Prednisone Dose?

What's the lowest dose anyone has ever started on to get their symptoms under control and how long on pred total? My GI's always start me on 40 mg and it takes at least 8 weeks to ween. The side effects are brutal for me and last about 8 weeks after weening (so up to 4 months total with some side effects). It's been 6 years since I've been on it and I really don't want to do it again.

I'm currently on cortenema and that is it. Nothing else works or it either makes me feel worse. I just feel like my body is surrendering. I'm having some crazy hay fever type allergies that I've never had before and I've been feeling like crap for about 6 weeks from the meds I've tried, the disease, and the allergies.

Does a small, quick dose ever work...like say 20 mg weening for 4 weeks?

100 doctors will prescribe prednisone 100 different ways. Most people don't realize that a good deal of the side effects are actually from "prednisone withdrawl" while tapering. The slower your taper the easier the withdrawl effects are. Most people and even doctors don't realize that the milligrams of the taper is not as important as the percent of the taper. The higher the percentage, the greater the withdrawl effects are. For example:

Tapering from 40 down to 35 is a 12.5% taper.

Tapering from 35 down to 30 is a 14.3% taper

Tapering from 30 down to 25 is a 16.7% taper

Tapering from 25 down to 20 is a 20% taper

Tapering from 20 down to 15 is a 25% taper

Tapering from 15 down to 10 is a 33.3% taper

Tapering from 10 down to 5 is a 50% taper.

This is the main reason people have so much trouble while tapering their prednisone. It also doesn't really make sense to put someone on prednisone and then immediately begin tapering it down before the person is even in remission. If you haven't yet achieved remission from 40mgs of pred after a couple of weeks, how does anyone realistically think you are going to magically get better by starting the taper too soon? I'm not an advocate of taking prednisone at all but if you are going to do it you shouldn't start tapering at all until you have reached remission first and then when you do start tapering you should taper by percents and not by milligrams.

Everyone's different I guess......but a 2 week course @ 20mg worked for me.  The bad side is the length of time it takes to get off the darn stuff.......

.and as it now turns out, my prolonged use of steriod made me insulin resistant, and I'm now type 2 diabetic.

So if you can, get off them quickly.......reduce by 5mg every other week.

I've been on 25mg for the past couple of weeks and it's not working as well as it usually does.  In fact I still have about 6-8 urgencies mostly in the early am.

I spoke to my GI's assistant and she said to up it to 30mg 'til I see the GI next week.

Can or will the extra 5mg make a whole lot of difference?

According to garylouisville's table I'm upping my dose by 16.7% so you would have to hope it could make an impact?

That's really clear Gary, thanks for putting it on here again. I'm going to discuss this with my GI tomorrow. I'm at 20 mg now after starting at 40. I didn't achieve remission, but my symptoms improved dramatically...very liveable now. From what you told me before, I'm feeling a lot more comfortable with doing this slowly, so thank you again.

There are no guidelines and there is currently some discussion about this in the GI community. The good GI docs will tell you to start out at 40-60mg per day (taken all at once in the morning) and to stay on that dose until you get symptomatic relief (a dec in BMs per day, blood in stool, tenesmus, etc). Then you can start your taper. DO NOT TAPER TOO QUICKLY. Prednisone sucks but tapering too quickly will throw you back into a flare even though you think you're doing okay. Try to go down 5 mg/week until you hit 20 mg. At this point determine whether you want to taper by 2.5mg per week or 5mg per week. When in doubt, go with the slowest taper.

Source: current medical literature and uptodate.com

Gary,
Thanks for the info! I am on day 8 of 40mg. I am DEFINITELY feeling much better, but still some blood at the end of the day...but not in the morning. I want to give 40 a full 2 weeks...but I am going with your thoughts...I should be very close to remission before I start the taper.

Off to Palm Beach today for the National Field Hockey Tournament with my 16 year old daughter!! Praying that the travel doesn't mess me up. HAPPY THANKSGIVING TO ALL!!!

~Cita