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Why Prednisone?

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Ulcerative Colitis
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Posted 5/1/2016 12:37 AM (GMT 0)
I am wondering why Prednisone is being used when it seems to have so many adverse side effects for so many people? Is there not another steroid that can be used that does not have such side effects?
Posted 5/1/2016 1:16 AM (GMT 0)
Prednisone is used because it works very fast. It's great as a "rescue" drug. The more serious problems occur when it's used for lengths of time therefore shouldn't be used long term. Even at low doses.
Posted 5/1/2016 1:51 AM (GMT 0)
and it works very well - many times it's a quick fix for first timers while the 5asa drugs kick in - it is a wonder drug for many - it was for me - got me out of bed and back to doing normal things like eat, go to work, and not be in pain !
Posted 5/1/2016 3:22 AM (GMT 0)
the problem is not pred - it is cortical-steroids. that's why the work on topical/targeted delivery, and new cortical steroids that can be taken in smaller dose,

also for many, reasonable doses for reasonable time have no long term effects. for most, benefits outweigh risks - like any med used properly
Posted 5/1/2016 12:27 PM (GMT 0)
Pred delivers you from the depths of hell and for most ( including me ) make you feel like a human being again very quickly........... and then you pay hell for it as the side effects kick in. It put me into a med-free remission for a year, and I'm praying for that again although I realize it may be unlikely.
Posted 5/1/2016 1:30 PM (GMT 0)
T_Mo, you mentioned paying hell for the side effects. Did you experience this? What did you experience?
Posted 5/1/2016 1:46 PM (GMT 0)
Why prednisone? Because it's a quick working anti-inflammatory medication that's great to rescue us from the worst of uc flares.

Why does pred cause these awful side effects? You need to look at what it is, or more specifically mimics within our bodies. Prednisone is a corticosteroid, which is chemically similar to your body's natural cortisol chemical. Cortisol is produced in quantity within our bodies during injury, stress, fight and flight situations along with adrenaline. Essentially you're putting a ton of stress hormone, more than the body normally produces, into our bodies with prednisone over a series of months.

Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream (great if you need large amounts of energy to run), enhances your brain's use of glucose (increasing energy for quick thinking) and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses (decreasing inflammatory response) and suppresses/slows the digestive system. Our bodies complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear. Hmmm why does prednisone cause anxiety, anger, and insomnia.... All that bioavailability of sugar only produces fat when not used...

I think that helps explain why it does what it does. Cortisol might've help us escape a threat and limp away from danger with an injury and live to see another day. Being in high quantity in our bodies for months, with our body in a constant fight or flight alarm mode, might have consequences which we experience as side effects.
Posted 5/1/2016 2:49 PM (GMT 0)
@ GC4249...... Yes I experience nasty side effects from Prednisone. I am on a Pred taper right now and living with them on a daily basis. For me ( and it seems to be highly individual ) by far the worst side effect that I experience and is severe cystic acne. I appear to be genetically predisposed to cystic acne and get it from time to time ( I'm 41 years old so it's not like I just the puberty related stuff ).

The main issue right now is that I get this cystic acne all over my scalp, face, and to a lesser extent my back and shoulders. I currently have hundreds of small lesions on my scalp that are incredibly sensitive to touch ( this isn't your normal acne - hormonal acne for some reason is 100x more painful for me at least ). During the day it is painful but tolerable, but at night when I try to sleep the pressure from my head against a pillow creates a nightmare scenario for me. I wake up in the middle of the night in severe pain. I've written here before that the only thing I can say to describe it is as if someone has been dripping hot acid or molten metal all over my head. In the morning my pillow cases are filled with pus and blood. I've recently started to use a pyrithione zinc shampoo ( head and shoulders ) every day on the affected areas and it seems to be helping a bit.

I do not tend to experience the other common side effects to much of a degree. My face gets a bit puffy, some water retention, but no rapid weight gain ( thats probably more due to my diet ). I do get very emotional from time to time but I think at least part of that is me trying to cope with the hell that UC is for all of us.... Prednisone has definitely put me in a better place than I was four weeks ago, but the side effects can become very difficult to deal with. They don't call pred "satans tic-tacs" for no reason.... ipoops explanation above on the endocrine system effects / mechanisms is very good if you wanted to understand more of the why behind the side effects. I hope that helps.
Posted 5/2/2016 2:49 AM (GMT 0)
T_MO, I'm sorry to hear you experience this. It must be very distressing on top of the horrendous UC symptoms.

