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Need a taper plan from 30mg prednisone

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Ulcerative Colitis
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Posted 12/9/2018 4:28 AM (GMT 0)
I have pred to use, if needed, before my January appointment. I have 200 tablets of 5mg and instructions to take 6 tablets per day and "taper as directed" with no clue about how long to take the 30 or how to taper. Any ideas?

I have not started the pills yet but at times have come close when there is blood and extreme frequency. 30mg sounds reasonable because a few months ago I "borrowed" 5 20mg tablets from a friend and started with 30mg for a couple of days and had amazing results within 24 hours. At the end of the day symptoms would return but I soon started Uceris foam which is keeping things at a simmer, or at least a low boil. The foam prescription has ended.

I am avoiding pred as long as possible because:
1. Reputation of the "devil drug" and side effects, long a short term
2. It would be a major bummer if it didn't work this time; my only rescue plan would be gone
3. I don't know how long to take the 30, how to spread the dose over the day or how to taper

We have a lot of experts here on pred tapers, and a few who have fine tuned on their own. I think I have come to the right place for advice!
Posted 12/9/2018 4:52 AM (GMT 0)
Have you ever been on Prednisone before? If so, you should have some idea how your body reacts to it. For me, my pred dosing is symptom dependent. I take the maximum dose until I am in remission (usually about 2 weeks), then taper by 5 mg per week, slowing the taper if symptoms increase too much. I have always been told to take the entire dose in the morning. The other thing is my various G.I. docs have always started me at 40. It may take longer to get into remission at 30.
Posted 12/9/2018 3:30 PM (GMT 0)
The two times I've been on Pred I started at 40mg and went down by 5mg every 7 days (252 pills total I think). BUT both times were after I was discharged from the hospital, so I was getting better (at the hospital I was on 60mg IV solumedrol per day, then they monitored my switch to Pred 40mg for two days before discharging me).

I did a bit of math and if you only did 30mg for 7 days and tapered from there, you only need 147 pills. So I'm guessing you take the 30mg until you feel better, then taper. Also, can you get a refill if you need more than the 53 pills (roughly 8 days on 30mg, then 7 more, then 7 on 25mg...) to feel better before tapering?
Posted 12/9/2018 7:31 PM (GMT 0)
I wouldn't put off taking prednisone if you need it. It is an evil drug, but it can help immensely when needed. It also works fast, and it sounds like you need to get things headed in the right direction. I would however get in touch with your GI to get a proper taper plan. You can't likely taper off without the addition of new medication. I would go get seen and come up with a longer term plan. pred can get you feeling well for the moment, but you don't want to be on it without a plan for getting off of it, and it sounds like you may need to add something in addition to your current medications. When was your last scope? Have you had stool tests recently?
Posted 12/9/2018 8:04 PM (GMT 0)
I tapered at 5mg every 5 days and have been clear since last sat and i feel fine , but ultimately it should be your doctors say as they know what will help buy how bad you are , i was a day or 2 from surgery and prednisolone and infliximab saved moi , i hated every day of pred but unfortunately it does tremendous things to help uc but horrendous sideys , so use it to get well and then get of it super quick ....
Posted 12/10/2018 4:52 AM (GMT 0)
Thanks everyone! I have not been on Prednisone (except for a short course for acute back pain years ago). I had a tough IBD year and a scope in August showed severe inflammation from the left side on down. The concept of getting into remission from pred mentioned by C_G-K is new to me. Is it possible to achieve symptom-free long lasting remission just from pred and the usual mild maintenance drugs? I have been thinking of steroids as a temporary rescue.

My doctor thinks Humira is next but I won't see him to talk about that or Prednisone details until January. I appreciate the thoughts on tapers all of which which make sense and might become suddenly essential.

