. And I think it’s really important that people have something that they can use. And so this is an option, but your doctor and you need to work together to find the very best solution. I am not replacing your doctor.

So based on that, here’s an option of what you and your doctor could work on. You could print this out and say, “Hey doctor, what do you think?”  And they can approve it.

Types of Prednisone Taper Chart

  1. Long-Term Taper Chart
  2. Slow Term Taper Chart

I’m going to be starting at 40 milligrams, and I’m going to do a short term maybe, or maybe I want to do this long-term or maybe. I’m going to do this really super long-term slow one. So once you have it, you can use it. You can put your prednisone and bottle right next to it and Mark it off.

So for example, if you had been given 40 milligrams and your doctor said, okay, take 40 milligrams every day for a week. So then you start on Monday, Sunday, and you just go, okay.

I took my Sunday dose. I always recommend taking it first thing in the morning with some food, but you don’t have to. Then on Monday morning, you can say, okay, I did Monday. Then you get through that week and you start another dose down to 30 milligrams.

That’s a typical one 40, 30, 20, 10, 5. So you could do that. You could follow this, but maybe you get to 10 milligrams. And you’re like, I can’t, I can’t drop to five I’ve. I can feel that withdrawal kicking or I can feel my condition coming back. Those are the two things withdrawal kicking in or condition coming back.

And so you can’t go that fast. you can’t drop 50% in one week from 10 down to five! That’s just too dramatic for you.

So you could try this one. This is a longer-term taper. So it’s just dropping about 20% per week. And so you’d go down, boom, boom. And you can do a week of each of these doses. Now we’re at one milligram per week dropping here.

Prednisone Tapering Schedule

That’s definitely doable here is that taken instead of per week, we’re talking per month. So you do each of these for a week. So month one, you’re doing 20 milligrams month, two, you’re doing 17 and a half milligrams. And so you would just go all the way across week one week, two week three, and week four.

Prednisone Taper Chart

So if you don’t want to do over 14 months or maybe you’ve already gotten down to 10 milligrams and you don’t need to start at 20 milligrams, well then just ignore this part and just start at 10 milligrams, make this work for you. This is just to make it as easy as possible for you to remember what dose to take and when then we have the alternate day strategy.

And so this one is if you are super sensitive if you cannot drop even one milligram a week, so then here’s a suggestion. You could go 10, nine, 10, nine taking 10 milligrams on one day nine on the next. Then the following week, you hold that lower dose at nine milligrams and the next week you would do eight, nine, eight, nine, eight, nine. The next week ahead, you could hold it at eight milligrams and maybe you have to hold it longer than one week.

Prednisone Taper Chart

That’s fine. You could hold it for two or three weeks at that lower dose, just slow and steady wins the race when it comes to tapering. So then you would just keep following this plan, seven, eight, seven, eight, and then seven and then seven six, seven six, seven, six, and then six and then six, five six, five, six, five, and then five and then five, four or five, four, and then four milligrams. And you just keep dropping, keep dropping until you get to one milligram.

 

And then congratulations three, cheers for you. You’re finally off prednisone!

So I’ve shown you how to taper prednisone, using a taper chart, and what to look for your condition coming back or withdrawal syndrome kicking in, and you can follow any of these taper charts that you work out with your doctor as the best for you.

 

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