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Anyone find it difficult to reduce pred below 20mg?

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Ulcerative Colitis
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Posted 12/2/2014 2:49 PM (GMT 0)
I am on a pred taper at present and started on 15mg on Sunday. My stools are good and I have not other symptoms except cramps. But over the past two days the cramps have gotten progressively worse and more painful. My GI nurse told me to sow my taper and to take 20mg today and then 15mg tomorrow with 20mg again the following day. After taking 20mg this morning, I feel my cramps have subsided but they are still there. My stools are still great and only two BM a day. I am almost there but its just the cramps! I asked the nurse if they could give me some 1mg tablets of pred to taper really slowly but she said that it would only be beneficial to do that when I am on a really low dose like 10mg or 5mg.

Anyone else have issues in tapering below the 20mg mark? Whilst I was on 25mg and above, I had no issues at all and no cramps. However it is quite a bad, stubborn flare I am coming out of. Does anyone have any tips as to what to do? I really do not want to stay on pred longer than I have to but then I do not want to go back to square one and back to 40mg a day.
Posted 12/2/2014 2:54 PM (GMT 0)
Yeah generally wait until you are below 10mgs for small 1mg dose pills. What do you have 5mg pills? You can cut them in half and do 2.5 mg drops.
Posted 12/2/2014 3:02 PM (GMT 0)

iPoop said...
Yeah generally wait until you are below 10mgs for small 1mg dose pills. What do you have 5mg pills? You can cut them in half and do 2.5 mg drops.

Yeah I have been told that I can cut them in half. I may do that so may try 3.5 pills tomorrow onwards. Yes on 5mg pills. I am just worried that I will never be able to get off this devil drug!
Posted 12/2/2014 5:05 PM (GMT 0)
Of course, your body makes around 7 so as you get closer the taper is critical ( slow, incremental ).

qing dai is shown to help exit prednisone and always helped me.
Posted 12/2/2014 7:55 PM (GMT 0)
Im exactly the same, been on 20mg for a week now and going to taper down to 15mg tomorrow. All my UC symptoms are gone and im feeling great, however for the last few days i have been having this bloated feeling with weak pain/cramping that comes and goes. Could be a side-effect from the prednisone? the pain/cramp is located in the entire stomach area, its not the same pain i had when my colon was bleeding at its worst.
Posted 12/2/2014 8:46 PM (GMT 0)
Pred only works while you are on it. Hopefully while you are on it your colon heals enough that when you taper down and off your maintenance meds can keep you in remission. If your maintenance meds aren't good enough to keep you in remission then how you taper really won't make any long term difference in regards to your UC, all it does is delay the inevitable. If you have been on the higher dose long enough and your symptoms return as you taper the only difference in the taper will be how long it takes for your symptoms to return. If you taper faster, you will get worse faster and if you taper slower you will get worse slower. Either way it looks like your maintenance meds are not good enough to keep you in remission and that's the real problem, not in how fast or slow you taper the pred. The second reason to taper the pred slower is due to withdrawyl symptoms but right now that's not your problem either.
Posted 12/2/2014 9:19 PM (GMT 0)
i don't have a problem reducing when my maintenance meds are working. if they aren't, i get screwed when i'm getting below 5 mg. i had prednisone withdrawal symptoms below 20 mg but that was mostly shaking and irritability, not painful cramping.
Posted 12/2/2014 11:53 PM (GMT 0)

garylouisville said...
Pred only works while you are on it. Hopefully while you are on it your colon heals enough that when you taper down and off your maintenance meds can keep you in remission. If your maintenance meds aren't good enough to keep you in remission then how you taper really won't make any long term difference in regards to your UC, all it does is delay the inevitable. If you have been on the higher dose long enough and your symptoms return as you taper the only difference in the taper will be how long it takes for your symptoms to return. If you taper faster, you will get worse faster and if you taper slower you will get worse slower. Either way it looks like your maintenance meds are not good enough to keep you in remission and that's the real problem, not in how fast or slow you taper the pred. The second reason to taper the pred slower is due to withdrawyl symptoms but right now that's not your problem either.

I agree, but there is also the adrenal restart side of that coin, if you cannot get your adrenal glands going ( I keep reading if prednisone 'works' you had adrenal problems keeping up with inflammation ).

So the slow taper near the adrenal ouptut level is critical to allow them to wake up and contribute, rapid taper creates damage without adrenal contribution.

Even then your may need MORE prednisone months later if you have surgery or extreme stress since your adrenals can elastically scale output from 8 to 80 when healthy, but certainly not after prednisone put them to sleep and shut them down. They ramp up slowly.
Posted 12/3/2014 11:12 AM (GMT 0)
Well I am on a very specific treatment plan at the moment. I am on the azathioprine/allopurinol combo which takes months to work. I have recently entered therapeutic levels for the drug so my GI thinks it won't be long before I start feeling the positive effects of this. It may be that drug combo that is keeping my stools so good and my BM's at a minimum. The cramping is in one specific spot, at the splenic flexure part of my colon where the descending colon connects to the transverse. That is the one spot where I have moderate colitis, every where else throughout my descending colon is mild and patchy. So it may just take a little longer to heal than the rest of my colon.
Posted 12/3/2014 1:51 PM (GMT 0)
20 mg was always my benchmark to determine if my other meds were working. I could not get below 20mg on Asacol or remicade alone. Sounds like you need to add something to the mix if you are unable to drop below that level withouot problems.
Posted 12/3/2014 2:03 PM (GMT 0)
Its all timing though. It because my other treatment plan has just started working after being on it for six weeks. My GI says another couple of weeks and I should be at the appropriate level to feel benefit. There is no point in me abandoning that treatment plan when it has just started to work (if not fully yet) and going on to something else. Its just unfortunate that it has just started to work when I am beginning to taper down from pred at the 20mg mark.
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