Hepatitis

  I was diagnosed with auto-immune hepatitis in
  l993. I am currently drug dependant.  I am
  trying to slowly reduce my dose of prednisone
  because of side effects.  I am reduced my
  dose by 2.5 mg. for a month now.  I am
  currently taking 7.5.  I have been very
  nauseated for the last 2-3 weeks. Could this
  be related to mydose reduction or should I be
  checked for something else. I am awaiting the
  results of my blood work. Also, I would
  appreciate any information on Budesonide.   I
  know it is being used experimentally.  Any
  news on side effects and effectiveness.  I
  have been considering try this steroid.  Just
  a brief family history,  I had a sister who  
  died in l969 from  Autoimmune hepatitis, I
  was diagnosedin l993 at age 40 and my oldest
  sister was just diagnosed with active
  hepatitis.  This is quite a family affair.
  Hope to hear from you soon.  Thanks

[HFHSM.D.-D.M.]

Dear Laurie DeBord:
I really enjoyed your questions and I am impressed and touched by your family history and the death of your sister.  
Your first question is excellent (as is your second).  Patients can experience a variety of symptoms when steroids are tapered.  These include fatigue, depression, irritability, muscle aches and weakness, low-grade fevers and nausea.  I suppose some of your symptoms can be due to the steroid taper but these usually improve with time.  It is important to know that steroids can be very hard on the stomach and some of your nausea may be due to gastritis which can be easily treated.  In more unusual circumstances, steroids can cause an infection in the stomach or esophagus that can also cause nausea.  You might want to discuss with your physician.  
Budesonide is a relatively new drug.  It is a steroid that is metabolized to some degree by the liver early on.  Because of this, some people feel budesonide may be a way to give patients steroids with fewer side effects.  Studies have suggested budesonide may be a vary good drug for people with asthma and inflammatory bowel disease (Crohn