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How much prednisone is too much?

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Crohn's Disease
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Posted 1/2/2014 3:05 AM (GMT 0)
Hello.

I am having a flare of my CD . . . not horrible, but bad enough to make life annoying. Although I hate to make a deal with the devil, the "P" is usually the one drug that actually controls my symptoms. I have never been over 40mgs (usually for a week and then taper down), but the last time I was a 40, it did not do as much good as usual. I just had a scope and the report was the usual (not horrible, but scarring and inflammation), but as I get back to work, I want to start feeling better. I have an appt. with my doc tomorrow, and I know he will put me on the "P" (which I want) . . . I just don't know if starting at 50 or 60 for a week and then tapering is too much.

Also - any thoughts on Cortifoam?

Any info would be appreciated.


45 y/o male
CD in Colon and rectum since 1989
One surgery (1998)
Remicade
6mp
Canasa
Posted 1/2/2014 3:45 AM (GMT 0)
I've been at 60mg for one week and after which I tapered by 5mg a week. That was for an acute arthritis flare when I flew home after being in a different climate for almost a month. I initially started at 40mg but it wasn't touching the inflammation so that's why I had to go up.

I recall a friend's husband being put on 200mg for an unusual illness (I don't remember what) and I thought at the time that it was a crazy high dose. He was really really sick with side effects. I'm sure that he wasn't that high for a long time, but still it was bad. He had to take diuretics due to the edema.
Posted 1/2/2014 4:01 AM (GMT 0)
I did 60 mg for two weeks. I won't lie it was hard! I was an emotional wreck! I couldn't wait to get down to 40mg. But it did bring things under control fast. Not sure I'd do 60 mg again, 40 I think is my limit. lol
Posted 1/2/2014 4:02 PM (GMT 0)
LDR1109 are you still on remi? Why not increase the frequency or dose of that med? As you have experienced already, repeated use of pred makes it less likely to be effective in the future.

Is the scarring and inflammation limited to the rectum? I assume this is the case based on your question about cortifoam. Cortifoam would be effective but it is a steroid just like pred and if you are developing steroid resistant disease I wouldn't choose this approach. What about mesalamine enemas? This is the same med that's in Canasa, but in a bigger dose that covers more ground. It would be the most effective and safe choice to treat stubborn inflammation in the rectum and sigmoid colon.

Another idea is to go on combination therapy, which is remi + 6MP I think.
Posted 1/3/2014 4:34 AM (GMT 0)
Thank you all for your responses.

Kazbern . . . are you my doc? He said basically the exact same thing you did. He doubled the frequency of the remicade; said the same thing you did about cortifoam; and he put me on a mesalamine enema regimen - just like you said! He also put me on 40mgs of Prednisone, but I cannot start taking that until my c-diff test comes back negative.

So, when all is said and done, it looks like Pred for a little while; double-dose of remicade; 6-MP; and the enemas. I am just hoping all of this works. The good news is that the report from my dec 23 colonoscopy wasn't too bad . . . mild to moderate Crohn's with no MAJOR inflammation or scarring, and the only polyp was a "pseudo-polyp." I just don't understand why I have been experiencing all the symptoms I have been if the results of the scope were the same as last year . . . oh well, the fun of living with CD!
Posted 1/3/2014 4:45 AM (GMT 0)
rectal inflammation is a *****. Use those enemas nightly for a good long time - 3 months maybe? And then taper off very slowly. I used mesalamine enemas for more than a year before really knocking that rectal inflammation out completely.

Glad my comments made sense and concurred with your DR! That feels good!
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