prednisone tapering schedule

just wondering how you are tapering on prednisone if you take it. i read a lot on here that people taper by 10 mg a week but my prescription is for 5 mg taper every week. how do doctors pick the taper dosage? i'd rather get off of it sooner than later because i still haven't noticed any improvements while taking it.

I have done both--5mg and 10mg tapers-and I can tell you if the pred isn't working too well anyway, a 5mg taper is probably safer. I was tapering successfully 10mg a week for awhile, but when I went from 20 to 10mg, all heck broke loose, my symptoms returned and I am now back to 30mg. My next attempt at tapering will be 5mg a week, starting next week when I have my new drug Cimzia in me for a week and we will see how this goes. Your doc probably wants to wait to see the Remicade kick in and then start to taper your prednisone.

Sounds like from your sig your disease has progressed really fast, sorry to hear that and I hope you feel better soon.

I certainly understand wanting to get off prednisone!

my dose started at 40 mg and i was on this for 2 weeks. i gained about 35 lbs of water weight but besides that, nothing really changed. i then tapered to 35 mg and lost all the water weight overnight- a lot of peeing. i saw my doctor and told him that the prednisone wasn't really doing anything so he added 6mp and started me on remicade. he told me to stay on the 35 mg of prednisone, but honestly, i've been tapering by 5mg every week since that appointment and feel so much better. the 6mp is what really made a difference. i just don't wanna be on prednisone at all because i hear it's really easy to become dependent on. i know it's not good to go against what he said, but i'd rather just listen to my body and still taper every week. i get blood work done every week anyways so i figure that will show if anything is going wrong.

I always tapered 10, I couldn't wait to get off the pred!

hey, Bananagirl

I hope everything goes smooth. Seems like you're doing pretty well.

For the prednisone tapering, you should get another script for 2.5mg tabs or 1mg tabs from your doctor.

It's the best that you go down slower as you reach the lower range like at 10mg. 7.5mg for the next week then to 5mg.

I know you haven't been on prednisone for long but if you go down slowly then you will find the post prednisone side effects like fatigue, not too overwhelming.

Good luck!

Crohn's disease is associated with involuntary weight loss in up to 75% of patients, due to diminished oral intake, malabsorbtion, and an increased total energy expenditure(1). This loss of mass is associated with an initial decrease in fat stores and later in lean body mass(2). Corticosteroid therapy produces further malnutrition and catabolism of Protein resulting in markedly diminished fat and Protein stores. Nutritional supplementation in these individuals has been limited to oral, enteral and parenteral support, which mainly serve to replenish fat stores while minimally affecting lean body mass.

We report the case of an individual treated with oxandrolone,an anabolic steroid effective in inducing Protein synthesis, for cachexia in the context of Crohn's disease.
The patient is a 29-yr-old woman with Crohn's disease diagnosed at age 20,who presented on 2/12/96 with severe wasting and a history of prednisone use since her initial diagnoses.
Physical examination revealed a cachectic, 160-cm tall,35.7-kg woman(60% of ideal body weight), with complaint of upper abdominal pain and oral thrush. Bioelectric impedance analysis(BIA) on 2/20/96 showed a fat mass(FM) of 0.6kg, a fat-free(FFM) of 35.0 kg, with a body cell mass(BCM) of 13.9 kg and a phase angle of 3.9 degrees. The patient was started on a daily oxandrolone at 7.5mg b.i.d. a typical regimen for a patient with HIV-associated wasting. Her other medications included prednisone 60mg did. pentasa 1g q.i.d. and ferrous sulfate supplementation.
The patient continued oxandrolone, which was later increased to 10mg b.i.d. on 3/26/96, and showed marked improvement in all aspects of her BIA. In addition, the oral thrush noted on initial presentation was absent on further examinations, and the patient subjectively reported that she felt more energetic than she had in years. On day 98 of treatment(5/28/96), oxandrolone was discontinued due to an increase in facial hair noted by the patient. BIA on 7/16/96 revealed a total body weight of 48.2kg, FM of 10.7 kg, FFM of 37.5 kg, with a BCM of 16.3 kg and a phase angle of 4.7 degrees.

