question about prednisone taper

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emrose
Regular Member


Date Joined Oct 2008
Total Posts : 63
   Posted 10/14/2008 10:36 AM (GMT -7)   
hello

My husband has been on 60mg of prednisone for about 2 months. He is in he hospital now because of an abcess. The abcess has been successfully drained and we are leaving today (looking at a resection surgery soon though).

Now the doc wants him on only 20mg of prednisone daily. Isn't that a pretty drastic drop? I thout you were supposed to taper much more slowly. Do you think this is okay?

Thanks for your advice

mj8dokken
Regular Member


Date Joined Dec 2006
Total Posts : 149
   Posted 10/14/2008 10:45 AM (GMT -7)   
It is a pretty drastic drop from what I can tell. I've always heard that slower is better. If it is too big of a drop you will be able to tell because he will probably not be feeling too well shortly thereafter.
Bad flare May '06 resulted in CD diagnosis-symptoms for 10 yrs prior.
Asacol: 2400 mg/day
Prednisone: 5 mg/day
Entocort: 9mg/day
 
"Life isn't about how to survive the storm, but how to dance in the rain"


Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 10/14/2008 11:17 AM (GMT -7)   
60 for 2 months then right to 20 is a very drastic drop. But as posted, you will know pretty quickly if it is going to affect him. I have dropped quickly but only after a few days of a high dose, never after a few months of a high dose. Please keep a close eye on him for a few days. I notice the most symptoms from a drop the third day, but sometimes on the second or fourth. So please watch him and call the doctor if things seem unusual.
Suzanne

CD 19 years offically, 29 unofficially. 3 resections '93, '95 '97
Symptoms constantly but all tests show only minor ulcerations. Currently having multiple episodes of gastritis with no known cause.


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....


Stef17
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Date Joined Feb 2003
Total Posts : 1811
   Posted 10/14/2008 11:51 AM (GMT -7)   
That IS a drastic drop. If you are unsure in any way - you should definitely ask the doctor about it. Tell him/her that you are hesitant and would like him to explain why he believes that is the best route to go. I've been on pred for almost 20 years and I would NEVER drop 40mgs like that. Question the doc. They are not perfect.

Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2691
   Posted 10/14/2008 12:04 PM (GMT -7)   
Holy crap! That would be a huge drop alright! I agree, call the doctor and discuss that with them. I had one that wanted to go too fast too, and had my GP give me a slower taper schedule that worked fine.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Taking Asacol, Questran, Toprol XL (for high blood pressure). Tapered off prednisone a month ago!


emrose
Regular Member


Date Joined Oct 2008
Total Posts : 63
   Posted 10/14/2008 4:39 PM (GMT -7)   
Hey everyone. Thanks for your responses. I agree - seems pretty crazy to me. BUT - we asked several people at the hospital, all who checked with our GI and he really wants to move to 20mg. He put him on 60mg to try and reduce the inflammation and now he wants him on 20mg for "maintenance" until surgery. Scar tissue seems to be the problem, so once the abcess heals, a resection is likely the next step. (at least we said NO to the entire colon removal, and now all other opinions have been on our side - a resection is all that is necessary at this point. fingers crossed) But, yeah, I don't know. We are keeping a close eye on things, and how he feels and will not hesitate to push back and ask for a higher dose if necessary. I personally want my husband to start with at least 40 this week, but my husband really wants to give 20 a shot. We'll see - I'll tell him what you are saying. (if was this community that convinced us to get a second option on the surgery too!) I was told its more important to taper in smaller amounts when you are at a lower dose to begin with. I dont know, I question it. We have a follow up with the GI doc in less than a week so we'll be talking to him about it then for sure. I'll keep you posted.

chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 10/14/2008 5:27 PM (GMT -7)   
I was on 60 mg of pred for about a month before I was hospitalized. Upon leaving the hospital a nurse told me that I could take all 60 mg at once instead of 30 in the morning and 30 at night. So, stupid me, didn't even question her, and I did it. Well, I thought I was going to die. I was experiencing withdrawl and within a day of going back to my regular schedule, I was feeling back to normal.

