Dosing for Prednisone?

[jessie438]

Hi Everybody!

I have a question concerning the dosage for prednisone that my neurologist prescribed for me.   I get attacks of occipital neuralgia and trigeminal neuralgia.  These attacks have been an issue for a little over 2 years now.  They last anywhere from several days to the longest which was 24 days (occipital neuralgia).  The attacks of occipital neuralgia make it impossible for me to function normally and I spend most of my time in bed.  The trigeminal neuralgia is very painful but for the most part, manageable.  

He prescribed 60mg per day for 3 days for acute attacks.  Three 20mg pills all at once, each morning for 3 days.  From what I have read, prednisone should be tapered down.  Maybe I am confused and that is only for long term use?  Also, I don't know if this matters but I am a small person and wonder if this dose is too much.  I am 5'3" and about 105 lbs.  

The only other medications I take are Baclofen, and occasionally Excedrine for headaches.  

The side effects of prednisone sound awful so any advice you can give me is very much appreciated.  

Jess

[essdipity]

Well, Jess, MS neuros have been administering huge doses of steroids for TN and other MS flares for many years. Most patients tolerate them well or at least feel that a few days of bearable side effects are worth it to get rid of the pain.

I've had 2 TN attacks that have been awful. I cannot take Tegretol because it destroys my blood platelets, also my balance. I seem to do well on IV Solumedrol for TN and other issues, and feel okay about that since it's been only once a year or so.  But for whatever reasons I can't do megadoses of oral prednisone, at say, 1000 mg/day for 5 days. That does wipe out my immune system.

I suggest you talk to both of these doctors and find out their reasoning. Also check out the web for common practices. In the cases where the low dose of oral pred does work, I'd stick to that, as it's always a good idea to take as little of any medication as is effective.

But if you're suffering for weeks while trying to run a household, that calls for much stronger measures. If need be, contact your local MS society chapter, see what they say, and line up some new medical help.

ess

[jessie438]

Thank you for your kind replies.  I feel much more informed and feel comfortable taking it now.  I had no idea it was such a small dose and now in retrospect my question seems silly.  Unfortunately, I had a very bad reaction to a prescription drug several years ago where my throat swelled.  It was scary and now I always get a bit paranoid about new medications.  

I do usually see a MS specialist.  However, he is of the opinion that occipital neuralgia is not caused by MS and since he only treats conditions related to MS, he referred me to a second neurologist in his office for treatment (second guy is not a MS specialist).  Neurologist number 2 gave me the options of taking daily tegretol for the trigeminal and occipital neuralgias or treating the attacks as needed with 3 day courses of prednisone.  The third option was nerve block injections.  

I do feel like neither one of my neurologists has taken the severity of my pain seriously.  Maybe they see so many people in pain on a daily basis, it just gets boring to them.  They are both great doctors and very thorough in their questioning and note taking but seem very unimpressed with my suffering ;)

These conditions leave me bed ridden and my life seems to be passing me by.  My friends have stopped calling.  I don't tell anybody in my family how bad my life has become because I don't want them to worry.  I am a single mother to 4 kids and I don't want them to feel like they have to take care of me.  They know I have excruciating pain in my head that makes me lay in bed for days or weeks but I don't think they realize how much it hurts because I don't tell them.  Sorry for the pity party but it actually feels good to write it down.  I don't have anybody to tell these things to.  I have tried to tell my mom but her eyes just glaze over and she changes the subject.  I know she cares, I just think she can't handle it.

Thanks for listening

Jess

[essdipity]

To me the real question is whether the 60 mg for 3 days works. If it does, good. If you've stopped abruptly like this in the past and have had no adverse events, then even better. This is actually a fairly small dose over a very short time, and tapering is necessary when your body --over time-- becomes dependent on the drug to take over some normal functions. From what you say, this isn't you.

Intravenous Solumedrol, the drug often used to cut short severe MS flares, is given for 3 to 5 days at 1000 mg per day. This is equivalent to 1250 mg per day of oral prednisone. And even after 5 days of this, many doctors, including mine, do not prescribe a taper. Just to put things in perspective...

Those who take prednisone regularly and long term are very likely to need tapering. However, if your doctor gives you a relatively low dose of pred for only 3 days and your attacks last as long as 24 days, then you are suffering way too long. Time to have a frank talk with your neuro. Is he or she an MS specialist? Doesn't sound like it. Severe pain should not be allowed to go on and on.

And no, 60 mg/day for 3 days will *not* wipe out your immune system.

ess

[immisceo]

For people with MS, we get given 3,000 to 5,000mg of steroids intravenously over three to five days. Yes, thousand. These are the big guns, and I've never tapered. Obviously this is a discussion to have with your health care team, and there will be varying opinions, but unless you have another medical issue that complicates things, you're talking about a small does compared to what we usually see here.

As with anything, some people will have side-effects, others will not. You don't really have a guarantee either way, but with such small doses, your chances are lower. Also, I have to disagree with the commenter above. It can potentially suppress your immune system to a small degree (in the doseage you stated, but it will most certainly NOT wipe it out.

[caregiver222]

There are arguments pro and con regarding taper. Three days of 60 mg a day will not cause harm if you abruptly stop, although a taper is recommended. People have various degrees of sensitivity to prednisone. It's genetic. Because of your weight 60 mg is kind of a lot. 40 mg would be plenty. But I believe he wanted to completely stop inflammation.   A short term use even at that dose should cause no lasting problems. You will have no immune system during that time so avoid contact with anyone with the flu. Look up DMSO, which is available in a cream in many alterrnative medicine stores. Never use it UNDILUTED or in less than medical grade.  But you must not have on ANY makeup whatsoever. It will drive the chemicals in the make-up into the bloodstream. DMSO is a far more powerful anti-inflammatory than prednisone.