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Prednisone upped to 80 mg - is it too much?

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Posted 4/21/2010 5:09 AM (GMT 0)
Need help please. I have been diagnosed with severe UC of the whole colon in Sep 09 about two weeks into my first flare. Was put on 30 mg Prednisone which helped in about a week and was then put on 4 pills/daily of Apriso. Apriso never helped much in my opinion but never quit taking it. Flared again in January 2010 and Predinsone 30 mg/daily helped again.

about two-three weeks ago I started flaring again and this weekend it got really bad with at least 20-30 bloody diarrheas a day. Lost about 20 pounds in 20 days. My GI started me on 20 mg Pred two weeks ago, this Saturday the doctor on call suggested hospitalization but then upped the Pred to 60 mg to see if it helps. On Monday (yesterday) it got even worse and my GI increased it to 80 mg. Already took 80 mg for two days but it hasn't helped yet. I am still taking 4 Apriso pills a day. Started VSL#3 yesterday. Took two packets yesterday and three today. Also took one Turmeric pill today. So far I am not seeing any improvement yet from anything I am taking.

Could some of you with more experience please let me know if they think 80 mg of Prednisone is too much and also, how soon should I expect to see improvement with such a high dose. I get very tired from Pred, get a very bad back pain, I am generally very tired, and my heart rate is crazy high sometimes. Do you think hospitalization is the better decision at this time?

Sorry for such a long post and thank you all.

Posted 4/21/2010 5:22 AM (GMT 0)
I would get a second opinion. That seems like an awfully high dosage.
Posted 4/21/2010 6:35 AM (GMT 0)
After being on IV steroids in hospital, I was released on 40 mg oral pred, which didn't stop my symptoms returning.  They finally upped my dosage to 75mg which got things moving in the right direction.  I would expect to see a fairly quick response at that dosage, and if you don't improve would consider hospitalisation. 

Hope things start to look up for you really soon!

Amygrace

Posted 4/21/2010 10:48 AM (GMT 0)
WOW...80mg is alot orally. I think 100mg IV is comparable to 60mg orally. I would definitly get another opinion. The side effects from the 60mg i was on were crazy. Good luck.
Posted 4/21/2010 1:36 PM (GMT 0)
     My doctor likes to start me at 30mgm when beginning a flare, but that doesn't do anything, so I usually have to start at 40 for the first week and then taper by 5 mgm per week.  In the hospital, they had me on 60 mgm through the IV and then cut back to 40 mgm the next day.  I believe you are on a very high dosage but I don't know if they regulate it according to body weight or not.  I am 5 ft 3 in and 120 lbs.

     Make SURE you take enough Calcium with D.  No one ever told me about that when I was first diagnosed and I now have full blown osteoporosis.

Posted 4/21/2010 1:47 PM (GMT 0)
what is your weight?
Posted 4/21/2010 2:44 PM (GMT 0)
A few thoughts...

Are you splitting the dose? Try taking 40 mg in the AM and 40mg early afternoon.

My daughter, age 9 was prescribed 40mg to get her out of her flare. The first time around it helped immediatly but
the 2nd time she had a flare it did not kick in for a lot longer.

I am always surprised that most of the adults on these boards are taking 20-40mg Prednisone for a flare and I am sure my
daughter weighs about half of all the adults and she handles it fine, let alone it takes a bit of time to get the flare under
control.

In fact with her last flare it has taken 4 weeks of 30-40mg to get the flare under control- we have finally started to wean.

Maybe you should also inquire about moving to the next level of medication.

Good Luck and keep us posted!
Posted 4/21/2010 2:50 PM (GMT 0)
If for some reason your liver is unable to convert prednisone to prednisolone they can give you solumedrol IV in the hospital which is basically straight cortisol and it could help if that is your issue.
Posted 4/21/2010 3:46 PM (GMT 0)
Thanks to all for quick responses. To be honest I asked my doctor if I could go from 60 to 80 as 60 was not only doing nothing but I was getting worse. He agreed but mentioned that that would be the highest he would allow. As I mentioned I took 80 mg for two days. This night was bad. I really can't tolerate the side effects, especially the back pain at night and in the mornings. I took only 65 mg this morning (hopefully it is not a big sudden drop from 80 mg) as I really can't take the 80 mg and now that I read all the responses I am thinking maybe 80 mg was a mistake to begin with. Do you guys think 65mg from 80mg is too fast?

I called my doctor's office this morning. They suggest I go to ER and get admitted to the hospital. I am really hoping they can "fix" my condition there.

By the way I am 5'10 weighing 170 lb now down from 190 lb 15-20 days ago.
Posted 4/21/2010 3:59 PM (GMT 0)
My aunt has severe RA, and has been on 80mg of pred before, so I imagine it's probably ok, but I wouldn't stay on it for long.

I wonder if you should consider Remicade? I don't think that the mesalamines are going to control your UC (even if you add rectal meds, given how quickly you're flaring again, and how severe you flare), and I don't think you have the time for Imuran to kick in.
Posted 4/21/2010 4:04 PM (GMT 0)
Just an aside about prescribing prednisone. It isn't prescribed by weight like many drugs are. The human adrenal gland releases an amount of steroids each day; because the whole body isn't the target for these, the amount doesn't really vary with weight. So it's normal for a 50 pound child or a 200 pound adult to have similar doses.

Other hormones like insulin, thyroid, estrogens, etc. are also prescribed without regard to body weight.
Posted 4/21/2010 6:53 PM (GMT 0)
Scary about the pred.

