Can anyone answer this?

What has a more potential health threat, 100mg of hydrocortisone (enema).  Or 5mg of prednisone (oral)?

I realize that there is no perfectly definitive answer to this, as I've tried the internet to no avail.  Although I'm confident that someone on this site can shed a bit of light on the subject.

I'm also painfully aware of the risks of (long term) steroid use.

just from what I've read about steroids which I can't guarantee is all true. Your body makes around 8-10mg of natural steroid a day (pretty sure my regular Dr. told me that) the problem with large doses of steroid orally, injections, etc... is that your body loses the need to produce its own natural steroid. Low doses below what your body produces on its own wouldnt shut down your bodys natural function it would only slow it down so the ability to produce it would never be lost.
I personally dont notice the "moonface" untill around 20mg+ of prednisone.
5mg of pred wouldn't be too bad in my opinon especially if you were trying to taper it prednisone comes from what I've taken in as little as 1mg tablets. The side effects of prednisone osteoperosis stands out in my mind but if your body is alredy making more than 5mg a day alredy I dont think such a low dose would affect you too much unless extreme prolonged use was the case. I was on prednisone solid for 5 years 2.5mg -60mg and haven't noticed any lasting side effects although I have not undergone tests to determine bone density.
Even surgically my surgeon before my J-pouch surgery wasnt too worried about prednisone he said even doses up to 20mg could be acceptable, I was on 5mg when I had surgery and he said that was fine.

subdued said...
Hmm... I would think the enema would reach the target better if the inflammation is down near the rectum. 100mg sounds like a really high dosage though. Why so high?

100 mg is a 60 ml bottle.

I have been on 100 mg enemas for six weeks, and have had no side effects

Thanks for all your replies.   It seems there are many differing opinions on this, which when you consider the way UC affects people, is to be expected.   I wasn't hoping for a 'one size fits all' response but the info is certainly very helpful.

The last thing my GI said to me acouple of months ago was to get the hell off of pred, and steroid enemas, even if I was tapered down to once or twice a week.

This is easier said than done.   I'm currently down to 5mg of pred (zero this weekend) but the cort-enemas are proving to be a more fickle animal altogether .    They are doing a fantastic job of keeping me in relative 'remission', ie.  2-4 bm's, hardly any urgencies, no blood, formed stools and generally feeling ok.

Soon as I so much as miss ONE night (or even use cortifoam instead) small amounts of blood on the TP appear the next morning. (not necessarily accompanied by the other usual symptoms) That HAS to indicate that there is still some tender area of inflammation lurking and that the enema is the ONLY thing abating it.

It will be interesting to see how zero pred impacts me.

Am I making too much of a big deal out of this?

What all other meds are you on? Is there anything you can switch up to perhaps allow you to get off of steroids? Probiotics, etc?

Do you have prescription insurance - might the DS strength of VSL be covered? It is for me, so it's cheaper for me than the regular VSL. I've been taking 2 of the DS sachets a day and - this stuff does help me, though I know we're all different.

I can't advise you what you should do about the steroids - I can just tell you what my experience is and how I see those choices for myself. It's tough.

Hang in there, I hope the pred taper goes smoothly!

FYI
I was on Cortifoam daily for one year...0 side effects.