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Steroids again. Advice please

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Ulcerative Colitis
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Posted 7/6/2015 8:55 PM (GMT 0)
Hi all

I just came off a taper from 40mg pred, last 5mg dose about 3 weeks ago. I'm flaring again now. Not hugely but there's blood and mucus and I'm going about 3-5 times daily.

Anyway, my consultant now wants me to up the ante on the meds and take aza, which I'm willing to do as this is a nuisance now. However, he wants me on 40mg steroids again to let the colon heal whilst the aza builds up.

My worry is that I've just come off them. This would be my third course in about a year and a half. Should I be worried about any long term side effects and should I just take the aza and cope with the disease symptoms for a few months until it kicks in??

Very scared about taking so much pred so often.

Thanks in advance guys
Posted 7/6/2015 9:06 PM (GMT 0)
What other meds are you on?
Posted 7/6/2015 9:06 PM (GMT 0)
I'm in quite a similar situation, I just tapered off pred and started getting symptoms again, and that was after a previous steroid course (of a drug called clipper) that had little effect. My doctor also wants me to start Aza, and I will likely have some pred again while it kicks in.

I think you should be okay, when they stress the importance of not taking steroids too often they're speaking in a very long-term sense. For instance, some people become pred dependant and take it for years and years, which is dangerous. A few courses in a year shouldn't do too much harm, and the Aza should mean that both you and I can hopefully avoid taking the steroids again for a good long time.

Having another course of pred is way better than suffering (and being in flare also damages your gut), and 40mg is not even such a massive dosage by steroid standards. So I'd say take the pred, you can spend plenty of time NOT on 'roids once the Aza kicks in.
Posted 7/6/2015 9:10 PM (GMT 0)
Aza is a maintenance drug not geared to fighting flares. That said if your symptons are mild I personally would hold out to see if things settled or go back on a lower dose of pred ... But not automatically jump back to 40mg. Maybe discuss possibility of a lower dose with your doc.

I was stuck on pred for a long time and it took me a number of tries to get off... I yo-yo'd and ended up needing a very slow taper (1/2mg per month) to get off.
Posted 7/6/2015 9:16 PM (GMT 0)
Mere parroting: a few courses a year shouldn't do too much harm.... Quite the opposite is true... It WILL do you harm!
Posted 7/6/2015 9:27 PM (GMT 0)
Obviously if you do choose to have some pred again see if you can go on a lower dose than 40mg this time. Since you're only going about 3-5 times a day you probably don't need a full-on dosage.

Duffle: I never said it wouldn't do any harm, just that it shouldn't cause TOO much just this once, especially when the alternative is suffering. Depends on how bad your side effects are, which varies.
Posted 7/6/2015 9:39 PM (GMT 0)
There are "side effects" and there can be permanent damage.
Posted 7/6/2015 9:49 PM (GMT 0)
A few courses in a year shouldn't do too much harm

www.healingwell.com/community/default.aspx?f=17&m=3446063
Posted 7/6/2015 9:54 PM (GMT 0)
Can you try rectal meds to ward off the flare so you can avoid pred
Or maybe see if you can get a really high dose of IV steroids
But just once so that you don't have to do a taper
Posted 7/6/2015 10:09 PM (GMT 0)
I feel like I am saying this in ever pred thread but....ask your doctor about Uceris.

It doesn't have the systemic effects of pred. It sounds like your flare is only mild? (I would consider 3-5 bms very mild) Uceris is designed for mild flares when tapering off pred.
Posted 7/6/2015 10:38 PM (GMT 0)
what is AZA?
I am new to this. Been on pred and am weaning off from 40 and aiming to stop at 10. Also taking
APRISO.
REALLY FRIGHTENED about what lies ahead.
Been in the hospital to get it all under control. Not having any problems at this minute.
Tell me what to expect...what will happen when I'm off the pred....what sets it off...I am so nervous this is NEW to be.
HELP with advice........
Thanks
Nanaone
Posted 7/6/2015 10:54 PM (GMT 0)
If your ASPIRO has not gotten a foothold, you flare will kick back in when you taper.

The choice may be to do another taper, take a low dose of pred for a while, and/or take something stronger than ASPIRO.

You can read about the immune suppressant drugs like AZA and 6mp. They are usually tried before going to a biological like Remicade.

Lets hope your ASPIRO works. You might also ask about putting the ASPIRO (mesalamine) in both ends. Suppository or enema can help if there is too much urgency.
Posted 7/7/2015 1:20 AM (GMT 0)

ONENANAnana323 said...
what is AZA?
I am new to this. Been on pred and am weaning off from 40 and aiming to stop at 10. Also taking
APRISO.
REALLY FRIGHTENED about what lies ahead.
Been in the hospital to get it all under control. Not having any problems at this minute.
Tell me what to expect...what will happen when I'm off the pred

Aza is short for Azathioprine, an immunosuppressive medication used to treat uc (others are Imuran, and 6mp).

Prednisone is a rescue medication, not meant for ongoing treatment of uc. If your uc medications are sufficient then getting off of prednisone is not a big deal at all. If those maintenance medications are not enough, then more maintenance medications must be added.
Posted 7/7/2015 2:05 AM (GMT 0)
I'd try rectal meds and a short burst of Pred (5-7 days at 40 or 50 mg/day). Rectals can work miracles and steroid bursts are commonly prescribed for asthma or sudden inflammation. It may be enough to get your GI inflammation under control until the AZA kicks in.

You don't need to taper after a short course of Pred.

Alternatively, you could do 15 or 20 mg of Pred and see if that helps.

In any case, definitely try rectal hydrocortisone.
Posted 7/7/2015 8:07 AM (GMT 0)
Thanks for all your replies.

I think I'll hold off on the pred until/if things get worse. For now I'll take the aza and stick with rectal meds and balsalazide. Fingers crossed.

I don't ever have any noticeable side effects from the pred but I do worry about the ones that I can't see.
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