Will splitting a prednisone dose lower its side effects?

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guila
Regular Member


Date Joined Dec 2008
Total Posts : 71
   Posted 10/26/2009 8:49 PM (GMT -6)   
My son is going home after a week at the hospital and 60 mg of prednisone through IV. He has to continue with 40 mg orally and then start 6MP and see if it works. Does anybody know if splitting the dose in two, (20 in the morning and 20 in the afternoon), will help lessening the side effects? He had significant psychological side effects that few times he was on 40 in the past. His GI is not very responsive and I would rather ask people who have taken the medicine. The doctor didn't think taking 40 is such big of a deal but we know differently. Thanks!

suebear
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Date Joined Feb 2006
Total Posts : 5421
   Posted 10/26/2009 9:02 PM (GMT -6)   

I doubt it and it might not be as effective either.  If your GI won't give you an answer call your pharmacist.

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Judy2
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Date Joined Mar 2003
Total Posts : 9498
   Posted 10/26/2009 9:09 PM (GMT -6)   
Prednisone is normally taken all in one dose, preferably in the morning. That most closely mimics how our adrenal glands release natural cortisol into our bodies, and is the most effective way to take it. Also, taking the medication in the morning may help decrease the insomnia that often comes with steroid therapy.

Be sure he takes it with food to protect his stomach. Taken on an empty stomach it can cause ulcers.
Judy
Co-moderator, Ulcerative Colitis
 
Diagnosed in 2001, finally in remission since March 2006.
Mesalamine is not my friend and steroids are from the devil.
Remicade has been my miracle drug.


keylime
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Date Joined Jun 2007
Total Posts : 359
   Posted 10/26/2009 9:19 PM (GMT -6)   
How old is you son? My daughter who was on it at age 8 and again at age 10. Her doctor has her split the dose morning and afternoon.

It wasn't until my son was 17 that he took the full 40 in one dose, before that he took a split dose, too.

{{{Hugs}}} Sorry you all are going through this!
Julie

Mom of Son 18 UC dx 07/02, Lailda, Azasan 100 mg, Primadophilus Reuteri, Zyrtec, Iron, Vit/Min

Daughter 10 UC dx 08/07 Prednisone 5 mg, Colazal, 6MP 25 mg, Culturelle, Iron, Vit/Min.


kops2da
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Date Joined Jun 2008
Total Posts : 2865
   Posted 10/26/2009 9:26 PM (GMT -6)   

VA hospital just put my husband on a short term of prednisone - starting at 60 and tapering - to be split morning and night.  I told him he would have insomnia and he did but he follows his doctor's directions!!

ElaineNY


 
Senior - diagnosed with proctosigmoiditis - 6/2008  
Allergic to all mesalamines including rectal meds, etc. 
Prednisone for about 4 months - tried 6 MP with no help.
Rectal meds only made bleeding, etc. worse. 
No prescriptions as of yesterday!  Hoping for best and possibly adding other supplements. Now treating only with Imodium and Pepto Bismal and below....
Probiotic Align, Prilosec for GERD, Gas-X, vitamins, Calcium/D
Tylenol for knees and arthritis.
 
 
 


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 18015
   Posted 10/26/2009 9:32 PM (GMT -6)   
The only thing splitting doses will do is cause less stomach upset (the main reason why some docs suggest a patient split their dose in 2) so no, it will not likely cut down the side effects.  Takikng all your pred first thing in the am will cut down or completely eliminate any sleep issues at night.

:)


