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Flaring while tapering - help

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Ulcerative Colitis
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Posted 2/18/2015 1:03 AM (GMT 0)
Hello,

After a recent flare, I started taking 30mg of prednisone. After a week, things looked better and my GI doc said I can taper at 5mg every 3 days. I was a bit reluctant to taper so quickly but I followed his directions. When I got down to 15mg, I started to see more red in my BMs, which was just over 2 weeks after I initially started prednisone.

I do plan to call my GI doc this week but I'm wondering if either I tapered too fast or my maintenance meds (Lialda 4x/day) just isn't doing the job here.

Did anyone have a similar experience and if so, what did you do?

Thanks in advance.
Posted 2/18/2015 1:31 AM (GMT 0)
I haven't had much exp with pred but it sounds like both from what I hear.
Posted 2/18/2015 2:15 AM (GMT 0)
If you were only on 30mg for a little over a week, then the taper is not too fast. it is very standard taper as part of short course.

but, you might have stayed on 30mg for a few weeks to give the Lialda more chance. Still, the Lialda might yet get the edge on a small amount of blood and mild symptoms.
Posted 2/18/2015 3:57 AM (GMT 0)
What meds and dosages were you on before the flare?
Posted 2/18/2015 6:09 AM (GMT 0)
MikezUC - I've not had prednisone with UC (yet) - have had it for Asthma.
Been on Lialda and it does take time to kick in. I'm in the midst of a flare/recovering - the thing that turned it around was Canasa suppositories. They're not the most pleasant thing in the world to have to use - but it did help pretty quickly.
Posted 2/18/2015 8:39 AM (GMT 0)
Lots of exp with pred and taper speed is a very personal thing ... Standard does not exist although common approaches do. I taper incredibly slowly as I know fast taper results in another flare before I get to the end. Talk to your doc ASAP ... And get them to review your individual needs. Ps ... I've never tapered as fast as you! Good luck.
Posted 2/18/2015 3:57 PM (GMT 0)
My GI wants me to go back to 30mg and come in for an office visit. Since Lialda (now taking 4x/day) doesn't appear to work, I'm assuming we will try something else.

Does it make sense to give up on mesalamines and move to the next level? Or are there other drugs in the same class as Lialda that might work better?

This is my second flare as I initially flared when I was on Lialda 2x/day after being on it for a few weeks. Moving to 4x/day worked for a couple weeks, but I got a really bad cold and everything got worse (which is why I am on pred for a second time).

If I have to move to the next level I want to make sure I've exhausted all other possibilities.

I do take a probiotic (Align) and other vitamin supplements, but they don't seem to make any difference.
Posted 2/18/2015 4:03 PM (GMT 0)
If you haven't yet tried using mesalamine enemas (rowasa) in addition to Lialda, it's not time to move up the ladder to immune suppressants or biologics. Studies show that UCers reach remission more often and more quickly when rectal and oral mesalamine is used in conjunction compared to only using oral mesalamine.
Posted 2/18/2015 4:09 PM (GMT 0)
ya, what fruity said - she's not the butt med queen, but she's her left hand girl -

do what she say !
Posted 2/18/2015 4:12 PM (GMT 0)

juststud said...
ya, what fruity said - she's not the butt med queen, but she's her left hand girl -

do what she say !

Harhar juststud. So I still get that title even though I seem to have developed an intolerance to the butt meds?
Posted 2/18/2015 4:22 PM (GMT 0)
Would you take Rowsa daily as a maintenance med, less frequently (e.g. 1-3 times week) or only when flaring?

Also, if things were to get better using this, would you discontinue Rowsa and take only as needed while still continuing Lialda?
Posted 2/18/2015 4:31 PM (GMT 0)
You should use it nightly when flaring.

Studies have also shown that by using it just twice a week in conjunction with oral meds, patients remain in remission longer than those who just use oral meds. I used them faithfully (twice a week) for the five years I was in remission, but when I had a mild flare last year, it seemed I'd become intolerant to them. So now, I'm just using Apriso. I'm thinking of trying to use Rowasa again, just to see what happens.

My GI, however, had been telling me for a while that since I was so stable, I'd probably be OK stopping the Rowasa. He said that since I was in a deep remission, he didn't think they were doing much. So my guess is that they're more important for the people who tend to flare more frequently.
Posted 2/18/2015 5:48 PM (GMT 0)
Your prednisone taper rate was fine, no worries. I believe you are right on not having good enough uc maintenance medications.

Keep the lialda at 4 pills a day and try nightly rowasa meslamine enema. Ask your gastroenterologist for the prescription. Try rowasa for a few weeks, it might be enough. Many take rowasa as their maintenance medication, in addition to lialda. If you do not respond to the rowasa plus lialda, then I'd get a prescription for an immunosuppressive medication (such as 6mp, Imuran, or aza). Immunosuppressive medications are often taken at the same time as lialda. With uc, a combination of medications is often the mist successful in treating symptoms. Good luck,
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