Prednisone for Avonex side effects

[JonM]

Hey all
Are any of you using Prednisone to control the side effects of Avonex.  My Nuero suggested I try taking 10mg 1 hour before the shot and another 10 mg 2 hours after the shot to control the Flu symptoms.  Any advice?

[Quixotic1]

Hmmm.  I've not heard of this.  In my teaching in Immunlogy where we used a lot of steroids, it is held that prednisone does not begin to take effect for about 12 hours.  High dose IV you can see an earlier effect.  But, I've not heard anyone suggest that it would likely be effective within 5 to 6 hours, which is when they say the side efects of Avonex usually appear.  Mine usually rear their head about 5 hours after the shot, so this matches what the lit says.

I guess if you want to try it, then do so.  If it doesn't seem to help, then each week take the two doses a hour or two earlier to determine the optimum time.  Or move back the first dose and keep the second dose closer to the dose.  I don't know.  I'll look up the pharmacokinetics and verify this.

Quix

[Quixotic1]

Okay, I looked it up and found evidence that prednisone's peak effect can be seen an hour after taking it.  My experience has been in treating already established asthma and allergic reactions and in those conditions the 12 hours to real benefit is what I saw.  But, for warding off the side effects of the Avonex, the schedule your doctor suggested might well work.

However, this means taking much larger than physiologic doses one day every week.  52 days in a year.  One might need to consider that you might become relatively steroid dependent.  I don't know.  If I were taking that dose that often then I would wear a "Steroid Dependent" ID tag in case of medical emergency.  This way if the adrenals had become lazy, then additional steroids could be given in the event of a physical stressor such as an injury or illness.

Let us know what you decide and how well it works.  I'm sorry.  I should have looked it up before speaking up.  I just know what my clinical experience and teaching was.

Quix

[JonM]

Thanks for the info.  Can you really become steroid dependent taking a relative low dose once a week?

[beaumike65]

Hi Jon,

My understanding of Prednisone is that it is used for the flare ups of Multiple Sclerosis and other autoimmune disorders to include infections. Prednisone destroys the immune system over a period of time of extended use. I know a lot of people that have been on it and are worse off for it. Solumedrol which is a high dosed steroid is used for major flare ups of MS. My advice to you although not a doctor would be to get a second opinion I would hate for you to not be able to fight off flare ups because your body is resistant to steroids. My cousin takes 600 miligrams of ibuprofen 2 hours before the shot and 4 hours after. The other thing you can do is take your shot at night a few hours before bed time so that you sleep through the side effects. I take Rebif and I did that and I was fine.
Good luck hope you find a solution.

Mike

[essdipity]

I too would wonder about the negative and serious effects of regular, high-dose steroids. I certainly defer to Quix on this issue, of course, but still I know what steroids can do to bones, for instance.

Some people simply cannot tolerate the effects of Anonex. For the rest of us, it's a matter of finding what works best. This may be just trial and error, all of us being so different. I find that my Avonex symtoms kick in almost exactly 3 hours after the shot. So an hour or two after the injection, I take an Aleve and an Ambien, and go to bed for the night. Once or twice I've awakened and found myself in the throes of very painful 'Avonex legs,' but still I managed to go back to sleep. Usually, though, I sleep through the whole thing and so have no flu stuff whatever.

I know I'm really lucky in this regard. I have to say it's about time!! I had horrible effects from Copaxone, and in the past have suffered greatly from other meds too. So between Avonex and Lyrica I'm coping very well.  Yay!!

Here's to everyone's finding the right meds for everything!

ess

[sllowe]

Hey Jon,

I'm not able to contribute to the discussion since I'm just not versed in this, but could not pass on the opportunity to say hello.

I do have a question though.  Does this mean your flu-like conditions never left you since you started Avonex?  You either Quix? Just curious.  I was taking advil, or naproxen for my flu-like sides, and it seemed to help a little.

Nice to see you PAL!
-Shell

[Quixotic1]

I need to clarify some of my and the other comments.  When I spoke of a relative steroid dependence, I meant that in times of physical crisis the adrenal glands might not be able to respond promptly with the large doses of cortisol they need to produce.

It is impossible for me to say whether one day a week would do this.  The current wisdom is to be very conservative in this.  And the concern is not the total dose, but the frequency of use.  Once a week is frequent, but just one day may not cause steroid dependence at all.  I certainly don't know.

However, if it is a possibility, then it would not hurt to have a little extra - or a lot extra - in times of severe physical stress.  I would not take the chance.

I wrote a Health Page on this when one of our members - who had been taking steroids for many months - went into Adrenal Crisis when she stopped them: "Steroids - Friend and Foe.

http://www.medhelp.org/health_pages/Multiple+Sclerosis/Steroids---Friend-and-Foe/show/365?cid=36

As far as the comment that steroids destroy the immune system over a long period of use.  This is not true.  When used continuously for a prolonged period - many days, the immune system is certainly "suppressed," but not destroyed.  This can allow certain infections to take hold and be far, far more serious than they would be normally.  TB can be reactivated, bacterial infections can become life threatening, and some viral infections that should be mild can become life-threatening.

I do not  think, but am not sure, that once a week at the modest dose of 20mg would be that suppressive to the immune sytem, leech calcium from the bones, nor make you severely steroid-dependent (from the adrenal gland perspective).  But, there are other things also to consider.  I have been told repeatedly that the cataracts, which steroids are known to cause, are cumulative exposure-dependent, along with being dose-related.  This means that the more days you have exposure to them, then more likely you are to develop cataracts.

I also think a second opinion, from an endocrinologist, wouldn't be a bad idea.  But, wearing a ID tag is harmless and could be very beneficial.

Quix

[JonM]

Thank You for the feedback
FWIW I have been on Avonex for 20 months now and the post injection symptoms have persisted.  I had been taking 2 Tylenol and 2 Naprox about 1 hour after the injection before bed but I still experience the side effects and mine will sometimes drag out for 2-3 days.  The Neuro suggested I try it, which I did and it did help the body aches but I had a much more general severe headache.

Jon

[GrannyJo6]

I have been on Avonex for years. When I first started I had some mild flu like symptoms and every once in awhile I will wake up with or develop a nasty head ache for no apparent reason. I take 4 Advil (with food!) about an hour before I give myself the shot and then head right to bed. I also take two Advil with my morning meds and that seems to ward off the stray headache. The Advil dose was suggested by my neuro right from the get go. I'm sorry you are still having the side effects. That must make you dread shot night - it would me!

[beaumike65]

In regards to steroids destroying the immune system over a long period of time I know first hand from my aunt and other family members and friends that it does in fact destroy your immune system. People I know cannot even leave thier home so as too not get an infection or a common cold because it can be life threatening. Occasional use may not be bad but years of use is.

Mike

[patty6950]

Thanks for all your input. I was searching to see about taking Prednisone with Avonex since I have developed Temporal Arteritis and am taking the Prednisone for that and tonight is shot night. I was wondering about the two together. I think you all have answered my question. I take two 8 hour Tylenol  or Ibuprofen before my injection. I go to bed immediately and only occasionally suffer any "flu-like" symptoms. I guess everyone has to just experiment and find what works for them.
Good luck to you all and thanks for passing along your experiences and thoughts. Patty