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Pred tapering getting easier as I get to lower dosages?

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Ulcerative Colitis
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Posted 7/30/2013 4:58 PM (GMT 0)
I tell you tapering pred has been one truly perplexing experience, sometimes my body has fits and other times it doesn't. I had been on 30mgs of pred for months:

  • Drop to 25mgs and withdrawal symptoms were present for 3 days, number of bms doubled and then settled down, I staid on this dosage for two weeks.
  • Drop to 20mgs my body was angry as hell with my bms doubling again and then taking a full week to settle down, I staid two weeks on this dosage.
  • Drop to 17.5mgs no problem; no noticeable withdrawal, I staid here just one week
  • Drop to 15mgs again, no problems or withdrawal. I'm only a few days into it but planning to stay here for a week total.

I had heard it gets harder the lower dosage you get during a pred taper but I seem to be experiencing the opposite. Unless it has something to do with the percentage drop of each dose (25 to 20 is a pretty steep hit) and I'll soon have another high percentage drop. Any ideas? At what point did you switch to lower than 2.5mg drops in your taper; like 1mgs?
Posted 7/30/2013 5:04 PM (GMT 0)
I haven't made it below 20mg since I was put on Pred (April). I tanked hard at 20mg and wound up back in the hospital shortly after. Not sure if there was any correlation, but as a result, I was back on the IV steroid in hospital and had to jump back up to 50mg coming out... I''m now down to 35mg and have noticed absolutely nothing between 50mg and 35mg... aside from nasty side effects slowly diminishing. I'm hoping it's the other drugs doing their job, and doing it well too.

I don't really get it either. Just sharing my experience thus far. about every six days I knock off another 5mg quite comfortably.
Posted 7/30/2013 5:16 PM (GMT 0)
Hi iPoop. You may have been on the pred long enough for the other meds you are on to fully take effect and begin to heal your colon on top of the Pred. So as you taper your are holding steady due to the other meds.

I've tapered Pred 3 times since February. The first was a disaster but the second went well. I dropped at 5 mg increments. On some drops I would have a day or two where things would have to settle but hold steady. I attributed this to the Apriso, Rowasa and 6 mp doing its job.

I just got a flex sig done and still have patchy inflammation and am tapering Pred once again. I started at 30 for 5 days, 20 for 7 days and then will go to 10 for 7 days. Things seem to be ok for now. They also upped my 6 mp from 50 to 75. So I am hoping that will keep me steady again as I continue to drop.

I hope that things continue going well for you. I know at one point that you were looking towards Remicade if the 6 mp didn't work for you. I'm in a similar boat to you and am hoping that the 6 mp is taking its time to heal me.

Posted 7/30/2013 5:28 PM (GMT 0)
You are very correct that the percentage of the taper really has more to do with it than the actual milligrams of the taper. Going from 30mg down to 25 mgs is a higher percentage drop than going from 20 down to 17.5. Most people's bodies make somewhere between 8 and 12mgs of cortisol per day and when you take that amount or more of pred it shuts down your adrenal glands and the body does not manufacture it's own cortisol anymore. When you start getting below this dosage your body should start to resume making cortisol once again. This is the hardest part of the taper from that point down so I would suggest, in your case, tapering by ones once you get down to about 10mgs.

Many people don't realize that there are actually two distinctly seperate parts of a pred taper. One has nothing to do with UC at all and is merely related to the withdrawyl effects of the steroid as you taper. The second one has everything to do with UC as if you taper too quickly your colon may not have had enough time to heal and hence has almost no chance of working if you are tapering too quickly before your colon is even healed. If I were a doctor I would prescribe pred at one dose with no taper whatsoever until your colon is completely healed (by examination). Once it has been determined that your colon is COMPLETELY healed, or the pred was not working at all, then I would taper based only on withdrawyl symptoms only since you should not have any UC symptoms anymore if your colon is actually healed already. Then, of course, you need a mainenance therapy of some kind to remain in remission.
Posted 7/30/2013 5:47 PM (GMT 0)

TotesMagotes said...
I know at one point that you were looking towards Remicade if the 6 mp didn't work for you. I'm in a similar boat to you and am hoping that the 6 mp is taking its time to heal me.

Yeah, I am hoping I dodged the Remi bullet for now, but I am 15mgs of pred away from knowing with any certainty. This is my second taper attempt after failing in april, afterwards my 6mp was increased from 50 to 75mgs, this time everything is going smooth in the taper so far at least *fingers crossed figuratively*.

garylouisville said...
I would prescribe pred at one dose with no taper whatsoever until your colon is completely healed (by examination).

Oh my GI is a strong believer in 'by examination', I've had in-office flex-sigs done half a dozen times since this flareup started in Jan of this year. It's a pain in the butt both literally and figuratively, but I think it is better medical policy to see what exactly is going on up the pipe rather than simply asking 'how ya feeling' during a 15 minute consultation (when asking how I feel is a very relative thing but the amount of inflammation seen in a scope can easily be quantified). In fact, I have another flex-sig scheduled for the end of August so he can see how the taper is going. I think I know how a Muppet feels tongue

Thanks, I was thinking of 1mg drops after 10mgs.
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