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When to reduce prednisone dose?

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Posted 10/14/2015 9:51 AM (GMT 0)
I started pred a couple weeks ago. Started at 40mgs and, per doctor's instructions, I stayed at 40 for 5 days then dropped to 30. I've been at 30 for 9 days and am now wondering if I should drop to 20. My question is this - do you wait until your symptoms are gone before dropping your dose, or just better? The pred seems to be helping me, but I'm nowhere near back to normal at this point. I've seen a big reduction in blood and the improvement I'm most happy about is that, rather than running to the bathroom all day long, I now get a good stretch where I don't really have to go between the morning and night. Things have also calmed down enough that I've started being able to retain Canasa and Rowasa for longer periods. Urgency has improved a little. But it's still liquid, it still hurts a lot sometimes, and I can't pass gas off the toilet. Is it okay to taper and assume that I'll keep improving at 20mgs?
Posted 10/14/2015 10:18 AM (GMT 0)
That's definitely a question for your gastroenterologist. Many of us improve on pred and then return to flare as we taper. Usually you stay on pred until your maintenance drug of choice has had time to kick in and work, which varies depending on the person and the maintenance drug.
Posted 10/14/2015 12:05 PM (GMT 0)
I know it's a question for the GI, but wanted people's experience on here.
As I improve, I am increasing my ability to use rectal meds. They have been effective maintenance meds in the past but this flare got away from me and before I knew it, I couldn't retain them.
Any others with input would be appreciated!
Posted 10/14/2015 12:35 PM (GMT 0)
Prednisone is a good temporary rescue medication, for when a uc flare is at it's worst and it can help quickly stop bleeding and bad symptoms. Prednisone buys you time while new medications are tried and given time to work. However, you've got to be able to maintain your symptom improvement without the prednisone.

Ideally, you should be mostly healed before you're completely off of prednisone, and shouldn't see symptoms returning as you reduce prednisone doses (that is taper).

Should you change your taper schedule now? If it were me, I'd call your gastroenterologist and say:

Hey I'm better but not a whole lot better, and already reducing my prednisone dosage... Does that make sense? Should I give it more time at this dose?

I think those are valid questions to ask. Personally, I feel the best prednisone courses aren't rigid taper scheduled, rather very flexible taper schedules based on patient response and symptoms. I feel it should be dynamically adjusted along the way, so keep in regular touch about your progress (or lack thereof) with your gastroenterologist.

You'd hate to have wasted your time on a quick course of prednisone only to find yourself back in the same flare again. Regardless, watch for returning symptoms as you taper and call asap if it happens.
Posted 10/14/2015 1:16 PM (GMT 0)
Thank you - very helpful!
Posted 10/14/2015 2:06 PM (GMT 0)
I started prednisone three weeks ago at 40mgs and today is the first day I dropped it to 30mgs. My flare was out of control as well and Ive been in this flare for nearly half a year. It took three weeks but the bleeding has been reduced to almost nothing, the occasional clump, and I have very little diahrea mostly formed and I go about 4 times a day, way less than 20 like before. Anyway, that is my progress so I'd have to agree with the others but also add that if you are still in pain and can't pass gas off the toilet you may want to push to either stay on prednisone longer at that dosage before lowering or get on a harder drug. That's the choice im about to have to make and its not a fun one. :(
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