I can't imagine that going from 60 down to 20 is going to work.

beave
Veteran Member


Date Joined Mar 2007
Total Posts : 1091
   Posted 10/14/2008 5:57 PM (GMT -7)   
emrose said...
 .......... I was told its more important to taper in smaller amounts when you are at a lower dose to begin with.........
That is consistent with conventional wisdom in medicine.  It's usually much easier to go from 60mgs to 20mgs than from, say, 20mgs to 0. 
 
Tapers are usually pretty fast down to 20mgs or so, then slower the rest of the way down.
 
Normal amounts produced by the body are in the 10-15mg range, so as long as the dose drop keeps him above that, he'll *hopefully* be ok.
 
However, like others said, he's been on 60mgs for quite a while now, and everybody responds differently to pred.
 
I wouldn't be suprised for him to have some fatigue and possible achiness when he drops down in the dose.  Hopefully it will be mild and tolerable, but if it does get bad, I agree with the others that you shouldn't hesitate to let the doctors know and then bump the dose back up higher.

Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2691
   Posted 10/14/2008 6:50 PM (GMT -7)   
I've always been told that if we don't go slow we really increase the chances of flaring back up big time. That and even going from 40 to 20 with a slower taper, I could feel it. Headaches, body aches, tired... Of course it gets harder once you get down to 10mg and lower, but tapering is always no fun. I can't imagine skipping down that fast, unless I've been on it for a week or something. After two months at a high dose, I know I would want to come down slower.


~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Taking Asacol, Questran, Toprol XL (for high blood pressure). Tapered off prednisone a month ago!


emrose
Regular Member


Date Joined Oct 2008
Total Posts : 63
   Posted 10/14/2008 9:42 PM (GMT -7)   
hmmm.... It's so interesting. So hard to know what the right thing to do is with this disease... The surgery, the meds, the diet... I could over analyze and research til I'm blue in the face, but will never really know what will work best for my husband.

I appreciate all your replies. Beave - very good info. However, so are all of the experiences you have all shared. I guess I should have mentioned that the doc also put my husband on cipro and metronidazole (500mg) for 14 days. Don't know how that impact this.......

Thanks again

gachrons
Veteran Member


Date Joined Mar 2007
Total Posts : 4527
   Posted 10/15/2008 12:00 PM (GMT -7)   
I guess I would go with his GI on this and just see if he has any problems and go from there .Dropping from 20 down will be slower no doubt. lol gail
Hallarious woman over 50 ,CD ,IBS 27 years--resection,fistula's,obstructions,and still alive.lol gail


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 10/15/2008 12:10 PM (GMT -7)   
Personally I would never go from 60 down to 20 and if any GI told me to I'd be kicking his arse out the door...I wouldn't take that chance with a crazy drug like pred.

:)
My bum is broken....there's a big crack down the middle of it! LOL :)


mj8dokken
Regular Member


Date Joined Dec 2006
Total Posts : 149
   Posted 10/15/2008 12:23 PM (GMT -7)   
I don't want to scare you but be careful with the cipro too. It's been blacklisted by the FDA for tendon issues. Most people don't have a problem with it, but I did end up having some tendon problems from it (luckily none have torn or ruptured though). The achilles tendon is the most susceptible and my problems started with some discomfort in my achilles.

Bad flare May '06 resulted in CD diagnosis-symptoms for 10 yrs prior.
Asacol: 2400 mg/day
Prednisone: 5 mg/day
Entocort: 9mg/day
 
"Life isn't about how to survive the storm, but how to dance in the rain"


emrose
Regular Member


Date Joined Oct 2008
Total Posts : 63
   Posted 10/15/2008 12:58 PM (GMT -7)   
Yeah, I have heard that about cipro. Our doctor didnt warn us about any negative side effects, nor did the pharmacist! I'm glad I do my research and check this formum! He's on the antibiotics for two weeks, and I am hopeful that it will be okay. We are just keeping a VERY CLOSE eye on his symtoms and how he is feeling. I wont hesitate to call the doctor and/or have him stop taking it.

