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Prednisone Stopped Working

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Ulcerative Colitis
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Posted 9/11/2015 1:46 AM (GMT 0)
Hello,
I was hoping to get some insight/info. I was diagnosed about 2 yrs ago with UC. I just went 9 months with no flare on 50mg Azathioprine and 20mg Prednisone. Started the Prednisone taper about a month ago and went into a flare within 2 weeks (got to 10mg Prednisone). A week ago, I stopped the Azathioprine and increased to 40mg Prednisone, and I'm still in flare with things getting worse.

Very odd because Prednisone, by itself, has always been very effective for me. And now it is not working at all.

Has anyone experienced this?

29 y/o
Diagnosed 4/16/14
Most effective Meds: 50mg Azathioprine + 20mg Prednisone
Posted 9/11/2015 2:45 AM (GMT 0)
Happens to most people either right away or with continued use. Happened to me after my first use as well.
Posted 9/11/2015 3:48 AM (GMT 0)
In a way you are lucky. Relying on pred as a long term treatment plan would have destroyed your body far worse than UC could.
Posted 9/11/2015 4:30 AM (GMT 0)
Maybe try biologics? Good luck!
Posted 9/11/2015 1:36 PM (GMT 0)
Thanks for the advice everybody, really appreciate it. I'll continue researching what's out there and stay in touch with my GI...it's a stubborn flare, but I've had way worse.
Posted 9/11/2015 1:45 PM (GMT 0)
Yes, I found that prednisone became less and less effective for my disease as it progressed over the years.
Posted 9/11/2015 2:17 PM (GMT 0)
50 mg of azathioprine is a very low dose. The dose goes by weight is is roughly about what you weigh -- if you weigh 100 lbs you would take 100 mg. Again this is very rough -- I'm sure someone else here can tell you the normal dosage formula for aza. 50 mgs of 6MP is pretty common but aza dosages are higher.
Posted 9/11/2015 2:38 PM (GMT 0)
Why were you put on prednisone for a year? This is something you should ask your GI. It is very unusual to do something like that. Prednisones has several short and long-term devastating effects on your body.
Did you ever try mesalamine meds?
Try both oral and rectal mesalamines if you have not.
If that still does not work I would raise the dose of imuran as you can go to 150 depending on your weight. Your blood needs to be monitored carefully on this medication although you should know that because you already on it.
If your G.I. does not have a good reason for putting you on longer-term prednisone and skipping the first step of medication that is usually given for Uc than I would get a second opinion ASAP.
Look for a university hospital that specializes in IBD.
Good luck.
Posted 9/11/2015 3:07 PM (GMT 0)
CCinpA...I agree. When I started the Pred taper and went into the flare...my GI told me to increase back to 20mg Pred and double the dose of Aza to 100mg which I did for one week..this didn't work, but I'm almost positive it didn't work because I was already in the flare and the combo just wasn't strong enough to suppress the flare...that's when we cut out the Aza and went to just 40mg Pred which also is not working.

But I do think the increased dosage of Aza could work if I can just kick this flare. Because the Aza at 50mg was effective in getting me from kinda-sorta-flare-but-not-really to completely normal bowel movements, etc.

Dikid...good question. I think he kept me on 20mg because it was working, especially in combination with 50mg Azathioprine. And now I'm paying for it because my body has built a tolerance to the Prednisone which is hendering me from re-entering remission...the 40mg Pred is just not strong enough to suppress the flare and it has to be from taking 20mg Pred for 10 months...no other logical reason.

I tried the Mesalamines (Lialda) a year ago and it made me even more sick...I was taking Lialda in Combo with Prednisone to kick a flare...once I stopped the Lialda, and stayed on the Pred...my flare immediately stopped...and that's when I just stayed on Pred for 10 months (and started the Aza 6mos ago).
Posted 9/11/2015 5:31 PM (GMT 0)
It does take a while for the increased dose to kick in and help. One week is too short. It wasn't helping because you were on too low a dose.
Posted 9/11/2015 8:27 PM (GMT 0)
Imuran/azathiopurine is dosed at 1.5-2.5 mg/kg for ulcerative colitis. I weigh 150 pounds or 68 kilograms.

68kg x 1.5mg = 102 milligrams a day
68kg x 2.5mg = 170 milligrams a day

A change in dose takes 6 weeks to make a difference (reach therapeutic levels in your body). You didn't wait long enough. Your dose was too low. Doses need to be increased with doctor supervision and with regular blood monitoring.

Biologics are your best option for a quick response (remicade, simponi, humira).
Posted 9/12/2015 1:37 PM (GMT 0)
Thanks for the input, you're right, I didn't wait long enough at all and I knew that. I know it does take about 6 weeks or so for Aza to take effect, that's about how long it took when I first started taking it at the low dose of 50mg. I just got impatient when the flare was getting worse and really just wanted the doctor to up the dose of Prednisone to get rid of the flare...not a good idea.
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