But, have you ever been on rectal meds????

q
Posted 4/21/2010 7:15 PM (GMT 0)
     I really don't think rectal meds would do much with severe UC throughout the entire colon.  I would ask about Remicade, worth a shot.
Posted 4/21/2010 7:24 PM (GMT 0)
I'm just asking the question out of curiosity....I didn't suggest using them at this point.

And Christine....you KNOW it's not used to treat the whole colon, nor would I suggest it to treat the whole colon.
It has a purpose in the treatment of UC....and I'm clarifying if they've even been suggested or used.

q
Posted 4/21/2010 7:31 PM (GMT 0)
Christine, enemas can make a big difference in severe pancolitis...they did for me. Now, I didn't have a lot of bleeding, and my c-scope only showed small ulcers, but I was having 15-20 bm's/day and I lost a lot of weight during my flare. My pulse was rapid, blood pressure was low, so yeah, I'd say I was severe. The reason I didn't suggest them to the OP is because with the frequency of her flares, I just don't think adding enemas to the bag will make much difference.
Posted 4/21/2010 7:38 PM (GMT 0)
But one never knows unless they're tried......correct?

They should always be suggested and the clarification of no matter where the extent of UC.

q
Posted 4/21/2010 7:38 PM (GMT 0)
     OK....enemas work for me but didn't think they would reach that far up..sorry.  Sounds like Barsa is really suffering.  Let us know how you are doing Barsa.
Posted 4/21/2010 7:40 PM (GMT 0)
The reason they work is because they're good at healing the lower part of the colon that the oral meds sometimes don't reach, especially the ones like Asacol, that start dissolving really high up.
Posted 4/21/2010 8:18 PM (GMT 0)
Yes. I too believe that it is good to treat from both ends. Moreover, flares usually start at the bottom. I find that it really helps to target the bottom--at least in my case. It's worth a try anyway.
Posted 4/22/2010 12:54 AM (GMT 0)
IBDISTHEPITS. i was on 40 -50 mg when i'm the same as your daughter age . i read my medical profile at hospital to just know what i was taken ...
i found that my weight was only 44 pounds , 10 years old .. i didnt know how they could do that to me . its completely affect my growth in that time and caused me arthritis when I'm 12 .

never repeat the same mistakes happened to me .....
(sorry about language errors ....i'm not English)
Posted 4/22/2010 1:39 PM (GMT 0)
Judy,
Perhaps I misundertood your post, but it is absolutely not the case that a small child and an adult are often or can be prescribed a similar dose of pred. My daughter's max dose is 18mg due to her weight. Her GI (very well regarded) explained that increasing this would not make any clinical difference because studies have shown that pred is as effective at a particular dose per kilo (I can't remember what it is - possibly 1mg/kilo) as it will be at a higher dose. Higher doses are more dangerous and not more effective in treating active UC according to the research.
Posted 4/23/2010 12:10 AM (GMT 0)
Just got a comp/net access at the hospital. Got admitted into hospital yesterday. Was put on clear liquid diet, IV fluids, IV prednisone. Could anyone with hospitalization experience please (!) tell me what the reasonable time is for starting to feel positive results? I am really anxious and hoping to get out of these flare.

Thank you
Posted 4/23/2010 12:30 AM (GMT 0)
     It's hard to say Barsa.  Everyone is different.  I was hospitalized twice.  The first time  in 1998 when first diagnosed.  It was an eight day hospitalization.  I was on IV meds and feeding for the entire time.  Discharged on meds of Asacol, Prednisone and Rowasa enemas.  The flare itself lasted two months and then I had a two year remission making the huge mistake of going off the Asacol and Rowasa.  Two years later, in 2000, I suffered another flare and was switched from Asacol to Colazal, prednisone.  Suffered flares yearly from 2003 till present (now more frequently)

     The second time I was hospitalized was May of 08.  Had a PICC line inserted for meds and IV feeding.  Ten day hospitalization but the flare lasted seven months.

     Been flaring quite a bit since last May.  Just trying to hold unto the colon.  SLOWLY improving with Humira, prednisone, Colazal and rectal meds.

     

Posted 4/23/2010 5:04 PM (GMT 0)
Thank you again for your responses. My white blood cell count is very high now and they are doing bunch of blood work to see if there is an infection. I hope I didn't / don'g get any infection here.

The dose of prednisone (I think it is actually a methylprednisolone) is 60 mg every 8 hours. The liquid diet includes a lot of stuff that has sugar and I don't think that sugar is good for me right now - but I could be wrong. The overall daily number of BM's is down but the stool itself has not changed much yet - still runny with blood - plus gases (sorry for "too mich info" on stool). So if judged by the number of painfull urges I think I am getting better.

What do you guys think about the clear diet - fruit juices (pasteurised), jello, decaf coffee, decaf iced tea, beef/chicken broth (packaged cubes microwaved)? That is pretty much what they provide here. Do you think I should avoid anythink specific from the list to minimize irritating the colon or is it pretty standard and harmless given all the IV I am getting.

Thanks for the kind words and wishes.
Posted 4/23/2010 5:11 PM (GMT 0)
I'd definitely ask if that broth they're giving you has MSG in it...in fact, ask to read the label. I can't tolerate MSG under the best of circumstances, and I can't imagine what it'd do to me if I were already in a flare. (MSG gives me URGENT liquipoopie about a half hour after eating it.) I'd probably also stay away from the coffee and tea, because I've heard that the process they use to decaffinate it involves some nasty stuff.

Good luck!
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