Oxandrolone therapy is currently used in patients with weight loss after surgery or severe trauma, with chronic infections, with prolonged corticosteroid use, and for some patients without known reason who fail to gain weight.(3). Recently, HIV-associated wasting has also been treated with this medication due to the very low risk:benefit ratio. Multiple studies have demonstrated the efficacy and safety of oxandrolone(4,5). In addition nutrition in HIV, specifically the phase angle, has been shown to be an even stronger predictor of survival than CD4 count(6).

We decided to initiate therapy in our patient to promote weight gain and to counteract the Protein catabolism caused by high-dose prednisone use. Much of the weight loss that occurs in Crohn's disease is secondary to lipid oxidation(2). However once a patient is depleted of fat stores, Protein, including body cell mass is catabolized. Our patient also had oral thrush, a sign of immuno-suppresion. While thrush may have been a consequence of corticosteroid treatment, once the patient started to gain weight, it resolved despite the continued use of prednisone.
Although the most significant improvement in BIA occurred in the fat compartment(+10.1kg), this patient also showed substantial increase in BCM (+2.4 kg), as well as phase angle (5.0 angle on 5/28/96).
Follow-up with this patient over 1 yr after treatment discontinuation showed maintenance of body weight (56.8 kg on 7/21/96) and well-being

Nutritional supplementation with TPN in Crohn's disease has been shown to substantially replace fat losses and water, but has little effect on lean mass(1). Enteral feeding aids in Protein as well as fat and water repletion, though it requires feeding through a nasogastric or nasoduodenal tube(7). Oxandrone therapy allows for Protein repletion via a non-invasive and safe oral medication.Based on these results, we will expand the use of oxandrolone in our practice to include severe weight loss in Crohn's disease.


REFERENCES

1. Fleming CR. Nutrition in patients with Crohn's disease: Another piece of the puzzle. J Parenter Enteral Nutr 1995; 19:93-4.

2. Mingrone G Greco AV, Benedetti G, et al. Increased resting lipid oxidation in Crohn's disease. Dig Dis Sci 1996;41: 72-6

3. Ferraresi RW. Clinical profile of Oxandrin. BTG Pharmaceuticals 1996; 1-7.

4. Berger JR, Pall L. Hall CD, et al. Oxandrolone in AIDS-wasting myopathy. AIDS 1996;10: 1657-62

5. Poles MA, Meller JA, Lin A et al. Oxandrolone as a treatment for AIDS-related weight loss and wasting. Presented at the Infectious Disease Society of America Conference, New Orleans, LA, September 19, 1996

6. Ott M, Fischer H, Polat H, et al. Bioelectrical impedence analysis as a predictor of survival in patients with human immunodificiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 9: 20-5.

7. Royall D, Greenburg GR, Allard JP, et al. Total enteral nutrition support improves body composition of patients with active Crohn's disease. J Parenter Enteral Nutr 1995; 19: 95-9.

Yep went from 10 to 0 every time and didn't have any problems even after being on it for more than 2 months and up to 80 mg.

all right. i am feeling weird. i started on 10 mg of pred on tuesday. i am feeling a little more crampy than usual and am just really anxious. i am just all around shaky and annoyed with things. should i go back up to 15 mg or is this just normal?

I definitely had a hard time when I tried to taper from 20mg to 10mg..eventually to go back up to 30mg and spent a month at that dosage and trying now to taper 2.5 a week in hopes of getting off it soon. I just cut my 5mg tabs in half, they are scored in the middle so not a problem. Better to ease off slowly so you can get off the stuff and not bounce around on the dosage as I have, not fun at all.

Vitamin C is really good for adrenal gland support. When I am tapering I usually try to make sure I am getting enough Vitamin C and B vitamins.

I always find I can taper pretty quick by 5 mg or 10 mg the first 20 from 40 mg to 20 mg, but once under 20 mg, I usually go slower. Either a few more days than usual at 5 mg increments or do 2.5 mg increments. I find my body needs more time to adjust once under 20 mg.

i'm so glad i have you guys! i am going to do 15mg for another week then taper to 12.5, 10, 7.5. i think smaller increments is better for me.

i wonder why going lower than 20 mg is hard for people. i really don't know much about prednisone. i'm gonna have to go to the library and see what i can find out about it.