Pred Taper Seems Fast?

While my Doctor thinks that the antibiotic therapy has helped, he still wants me to proceed with Remicade. He thinks the two could be working well together.

He also wants me to taper my pred as follows: 15mg 1 week, 10mg 1 week, 5mg 1 week and then stop.

Seems fast to me given that I have been on 25mg since the beginning of May.

I have done a quick taper in the past, but that was when I was only on a short course (2 weeks).

Anyone else think this is too quick?

You could ask him if you could drop by 2.5 mg per week instead of 5 if you are worried about it. 5 mg per week would likely be too fast for me, but everyone is different. IMO, trying to taper too fast is a mistake, but you haven't been taking pred overly long.

Prescribers fail to explain the risk of developing Adrenal Insufficiency as a result of having taken corticosteroids, e.g., prednisone.

Migraine headaches, bone pain, and extreme lethargy were the physical symptoms that had me down for two years. Chronic depression was also exacerbated.

The disabling symptoms of adrenal insufficiency are not due to "withdrawal" from prednisone. Rather, it is the failure (insufficiency) of the adrenal glands to produce the all-essential cortisol. Prednisone is far more potent than it's natural analogue, cortisol. Symptoms of insufficiency can emerge during and after tapering off prednisone, and vary in severity.

Taking prednisone overrides your natural production of cortisol. Developing adrenal insufficiency is more likely after taking high doses (~40 mg) for long periods (~several weeks). A rapid taper off of prednisone (of dose and schedule) hastens the emergence and severity of the symptoms.

In my case it took two months in bed to figure it out by re-reading the chapter on medications in an IBD specialist's book. I took the book to my PCP who promptly stepped out to call an endocrinologist. I was put back on a dose of prednisone just above where I first developed symptoms of insufficiency (~15 mg). The taper was unbelievably slow (reduction by 1-1.5 mg every 1-3 months). Symptoms re-emerged at 5 milligrams. So the dose was bumped up again; resetting the taper at smaller dose reductions over longer periods. At 1-2 milligrams of prednisone, I was switched to cortisone and continued the slow taper. Every three months I underwent adrenal challenge tests* to evaluate adrenal functioning and determine if & how much to taper.

*Adrenal challenge testing included; baseline blood draw, injection of cortisol stimulating hormone, followed by two more timed blood draws to measure cortisol and ACTH response.

In total it took two years and three taper attempts to get off steroids and restore adequate adrenal function. It then took another 6 months and two attempts to taper off of opiates that were controlling the bone pain and frequent migraines.

I have vowed to never take any steroid unless it given down an ET tube as a life saving measure.

Hope this information helps.
Ciao

Pay attention to your symptoms. If your muscles or joints hurt or if your flare symptoms worsen, then go slower on the taper.

I have been on steroids since May 2010, although for the last 8 months or so, I have only been doing enemas and foam. I tapered off oral pred in about 5 months, then continued with the rectal form of steroids. I only was at 40 mgs of prednisone for about 3 weeks.

I was really worried about my taper, but I have done very well. I am down to one enema every 3 days. I have been doing that for about a week (dropping from one every 2 days) and feel fine. Sometimes I feel a bit irritable, but no headaches. My joints ache sometimes, but nothing severe. My appetite is fine and I sleep like a baby. The funny thing is I sleep longer on the nights that I don't take the enema. When I do the enema, I always wake up early without fail. Steroids have always wrecked my sleep.

My GI doc seems to be taking it lightly and not suggesting any adrenal tests or a visit to an endocrinologist.

I'm shocked that you adrenal system didn't kick in after two months of being off steroids. That does scare me a bit.