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No prednisone relief now what

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Posted 5/20/2015 8:34 PM (GMT 0)
Hey guys,

I started prednisone after a pretty bad flare last Friday (12 days ago) and it still hasn't improved much (40mg a day). Getting worried now that pred won't do anything for me at this point. Before that I was on Uceris for a week without any results either.

What do I do now for short term relief....? I started Imuran as well 12 days ago but that'll take a while to kick in. Pretty frustrated and disappointed.

Thanks for any help.
M
Posted 5/20/2015 8:58 PM (GMT 0)
Only time it failed for me was when liver was not converting prednisone to prednisolone.

So get some of that also known as Solumedrol but that is the injectable form I believe.

Very much doubt that these will not provide relief.
Posted 5/20/2015 9:13 PM (GMT 0)
Sometimes people start on a higher dose than 40mg. If you need immediate response, i think pred is your best bet, that or a TNF blocker. I wish TNF blockers worked better for me, so many people do so well for years and years.
Posted 5/20/2015 10:02 PM (GMT 0)
12 days may seem like forever at this point, but it can take longer than that for the meds to start "working together." In the past, it has taken over 3 weeks of pred +other drugs to kick in for me. The wait time is miserable though.

I'd give it another week and if you don't improve, your doc may want to try something else.
Posted 5/20/2015 10:23 PM (GMT 0)
My first time taking pred it worked really fast. The second not so much. Twelve days just may not be long enough or you may need a higher dosage.
Posted 5/21/2015 1:16 AM (GMT 0)

web said...

Prednisone is metabolized by the liver to the active metabolite prednisolone, which is then further metabolized to inactive compounds

Prednisone is inactive in the body and, in order to be effective, first must be converted to prednisolone by enzymes in the liver. Therefore, prednisone may not work as effectively in people with liver disease whose ability to convert prednisone to prednisolone is impaired.

Other meds/alcohol could be effecting the enyzme.

Cytochrome P450 enzyme system likely to be involved.

Post Edited (aguywithuc) : 5/20/2015 7:24:03 PM (GMT-6)

Posted 5/21/2015 1:28 AM (GMT 0)
I am just in the middle of tapering off prednisone. I was on 45mg for 10 days and then decreased by 5 mg every 7 days. I saw blood up until I decreased to 30mg. Try and be patient - might just take time. Like others it worked super quickly the first couple times I was on prednisone
Posted 5/21/2015 1:53 AM (GMT 0)
Yea, first time it worked like a charm in about a week. Now minimal if any improvement. I'll give it some more time and pray I guess. This is miserable :( thanks for the feedback!
Posted 5/21/2015 2:13 AM (GMT 0)
You can go higher on the Pred, but it is a dangerous game. I'll assume you have tried the rectal meds and all of the Asa's. Uceris was worth a try, but I am not a fan. Might be time to consider Entyvio or another biologic. Imuran is usually less preferred than even 6mp, if you have UC. Perhaps I have missed what you have tried. Easy BRAT diet while you are healing. How high is your inflammation? Blood work ok?
Posted 5/21/2015 11:20 AM (GMT 0)
If a bad flare - administered via IV pred (larger dose) for a week or so followed by oral pred on slow taper. The Meds via IV work far quicker but require hospital admission obvs.
Posted 5/21/2015 12:05 PM (GMT 0)
Yeah I got diagnosed in January, was put on pred 40mg that kicked in in like a week got me pretty good. Delzicol and Lialda didn't do the trick I was just simmering (used Rowasa as well) then a few weeks back started seeing blood again and then a flare that was worse than the previous 1 I'd say. Was on Uceris for a week didn't do anything kept getting worse jumped on prednisone and it got really bad for a while, now 13 days later it's still pretty bad (10-20 times a day with mostly liquid blood and extreme urgency). GI preferred Imuran over 6MP, not sure why (he wanted Remicade initially and was very reluctant to put me on Imuran but due to cost and ease of it I wanted to try Imuran first). So that's where I'm at now. Still doing delzicol and Rowasa daily but I can't hold it for more than 1-2 hours these days.

Thanks,
M
Posted 5/21/2015 12:53 PM (GMT 0)
40mg was always my starting point & it worked great for many flares over a 10 year period. Last one 40 did nothing...upped to 60 and that helped almost immediately. However, after tapering within a week symptoms recurred. Back to 60 and off again...same thing. Last time I took pred 60 took about 10 days to kick in and when I got down to 10 mg symptoms returned (also on Humira at the time). I had become "prednisone dependent" and opted for J-Pouch surgery.

Vicki
Posted 5/21/2015 2:39 PM (GMT 0)
Don't expect the same medications and dosages that worked last time, to work as well this time. Every uc flare is different, varying in severity from mild to hell incarnate.

I've heard of oral dosages of prednisone up to 60mgs a day, ask your gastroenterologist and tell him/her about your lack of progress. IV steroids are sometimes necessary to pull one out of a flare...
Posted 5/21/2015 7:31 PM (GMT 0)

Duffle said...
The Meds via IV work far quicker but require hospital admission obvs.

Because there is no requirement that the liver convert the medication to a usable form, bypassing any current or long term issues going on with the liver.
Posted 5/21/2015 11:52 PM (GMT 0)
Prednisone stopped working for me after several flares. To me, it seems like twelve days would be enough. I would try moving on to biologics.
Posted 5/22/2015 12:23 AM (GMT 0)
Have you tried to use steroid enemas as well? It could give you the extra little kick you need from the other end with a steroid without jumping up on the oral dose.
Posted 5/22/2015 8:55 PM (GMT 0)
Pred usually worked fairly quick, but for me it only worked a handful of times, each time I went on it, it took longer to work until the last time I went on it, it did nothing, that's when I knew pred was no longer an option for me (it only helped me minimally anyway in the beginning) are you on any maintenance meds? If not then you should be since pred is really more of a band-aid med that is used to help kick start maintenance meds, all by itself is really more of a waste of time since it eventually wears off and symptoms come back as they were or sometimes even worse because it designed as a short-term releif or kick-start med.
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