Does pred always lose effectiveness over time?

Sara14 I am not making a direct comparison. I am merely highlighting a common principle that is the same. A drug is a drug. And with repeated use. Your body will need more for the same effect. Ask any learned health professional.

And I am talking about addictive drugs. Those which your body builds dependence on. Which Pred is surely one of. Not blood pressure drugs or thyroid meds etc. Those are different.

Post Edited (barnsbury) : 2/15/2019 3:09:52 PM (GMT-7)

barnsbury said...
Sara14 I am not making a direct comparison. I am merely highlighting a common principle that is the same. A drug is a drug. And with repeated use. Your body will need more for the same effect. Ask any learned health professional.

And I am talking about addictive drugs. Those which your body builds dependence on. Which Pred is surely one of. Not blood pressure drugs or thyroid meds etc. Those are different.

Yeah, I got what you were saying. And I completely disagree. But I don't feel like debating it.

NiceCupOfTea said...
Yes it does. It may not stop working entirely, but it's never quite as effective as that first time you take it. It may not be so obvious for naturally slow responders to pred, but I was a lightning fast responder. I continued to get a good response for the next few years (taking an 8-week course once a year on average), but once my disease took a turn for the worse and I needed to go on steroids more frequently, the loss of response became much more obvious. It took longer to get better and quicker to flare up again. By the end I was on a high dose of steroids continuously just to stay out of hospital. It wasn't sustainable so I had surgery fairly soon afterwards.

Similar story for steroid eye drops unfortunately. I've got uveitis and the first time Maxidex worked like a charm. It's gradually become less effective over the last 3 years. I've been terrified it will stop working completely, but I've been reassured that shouldn't happen. However, it takes longer to start working, longer to clear it up, and I can't get off the drops for longer than a few days without the eye inflammation returning.

Anyway, prednisone isn't addictive in the traditional sense but your body can become physically dependent on it with prolonged use. At that point you can be said to be steroid-dependent and yes it does suck.

NiceCupOfTea (I am drinking a nice cup right now, its breakfast time here in the UK) I am sorry to hear of your story. I know exactly what you mean. I was taking more and more steroids for longer periods of time, just like you did, to stay out of hospital and not drown in blood in the bathroom. It was such a nightmare. With each course of Pred, I just could not believe it no longer worked as it did when I first went on it in the summer of 2000.

The side effects of 80mg Pred were crippling yet the benefits of it were so small. It was so scary seeing my original lifesaver treatment was deserting me. I remember standing in the corridor of my hospital, begging my gastro consultant for another course of Pred, longer and higher than he would ordinarily give to a patient. It was a miserable time in my life. Thankfully, I am now off of it, but i still have the scars. And I am told they will never go.

I’ve read switching from prednisone to prednisolone might help.

I always used the two terms interchangeably ha ha. Just checked a box that i had left over and it does indeed say prednisolone. I am in europe.

That's what I thought. Thanks.

It happened to me years ago, I had a bad flare, I was on the maximum dose of Imuran +Asacol +Pred, but the inflammation kept getting worse, my doctor kept increasing the pred, but I kept getting worse!
All these medications couldn’t supress the immune system alone, so he decided to add a fourth drug ( Prograf immune suppressant similar to Imuran he uses for liver transplants) and it worked!

The_Swan said...
It happened to me years ago, I had a bad flare, I was on the maximum dose of Imuran +Asacol +Pred, but the inflammation kept getting worse, my doctor kept increasing the pred, but I kept getting worse!
All these medications couldn’t supress the immune system alone, so he decided to add a fourth drug ( Prograf immune suppressant similar to Imuran he uses for liver transplants) and it worked!

Yes, its Tacrolimus. I was put on that but didnt work for me. I just got awful hand cramps which made doing the simplest tasks impossible. I am glad it worked for you.

Yep. Also from the UK and always been given prednisolone.

@Sara14 - Thanks >_>.

Surgery removed the vast majority of my disease, although there is still some inflammation at the join between the rectal stump and the small bowel - I've got a stricture there now.

I hope you don't mind me offering an opinion on your taper regime, but going from 10mg to 0 is a massive jump, particularly for somebody who has become steroid dependent. Generally speaking it's okay to reduce high doses of steroids quickly, but once you reach 10mg (or the symptoms start returning, whichever comes first) you should go more slowly. You can get prednisolone tablets in 2.5mg and 1mg doses.

My usual pred taper was as follows: 40mg for one week, followed by a 5mg reduction every week until I reached 0. Even that is too fast imo. It's the last 10mg or so which is problematic for so many people: they get the disease under control when they start pred, but the symptoms start returning when they drop below a certain point.

@barnsbury - I was always able to get pred when I needed it back then - if I flared up, I just went to the GP or A&E and got another course prescribed. I couldn't do that nowadays - I'm not ill enough and I would rightfully get turned away >_>.

The long term legacy of pred has left me with oesteopenia and seriously borked teeth. The problems with my teeth started a few years ago - gum recession mainly. An absolutely useless NHS dentist kept on fobbing me off and by the time I got to see an actual proper dentist, I had advanced periodontal disease. The bone loss is irreversible and has worsened in the last two years. I have bleeding I cannot stop in some teeth. And dunno if this is relevant, but I have chronic sinusitus too - get a lot of pain in the upper teeth and around the eyes.

@IaC - No, no other drops! As steroid eye drops can raise eye pressure or cause glaucoma though, I may have to go on glaucoma drops one day. But I'm not on them yet (and hopefully never will be).

Cheers for the link though - it was an interesting read.

Nicecup - Thats so awful. I have gum problems now too and ostopaenia. I cannot get rid of my pred belly fat and I have awful stretch marks on my stomach from when I ballooned on Pred.

I think 1mg a week too fast. Once I got down to 7.5mg I would come down by 0.5 mg a week. And I would stay at 5mg for 2 weeks. And then come down by 0.5mg every 2 weeks. I know, super slow, but I was so steroid dependent, anything quicker would have been a disaster.