I appreciate the info! Also - pb4 - I hear ya. I feel a little bit like kicking our GI's arse out the door myself! However, we do really like him for the most part and my husband trusts him and has built a good relationship. I am finally in a place wiht him where I feel like I am educated enough to challenge him if I feel like I should and he is totally open to that and open to hearing me out and exploring our options. Not to mention - there are a ton of great GIs at the clinic and we talk to all of them a lot.

As for the prednisone - I am sort of stuck. My husband is stubborn and he really wants to drop the dose and the doc has repeatedly told him he thinks that is the right thing to do. Like I said - keeping a VERY CLOSE eye on him and he has a follow up appt next week.

I appreciate all of your responses. They are making me nervous, but I am glad to be aware of potential problems so I we can act immediately if necessary.

Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2691
   Posted 10/15/2008 4:16 PM (GMT -7)   
pb4 said...
Personally I would never go from 60 down to 20 and if any GI told me to I'd be kicking his arse out the door...I wouldn't take that chance with a crazy drug like pred.

:)

Yup! I agree. My GI didn't even want me to go down quite that fast, but it was still too fast for me, with no good plan to go even slower at the end. So that's when I turned to my GP for help. It is a crazy drug, one that can be darn right dangerous if we go down too fast. No way would I go for that.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Taking Asacol, Questran, Toprol XL (for high blood pressure). Tapered off prednisone a month ago!


lilturbo
Regular Member


Date Joined Feb 2008
Total Posts : 298
   Posted 10/15/2008 5:39 PM (GMT -7)   
Wow, that's a HUGE drop!

I have only been allowed to taper by 5mg a week when tapering. I think that he should get a second opinion on that. Or recheck with his doc, and find out his reasoning. Maybe the doc will see he made a RIDICULOUS mistake. If he insists, I would get a second opinion. I've never heard of anybody dropping that fast on the prednisone. I agree with Jen and pb4, it could be crazy dangerous with too quick a taper.

I've been on and off the 'roids for two years. I wouldn't taper that fast. It can wreck some serious havoc on the body. =(

Take care and please keep us updated.

-Em
turboemma.blogspot.com/


Miss3
Regular Member


Date Joined Sep 2008
Total Posts : 97
   Posted 10/15/2008 5:54 PM (GMT -7)   

When I was in the hospital they went from 120mg IV to 80mg pill. I came home on 75 tapering 5 mg every three days. When I got down to 10mg I took it upon myself to taper 2.5 mg every five days just to see how that goes. I was afraid to go from 10 straight down to 5 and then 0 in less than a week! I'm currently at 7.5 now.

 

Miss


emrose
Regular Member


Date Joined Oct 2008
Total Posts : 63
   Posted 10/19/2008 10:00 PM (GMT -7)   
just thought I'd post an update:

My husband did go ahead and drop to 20 because 1) he wanted to be on a lower dose and 2) because the doc said it was important to drop to 20 so he would heal from the abcess surgery.

It's been almost a week and he's doing really well. He's lost some of the energy that he got from the pred. And he has some cramping, but no more than when he was on the 60mg dose. He has just over a week left of the flagyl (sp?) and cipro.

The surgeon we talked to was thrilled he dropped the dose so much and said that hopefully he's on even less for the resection surgery late next month. however, the taper from 20 down will go MUCH slower!!

Thanks for all of your input. I owe so much to all of you, as I am just so much more educated now and my husband won't be losing his entire colon thanks to advice given here!!!!



Thanks!!!

mj8dokken
Regular Member


Date Joined Dec 2006
Total Posts : 149
   Posted 10/20/2008 10:49 AM (GMT -7)   
I'm glad to hear your husband is doing well and I hope it continues!

Bad flare May '06 resulted in CD diagnosis
 
Asacol: 2400 mg/day; Prednisone: 1.25 mg/day; Entocort: 9mg/day; Metronidazol
Started seeing a Naturopath-Castor Oil Packs, Liquid B Complex, Floragen, Ribes Nigrum, Herbal GI, Chlorella
 
"Life isn't about how to survive the storm, but how to dance in the rain"

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