NSSG: I won't delay. I am ready to jump on it. I have no intention of returning to that dark place
Posted 12/10/2018 5:01 AM (GMT 0)
Smart move. With severe, it's a good idea to stay ahead of it. Humira is a good option. I would definitely see about getting stool tests sooner than later, but if it was severe in August, it is quite possibly a continuation unfortunately. That said, if there was a pathogen, it would make the UC seem unresponsive, so it's best to rule it out. I haven't seen too many people have luck tapering off without an adjustment of meds, since you can't tolerate a higher dose of mesalamine, and you're already using enemas, i think Humira makes sense. Have you tried Uceris orally? it's not really for severe, but the side effects are more tolerable than pred. Actually when I started pred, it was always at 40mg and soon after starting, I felt great! Tons of energy, symptoms waned, felt better than usual. The problem for me, was after a few weeks or months, I'd be gaining weight like mad, pimply, big round face, mean...
Posted 12/10/2018 3:29 PM (GMT 0)

naturalcurl said...
Is it possible to achieve symptom-free long lasting remission just from pred and the usual mild maintenance drugs? I have been thinking of steroids as a temporary rescue.

Yes it is possible. But in the end, it really comes down to:

1.) "Is this a run-of-the-mill-flare?"
or
2.) "Is this disease progression in extent or severity?".

A short course of pred will solve scenario #1, but NOT #2. In scenario #2, you end up regressing to a flare during a taper due to a stronger maintenance dosage/meds being needed to kick the pred to the curb.

The idea on #1, is that if you can cease the immune attack for approximately 2 months via prednisone, that seems to shut off the immune attack mode, and put it back into a quiescent/quiet/remission state. And you can continue with a remission without the pred. If you're not sure whether you're a scenario #1 or #2, then a short course of pred and taper can answer it definitively.

If you're on the fence about humira, then asking for endoscopy (that is a colonoscopy or a flexible-sigmoidoscopy) beforehand can help justify whether it is necessary or not.

When deciding whether to take pred, I always ask which is worse the pred side effects or my UC side effects? The times I've taken pred I was near incontinent, going 24+ times a day, and in pain. Taking pred then was a no-brainer, and I took it with a smile on my face. If you're 3-4 bms a day with minor inconvenience from your UC, pred is likely a firm no (I'd consider steroid enemas or Uceris pills/foam before going the pred route in this scenario). Pred is like the biggest weapon in your arsenal, as you use it cautiously only when nothing else works, things are FUBAR, and there's no other way out of that situation.
Posted 12/10/2018 9:29 PM (GMT 0)
What do you mean by steroids ?? What type of steroids do you mean ? Anabolic ??
Posted 12/10/2018 9:48 PM (GMT 0)
No. Within the context of Ulcerative Colitis treatment, "steroids" means anti-inflammatory glucocorticoids, like hydrocortisone, budesonide, prednisone, etc. They're prescription medications for treatment of UC that treat inflammation and reduce immune system attacks. A lot different than what you are describing.
Posted 12/10/2018 10:55 PM (GMT 0)
Sorry my bad , just my natural reaction as i use them and think they work very well and i have no flares or any such affects from using them , i only flared when i had a break without any meds , i think there is a trick to be had with anabolics and uc just wish they would trial it properly , i genuinely believe they are a massive help , but im not condoning the use its my personal experience , i use a pre mixed steroid called ttm which is a mixture of testosterone , trembolone , masteron , i dont abuse it i have a 1ml injection every 4 days and it maintains my size , appetite, and uc , stops muscle wastage etc , i was using for a couple of years without a twitch it was only when i had a 3 month break instead of my normal 6 week that i got sick and it didnt help that i had no normal medication , but i will say again i dont condone the use of anabolic steroids , i just find life is so much better on them and my uc is non existent ... I know alot of you guys will frown and tut but i suppose its a matter of opinion and experience 🙈🙉🙊 also testosterone is a natural anti inflammatory 😏
Posted 12/11/2018 3:18 PM (GMT 0)
Yes, I was using the term steroids only as a synonym for prednisone and related. I had a c diff test before the last colonoscopy in August of this year and it was negative. I have tried oral Uceris (it has been a couple of years). I followed the full prescription instructions and it didn't help, or maybe I was going downhill at the time in any case. In fact oral Uceris had more side effects than the foam: dark diarrhea and D like that has never been one of my common symptoms.

I am going to up the Lialda from 2 to 3 and see what happens. At my first post years ago one response advocated for self-management. Good advice, in partnership with the doctor.

I appreciate all the thoughtful responses. I know how much time it takes. But I now have a much better idea of how to proceed and why.
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