Prednisone taper question

I was put on a rapid taper of 40 for 5 days, 30 for 5 days, 20 for 5 days etc. while my symptoms and bleeding improved they never Quite went away as every morning I have a couple diarrheas and mild blood. When I went to 20 the blood increased so I am now back up to 30 since yesterday but the bleeding isn't quite improving. Called my GI but had to leave a message bc he's busy. Anyways I doubt a rapid taper is going to hold me. Do I stay at 30 and wait a little longer or just go on up to 40. So I try to stick with his rapid taper or go slower This time as I had in the past during my pregnancy (which worked). I hate prednisone so much.

I am on Lialda too but I just started it in late April. Not sure how long it takes Lialda to start working. I'm taking 4 pills a day.

GMSAF said...
I am on Lialda too but I just started it in late April. Not sure how long it takes Lialda to start working. I'm taking 4 pills a day.

You should have a response within 3-4 weeks, it can take longer to fully heal. I see you are on 4,800 milligrams of oral mesalamine. You should also be on 4,000 milligrams of rectal medications either rowasa enema or canasa suppository. Treating from both ends is the best method of quickly getting uc under control, ask your gastroenterologist. They don't always mention them as people cringe at the thought of putting stuff up there and patient compliance is bad, but do what works!

If that's not enough then immunomodulators are the next stop (Imuran or 6mp).

I'd wait to hear from your gastroenterologist, call again if you haven't received a response. Sometimes you got to be a hornet in their ear to get a response. And ask about the mesalamine enema, combine 4,800 mgs oral and 4,000 rectal and you might just beat your flare and avoid stronger classes of medications.

I'm not entirely sure what a rapid taper is going to accomplish. Prednisone emulates our body's cortisol. In high concentrations, prednisone surpresses your immune attack on your large intestine (due to uc). While that immune attack is stopped (or at least quieted) your body has a chance to heal. And the process of your body healing your large intestine isn't a very quick one (especially with food passing through it). Over a multiple months, I could see a significant amount of healing. But a fast taper of two weeks...dunno

how much blood are you seeing ? is that your only current symptom ?

I think the standard steroid taper the NHS does (start at 40mg and drop by 5mg/week for 8 weeks) is too fast. It's not good to be on steroids for too long but you don't want the disease to come crashing back halfway through the course either. Once you reach 10mg it becomes even more important to taper very gradually.

If I had my time over I'd have tried to get more steroids prescribed (I was only ever given enough for an 8-week course) and tried to time the start of the course with the start of another maintenance med. Some doctors prescribe steroids weeks or even months before getting you onto a maintenance med and that's not a good idea either.

Well a scope will tell you what's really going on. Reassess based on it. Choose a flex-sigmoidoscopy if you have a choice.