Prednisone dosage question

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fruitgirl
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Date Joined Feb 2009
Total Posts : 7150
   Posted 3/16/2009 1:26 PM (GMT -6)   
So I'm thinking of asking my GI about starting prednisone.  I am still having 6-10 BMs a day since I had a stomach bug on March 3-4.  Before the bug, I was down to 2 relatively formed BMs/day. 
 
I know that it might be worth it to give the Asacol and Rowasa a bit more time to work, but I have projects I need to get done at work that require me to be outside and away from a toilet for hours at a time.  Plus, I have a two-day long job interview (that will require me to give an hour-long seminar as part of the interview) at the end of April, and I HAVE to be well by then.  There's no way I can do an interview in my current condition as I have severe urgency. 
 
Anyway, how low of a dose of prednisone do you think I could start at?  Would it even be worth it to start lower than 40mg?  I am very hesitant to take prednisone because of the side effects, so I'd like to start at the lowest possible dose. 
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, Culturelle probiotic, and Zoloft (25 mg).


mbx5
Regular Member


Date Joined Sep 2007
Total Posts : 365
   Posted 3/16/2009 1:49 PM (GMT -6)   
I would imagine the doc will prescribe based on the severity of your flare, your body size, and probably other factors I am unaware of. I do know that when I am prescribed pred, I am usually started at 40mg for about 2 weeks, then taper down 5mg a week from there.... I would say that a larger dose is the key to get inflammation down, then a slow taper.... It may not be as effective to start low and you may still experience the same side effects.
34 yr old male. UC for 14 years. Started left-sided, most recent scope shows pancolitis. 30mg pred (as of 2/01/09), 12x pills Asacol per day, 1mg Atavan per day (anxiety) when needed, 20mg paxil per day, Super-omega fish oil pills - 1x per day, Flax oil pills - 1x am, 1x pm, Culturelle probiotics - 2x am, 1x pm, Spinach and sunflower seed diet (moderated recently due to kidney stones). Multivitamin. Recent Endonasal brain surgery to remove non-cancerous hormone producing tumor on pituitary gland (and I am still more afraid of my UC!!) "I poop in the woods because I can"


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 3/16/2009 3:05 PM (GMT -6)   
Regarding your specific question, at least 20 mg I would think. But I would go higher. And as you taper, if you notice yourself getting worse again, stop tapering and stay at that dose longer. You can do that until you get through the next month, then worry about getting off it after your interview! This requires different action than what you might do normally, that's the reality, isn't it? (and good luck with everything)

But ask your doctor, you don't have a lot of experience with the prednisone and how you respond to it, like I do about myself.

And start experimenting with what dose of immodium calms you enough but doesn't make you feel too uncomfortable. I occasionally take 1/2 just to calm things down, but will take as many as two on a day that I really need to control things if I'm flaring.
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, trying 15/20 mg. Appt 3/6 to discuss Humira, etc.   


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 3/16/2009 3:20 PM (GMT -6)   
Thanks for the info! I suppose I could start at 20 mg, then go higher if I don't respond within a few days. I just want to be able to taper as quickly as possible, and I know that starting at a low dose will help make that possible.

Unfortunately, immodium doesn't seem to do squat for me. I took some (I think about 3 pills total) on Saturday, and didn't notice any difference. I've also been taking 1 pill at bedtime for the past four or five days and it hasn't helped me hold my enema all night, so I tried two last night, and was still up at 2:30 with a BM.

The GI's office just called and I have an appointment in a couple of hours.
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, Culturelle probiotic, and Zoloft (25 mg).


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 3/16/2009 6:24 PM (GMT -6)   
That great that you got in already!
Yeah, immodium can help but it can't work miracles if you gut is really, really inflamed and spasming. Try it again maybe when you are doing better from the prednisone. Well, now you can ask your doc!
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, trying 15/20 mg. Appt 3/6 to discuss Humira, etc.   


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 3/16/2009 8:03 PM (GMT -6)   
Yeah, Peety, that's one of the things I like most about my GI. The other is that he knows I do a LOT of research about UC, and respects my opinion when it comes to my treatment. And he always takes plenty of time with me.

Anyway, I'm on 40 mg of pred for 5 days, then taper 10 mg every 5 days. Once I'm at 20 mg for 5 days, I'll go down to 15 mg, and I see him 5 days after that. Hopefully it'll be taken care of by this relatively quick shot.
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, Culturelle probiotic, and Zoloft (25 mg).


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 3/16/2009 9:40 PM (GMT -6)   
Cool. Just be sure to call about slowing that down if you start to get worse again. I don't think it makes sense to keep tapering if you're getting worse again.
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, trying 15/20 mg. Appt 3/6 to discuss Humira, etc.   


Dynamo1
Regular Member


Date Joined Mar 2009
Total Posts : 33
   Posted 3/17/2009 3:29 AM (GMT -6)   
Sounds like the projects and the thought of the job interview might not be helping the flare-up, it is all stress in some shape or form. Depending on how important the job interview is to you, I would stick to relatively high doses until you have seen it through, then look to taper off.
UC first diagnosed 2007.
Asacol 3 tabs twice a day / Predisolone 20mg, 15mg, 10mg 5 mg
 
Flare-up Jan 2009 used Prednisolone came off it then had major flare up and developed gout.
 
Colonoscopy March 2009 reveals Severe Pancolitis.
Asacol 4 tabs twice a day / Prednisolone 40mg 2 weeks, 35mg 2 weeks
then start Azathioprine.
 
 
 
 


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 3/17/2009 10:32 AM (GMT -6)   
I'd rather go ahead and start to taper and see how I do, then go back up if I get worse again. The interview isn't until April 23-24, so I have a lot of time yet. Plus, I'm really excited about it...not nervous! I'm also on Zoloft (I was diagnosed with post partum anxiety/depression) and have decided to stay on it until my colitis is in remission to help with the mood.

So far, pred seems to be agreeing with me. I didn't get up for a BM last night and didn't have my first morning one until I'd been up for an hour and a half, which is a big change. I also had no problems sleeping last night, and since I had two doses (I'm taking 10 mg four times a day right now) before bed, I found that to be really encouraging.
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, Culturelle probiotic, and Zoloft (25 mg).


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 3/17/2009 1:40 PM (GMT -6)   
     The 40mgm sounds good.  Last year the doctor started me at 30 mgm twice with tapering and both times I went back into a flare within two weeks.  Only when he started me at 40 mgm with a 10 mgm taper per week was I able to achieve remission.  Good luck!
     I cannot even imagine having to go to work while flaring.  Last year I was hospitalized for ten days and still felt like crap when I came home.  The flare lasted seven months!
62 yr old granny. South Jersey
Diagnosed with ulcerative proctitis in 1998 in hospital
Hospitalized (2nd time) in May 2008
Update 11/03/08...finally in remission!!  Hope I don't jinx myself.  Off the prednisone since 11/01/08...now see if I can stay off for longer than two weeks.  Other meds: 6MP (75 mgm), colazal (6 per day), Benicar and Toprol (high blood pressure meds), Probiotic (2 per day), fish oil capsule and multi-vitamin and calcium with vitamin D.

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