bee propolis caps 500mg one cap twice/day
omegas 369 caps one cap twice/day
probiotics 10 billion cfu once/day
vitamins C-calcium ascorbate (easy on the gut) and vitamin A each once/day
Prodiem fibre supplement one cap before bed
I've also altered my diet (no junky stuff at all, processed, fast-foods, refined sugars, ect) and exercise regularly.
I went from 30+ bloody BM's/day with lots of lower back pain to an average of 5/day no bleeding no back pain and completely formed stools, still have severe urgency issues.
~~~~~~~~My bum is broken....there's a big crack down the middle of it! LOL :)~~~~~~~~


guila
Regular Member


Date Joined Dec 2008
Total Posts : 71
   Posted 10/26/2009 10:32 PM (GMT -6)   
Thanks! He is 21 and he started with his first flare about a year and a half ago. Keylime, how is your daughter doing with the 6MP? My son should start next week. Is she having any side effects?

fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 6915
   Posted 10/26/2009 10:44 PM (GMT -6)   
My GI had me split my dose into 4 when I was on 40 mg (10 mg each at breakfast, lunch, dinner, bedtime). When I dropped to 30, I dropped the bedtime dose, etc, etc, etc. A lot of people on here thought my GI was nuts, but I gained remission quickly, had very little problem with side effects, and had no problems with my taper. Of course, that might just be because I tolerate pred very well.
Status: Remission since May 2009!
Symptoms began in November 2008, ~4 weeks after giving birth to my son
Diagnosed with pancolitis on 1/30/09
Meds: Apriso (4 0.375g pills ONCE!! daily), mesalamine enema twice weekly, Natural Factors Ultimate probiotic 12/12 Formula, OrthoNovum, multivitamin.  Used prednisone (starting dose 40 mg) to get into remission.


keylime
Regular Member


Date Joined Jun 2007
Total Posts : 359
   Posted 10/27/2009 9:22 AM (GMT -6)   
guila, she is doing well on it. She has been on it for over two years. She recently had he dose raised and had a little bit of inflammation of the liver show up on the blood work and he white count was down just a tiny bit. We lowered her dose back down, but then some UC symptoms returned so we have raised it back up. I take her in for blood work this week to see how her liver is doing.

All in all, she tolerates it very well. Hope it works well for your son. My son take the "sister" drug to 6mp(azathioprine) and also does well on it. He has been on it for almost 2.5 years. He took 6mp years ago and it wiped out his white count almost entirely and cause liver inflammation, but the Aza is okay for him so keep that in mind for your son if the 6mp doesn't work for him.

Make sure he gets the regular blood work done, especially when first starting out. Feel free to ask any questions.

Good luck!
Julie

Mom of Son 18 UC dx 07/02, Lailda, Azasan 100 mg, Primadophilus Reuteri, Zyrtec, Iron, Vit/Min

Daughter 10 UC dx 08/07 Prednisone 5 mg, Colazal, 6MP 25 mg, Culturelle, Iron, Vit/Min.


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2838
   Posted 10/27/2009 4:45 PM (GMT -6)   
It's always been my understanding that taking it all at once in the morning actually reduces the side effects.
49 year old female attorney, diagnosed UC/pancolitis 1985. 
Asacol maintenance for 20+ years; Prednisone & Rowasa for flares. 
Food sensitivity test by Naturopath showed wheat/gluten, other intolerances, helped some. 
Remicade started April 2009 (Humira denied) and doing great~ learning what normal is~ wow


songlady
Veteran Member


Date Joined Aug 2009
Total Posts : 3252
   Posted 10/27/2009 5:49 PM (GMT -6)   
I remember reading that splitting the dose lessened side effects.... it was in one of those books from the ccfa.
Diagnosed UP 1983, Azulphidine
Diagnosed UC 1986 Prednisone almost 2 years
Asacol - 16 pills/day
Metamucil - 2 doses/day
Cortenemas until recently, Rowasa as of 9/8
VSL#3, Ultimate Flora Critical Care
Vitamins, Calcium and D,Flax Seed Oil
Bee propolis as of 9/2, melatonin as of 9/14


guila
Regular Member


Date Joined Dec 2008
Total Posts : 71
   Posted 10/27/2009 6:28 PM (GMT -6)   
Julie, is your daughter on 5 mg on a regular basis? My son was on 5 for about two months and doing well but when he got down to 3 the symptoms started again and with a vengeance and that is why he needed to be hospitalized. I will keep in mind the Azathropine if the 6MP doesn't work. He had testing done at a Prometheus lab and that is what the doctor recommended, (I wonder if those results make you go one way or another). Did your daughter have the Prometheus lab done beforehand? Did she have any side effects that were apparent to her or you, (besides the low blood count?). My son is a college student living out of state so I am not with him to check what happens, which makes things hard. Thanks!

kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 10/27/2009 6:33 PM (GMT -6)   

Just a note that I had the Prometheus testing done which showed that 50 mg. of 6MP was not therapeutic for me and I could not tolerate any higher so I had to quit taking it!  No sense taking something like that if it doesn't work.  However, it take a while to really find out.  I was on 50 mg. for four months and then up to 75 mg. - too many side effects then.  That is the way it goes sometimes.

ElaineNY


 
Senior - diagnosed with proctosigmoiditis - 6/2008  
Allergic to all mesalamines including rectal meds, etc. 
Prednisone for about 4 months - tried 6 MP with no help.
Rectal meds only made bleeding, etc. worse. 
No prescriptions as of yesterday!  Hoping for best and possibly adding other supplements. Now treating only with Imodium and Pepto Bismal and below....
Probiotic Align, Prilosec for GERD, Gas-X, vitamins, Calcium/D
Tylenol for knees and arthritis.
 
 
 


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 18015
   Posted 10/27/2009 8:22 PM (GMT -6)   
Peety said...
It's always been my understanding that taking it all at once in the morning actually reduces the side effects.

Only the insomnia side effect is reduced from taking it all at once first thing in the morning, not necessarily with any of the other side effects, like weight-gain, acne, mood-swings, ect.

 

:)


bee propolis caps 500mg one cap twice/day
omegas 369 caps one cap twice/day
probiotics 10 billion cfu once/day
vitamins C-calcium ascorbate (easy on the gut) and vitamin A each once/day
Prodiem fibre supplement one cap before bed
I've also altered my diet (no junky stuff at all, processed, fast-foods, refined sugars, ect) and exercise regularly.
I went from 30+ bloody BM's/day with lots of lower back pain to an average of 5/day no bleeding no back pain and completely formed stools, still have severe urgency issues.
~~~~~~~~My bum is broken....there's a big crack down the middle of it! LOL :)~~~~~~~~