You mentioned you are in a better place now than 4 weeks ago. Does that mean the acne came on almost immediately after you went to Pred rather than the result of long term use?

I hope the acne does not cause permanent damage. It sometimes seems like another problem is created in trying to resolve the original problem - which might not be so bad if UC never returned, if you know what I mean.

Isn't there another steroid that can be used that have less systemic side effects?
Posted 5/2/2016 11:24 AM (GMT 0)
Yeah delayed-release steroids like uceris, or enema-route steroids have a lot less side effects.
Posted 5/2/2016 7:12 PM (GMT 0)
Uceris is a good option. It seems to be most effective for mild/moderate inflammation. Once things are severe, sometimes prednisone may be the only way to pull out of that condition (or IV steroids or cyclosporie). I personally hate steroids!! It's also pointless if your plan for maintenance doesn't work out. You take all that awful drug i hopes of getting on something "less awful", in my case, the less awful option never panned out. I would end up flaring as I got to lower doses of prednisone. At that point, it was time to start over at 40mg and look for the next less awful drug for maintenance. By the time I was able to get off the prednisone, a year would pass, and then I was waiting for the next flare up to occur.
Posted 5/2/2016 10:21 PM (GMT 0)
@ GC4249........ Yes. Thank you for the concern. To answer your question no the side effects do not start immediately. It takes around 10 days to 2 weeks for the high dose Pred to start to temporarily alter the normal HPA ( Hypothalamus-Pituitary-Adrenal ) axis. The first week or two aren't that bad, and yes the Pred rescused me from the depths of hell. I went from 15 - 20 ( I would lose count eventually ) bloody BM's per day to 3 to 5 semi-formed BM's in less than a week.... I just started week 5 and am now at 20mg / day. I am currently at around 3 BM's per day. This morning started with a semi-loose stool with some mucus and a tiny bit of blood, and then the last two today have been really good. Very little mucus, no blood, and formed nicely ( although far from perfect - I'd give them a 85% or B+ ).... The acne is incredibly painful ( physically and emotionally ) and creates a hell all it's own for me, but I fight through it and here's why ( besides not having much of a choice lol )

The way this went for me last time ( and what I literally pray for every night ) is that I was on pred for 10 weeks ( got stuck at a few dose levels but continued the taper largely unabated ). Symptoms improved rapidly but progress was not linear. I would have set-backs. Several days in a row with blood and then things would get better and I'd drop the does again. The acne was incredibly bad but I held onto the fact that the UC symptoms were improving and the acne would get better if I could just get off the pred.

After 10 weeks I was off the pred and the UC symptoms were manageable. 6 weeks later I was in clinical remission w/o any other meds and feeling great. The acne went away slowly and would pop up from time to time but was more of an inconvenience than anything else.

I have a very good, clear, and specific idea of what triggers me to flare. I've detailed this in previous posts and it's something that I can easily avoid in the future.... So I fight through the horrible pred side effects knowing that last time it did help put me into an otherwise med free remission, and can only hope, pray, and try to do everything else right on the long, difficult road back to remission. If my theory about what triggers me is correct ( and I strongly believe that it is ) I'm hopeful that I might be able to enjoy a long period of remission without any other drugs. Only time will tell.

As notsosicklygirl above stated Uceris is an alternative for some. I tried it before this most recent pred taper, and it made a mild / moderate flare turn to severe in only 6 days. There's something in Uceris that has an extremely negative effect on me, but that's just me. For others it's a great alternative to Pred as the systemic side effects are muted to a high degree.
Posted 5/2/2016 10:37 PM (GMT 0)
Prednisone is usually used when you are flaring. Once the flare is in remission, you can ask for Uceris which is a maintenance drug taken once a day. It is a steroid, but doesn't have all the bad side effects. At least, for me it doesn't. I took it for over 2 years and did very well with no flare. Good luck to you!!
Posted 5/2/2016 11:44 PM (GMT 0)
Just to clarify...Uceris is not a maintenance medication. That doesn't mean that some people aren't using it that way, however, that is not the recommended application of the drug. My GI calls it "off label" if used as a maintenance med. Topical steroids are not supposed to be used daily on a long term basis. Obviously, systemic steroids (prednisone) are worse long term than a topical steroid. Topical steroids do have side effects if used long term.

As far as a substitute for prednisone without the side effects. There isn't any. There are no steroids that act in the way prednisone does that can be used in lieu of. Even the IV ones (solumedrol) have a similar effect systemically on the body.
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