Prednisolone

[George_88]

Hey,

I'm a new guy here just wanted to ask some questions

Had my first flare up a couple of months ago since my Crohn's was put into remission with Infliximab in summer 2007.

I went to hospital recently and was on Hydrocortisone injections 4 times a day for 5 days which was then switched to Prednisolone 40 mg/day (tablets), on a reducing dose. I also had an infusion of Infliximab (Remicade) while I was in.

Since I've been out of hospital I have had no problems and the severe diarrhea I was getting stopped and my weight loss also stopped and I've put on quite a but of weight already.

But, I reduced my dose on Saturday for the first time and today (Monday) I woke up to a bout of diarrhea and stomach gargling. I know that Prednisolone can cause gastrointestinal disturbance but can it give you diarrhea as a side effect? Or could this diarrhea be caused because I've reduced my dose and inflammation is back?

I am supposed to reduce my dose by 5 mg a week. However, after reading some of the side effects, I got scared and at my own accord decided I wanted to get off these ASAP and reduced by 10 mg instead of 5...

The reason is, when I was first on steroids in 2007, I didn't know I couldn't just stop taking steroids, and when I received infliximab and my Crohn's was in remission within days of taking it, I thought I no longer needed to be on steroids. My doctor didn't inform me to taper off my dose so I came off them instantly and as far as I know had no problem.

But is 10 mg a week really THAT much of a drop? I don't know what to do now...

Currently I should be on 35 mg a day (7 tablets) until this Saturday. But I'm on 30 (6 tablets) for the reasons explained above.

Should I begin taking the extra tablet a day until Saturday or leave it and not reduce my dose on Saturday? as by then I am supposed to be on 30 mg a day anyway.


Thanks for reading.

Edit: by the way, I'm also taking Azathioprine (100mg/day).

 

[soupdragon69]

Hey George,

Welcome to the forum..

Your question about pred is a valid one and I can understand why you feel as you do having read the info leaflet etc..

Its also a drug we discuss alot here and you will find more info in relation to taking it on the support section.

Main thoughts are: decrease according to your agreement with you doctor. If you decrease too fast having been on them more than 2wks you are at risk of addinsonian crisis. This means your adrenal glands dont kick in and produce cortisol naturally that the steroids took over the job of in a higher dose!

You have to allow time for your body to register the decrease in pred and for the adrenal glands to "wake up" as a result. It must be a gradual process and not a shock to your system!

It is up to you whether you take the extra one and from a personal perspective I would to be honest as it is a big drop considering you were on IV for a while too. HOWEVER TALK TO YOUR DOCTOR. They cannot give you good accurate care tailored to you if you dont communicate with them. Tell them your concerns and listen to what they have to say.

It is also possible that your guts have had a brief flare of inflammation in response to the decrease in pred (also take into account your adrenal glands not working totally yet too).

It could be that your body needs more than pred to give you longer remission and it is a sign of a longer flare crohns wise.

Only you, time and your doctor can decide these things. Does that make sense?

Keep in mind that pred can also cause weight increase due to some extra fluid being retained so you might lose some weight with stopping eventually. It also causes the "munchies" so raiding the fridge can be an occurance too! ;-)

The main thought is dont ever stop or decrease any meds outside the agreement with your doctor as they know you best!
Hope what I have said helps. Looking forward to seeing you around.

 

[My Butt Hurts]

Hey George - welcome!
I would say that a 10mg drop is too much. Usually whenever someone on here says that they dropped 10mg of pred it is also accompanied by the fact that their symptoms have come back. With prednisone, it seems the slower the taper, the better the result. The 4 or so times I have been on pred, I tappered 5 mg each week. The last time I was on it I tapered 5 mg every 2 weeks. I did that on my own, cuz my flare was so bad, and I just wanted to be well. I even had to call me doc to tell him what I did (as I ran out of meds and had to ask for a refill) but he didn't seem to mind.
KatieSue recently wrote about percentages when dropping off pred and it explained the reduction really well. Going from 40mg to 30mg is a 25% reduction (I think?) but 40 to 35 is only (well heck - I don't do math unless it's for a sale at the mall - but see my point?)
Anyways - good luck and feel well.

 

[robbo87]

i had a similar problem. came out of hospital and was lowering at 10mg a week, by the time i got to 20 mg everythin came back, stomach pains, diahrea sore mouth etc etc, so i went to the docs and was temporarily put back to 40mg. saw a specialist today and now ive been put on them for longer with a slower tapering down, so by 5 mg each week this time.


the doctor said i was coming of the pred to quickly and id imagine this is the same for you.

 

[George_88]

Well that's just great. Now I'm too scared to come off because of Addison's disease!

:depressed:

Are palpitations normal while on these? I've been listening to my heart beating the crap out of my chest for a while now. Sometimes my breathing feels heavy too... and my hands shake a little...

Also, been on the steroids for 2 weeks today (Tuesday). Is it safe to cut them off? :lol:

Thanks for replying.

 

[MINI Cooper]

i had a similar problem. came out of hospital and was lowering at 10mg a week, by the time i got to 20 mg everythin came back, stomach pains, diahrea sore mouth etc etc, so i went to the docs and was temporarily put back to 40mg. saw a specialist today and now ive been put on them for longer with a slower tapering down, so by 5 mg each week this time.


the doctor said i was coming of the pred to quickly and id imagine this is the same for you.

Same here. I had a relapse after trying to taper the first 2 times.
Now I am tapering 10mg, down to 30mg right now. Doctors usually taper 10
at first, then 5 after you get down to 20mg. But each doctor is different.
Just keep your doctor posted on all your symptoms, and go from there.
Hang in there, Pred can have lots of yucky side effects :voodoo:

 

[robbo87]

yeah im starting to learn its not the greatest thing to be on after the first two weeks of feeling great lol. also start a 4000mg daily course of pentasa tommorow too so hopefully all will go well!

 

[soupdragon69]

Hey George,

The whole point of me telling you the facts is so you are aware that ANY med can have implications on the positive and negative fronts. Also the need to stick with your meds regime and highlight any problems you are having so you getter better and not worse!

You need to be sensible and realistic. None of us likes taking meds for any length of time but having the right info and understanding helps you to manage things day to day. It also helps you to have an accurate input into your own care by making sure you tell your medical team anything that is impacting on you.

They cant tailor your meds and care to YOU if you dont have an input!

The symptoms you mention may have been felt by some on pred as I know some have mentioned their hands shaking - anything is possible but it also sounds like you could be suffering from anxiety and this disease certainly makes us all stressed at different times.

Make sure you talk to your medical team about this or have a chat to the Crohns organisation nearest you so you know what is causing these symptoms for you.

Hope you feel better soon.

Robbo, am glad they are levelling you out and you have a decent plan now. Hope all goes well and you start to pick up overall as you decrease your pred this time round.