keylime
Regular Member


Date Joined Jun 2007
Total Posts : 359
   Posted 10/27/2009 8:31 PM (GMT -6)   
guila, my daughter had a flare at the end of June and did 4 days at 40mg of pred, then 20 mg for a week, then 10 for a bit, then 5 for a month, 2.5 for a month and just when we were dropping to 2.5 every other day she came down with a nasty cold that kind of caused her a bit of IBD trouble (that was also about the time we dropped the 6mp dose down). So we put her back up to 5mg and raised the 6mp back up. We haven't seen blood since first week in October, so I suspect when I talk to the doctor after this weeks labs, we'll likely drop down to 2.5mg again for a bit then every other day and then off.

Both my kids had the prometheus test to check if they have the enzyme to process thiopurine drugs (6mp/Aza) and both do. They have both also had the tests to see if they are therapeutic levels and neither are, but both do well disease wise on the dose they can tolerate so we stay where we are. I'm pretty sure their livers could not tolerate a therapeutic dose.

Even the times my kids had a bit of liver inflammation, there were no outward symptoms. Both kids take their 6mp/Aza at dinner. Some take it at bedtime in case they do get nausea, but my kids never did (I also don't tell them those kinds of side-effects to not "plant" the idea).

My son will be entering college full time next year and I am nervous about how responsible he will be handling his disease/medications so I can only imagine what you are going through.

I don't know if you have heard of DragonPack, but it is an IBD support for parents and there are quite a few parents of college age and even older kids and they are a great resource for ideas on keeping your sanity while your IBDer is away at college and life. Here is a link: http://www.dragonpack.com/ibdsupport/parents/

You can also email me anytime if you would like.
Julie

Mom of Son 18 UC dx 07/02, Lailda, Azasan 100 mg, Primadophilus Reuteri, Zyrtec, Iron, Vit/Min

Daughter 10 UC dx 08/07 Prednisone 5 mg, Colazal, 6MP 25 mg, Culturelle, Iron, Vit/Min.


guila
Regular Member


Date Joined Dec 2008
Total Posts : 71
   Posted 10/28/2009 12:50 AM (GMT -6)   
Thanks a lot keylime. I have been reading the posts at the site and already got some new information I was not aware of. People have been extremely helpful in all these forums.

Probiotic
Veteran Member


Date Joined Mar 2007
Total Posts : 2787
   Posted 10/28/2009 8:09 AM (GMT -6)   
For what it's worth, I always get more bang for my buck (in terms of reduced symptoms for a given dose) on prednisone by splitting the doses.  Otherwise I get the benefits in the day but suffer too much, in terms of pain, at night.  Never had more sleep issues with splitting the doses, either.
"In order to save the village, we had to destroy it." -- Medical proverb. 
 


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2838
   Posted 10/28/2009 2:43 PM (GMT -6)   
pb4 said...
Peety said...
It's always been my understanding that taking it all at once in the morning actually reduces the side effects.

Only the insomnia side effect is reduced from taking it all at once first thing in the morning, not necessarily with any of the other side effects, like weight-gain, acne, mood-swings, ect.

 

:)

That makes sense.
49 year old female attorney, diagnosed UC/pancolitis 1985. 
Asacol maintenance for 20+ years; Prednisone & Rowasa for flares. 
Food sensitivity test by Naturopath showed wheat/gluten, other intolerances, helped some. 
Remicade started April 2009 (Humira denied) and doing great~ learning what normal is~ wow


guila
Regular Member


Date Joined Dec 2008
Total Posts : 71
   Posted 10/28/2009 4:50 PM (GMT -6)   
LookingfortheCure,  Unfortunately we are aware of the nasty side effects.  He has tried Lialda, Humira, Remicade, rectal Entocort, Asacol and other rectal medicines in the meantime while trying to taper the prednisone, but every time, he has to go back to it.  He had to be hospitalized twice so that the prednisone was given through IV as he was losing too much weight and the pain was unbearable. 
 
During all this, I have and still give him VSL#3 DS, fish oil, turmeric (the raw root), Aloe Vera, home made yogurts, SDC diet.  He gets better for a couple of months, (always while on prednisone), but once we decrease it to 5g, the symptoms start again, so we never knew if any of the supplements were working or not.  I bought the psyllium seed powder, (I am not sure if what I bought is the correct one, as I could not find the powder anywhere where I live, included Whole Foods, I could find the husk powder but not the seed powder), and he is going to try next.  He only has 6MP to try, (he started with it yesterday).  If that does not work, we will have to consider surgery... 
 
The doctor wanted him to be on 60 of prednisone and we said definitely not and asked if he could be hospitalized instead and given it through IV, which does not give him so many side effects.  The doctor said that it was the same thing, but I know it is not.
 
Also suggested the fecal transplantation, and I might be able to convince him.  Other than that, I think the bee propolis is the only thing that we have not tried yet. 
 
It is very very frustrating.  Thanks for listening and caring.  It is so hard to see him suffer.
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