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Effectiveness of Prednisone over time

Posted , 10 users are following.

jean39702
jean39702

Has anyone noticed the effectiveness of prednisone wane over time?  For example: in the first year of treatment it's effective for18 hours, but another year in, it only seems to be effective for 10 hours.

I realize the dose a person is on and the timing may play a part.  However, I get a sense that the drug isn't quite as effective for me 2 years into treatment.

0 likes, 12 replies

12 Replies

  • constance.de
    constance.de jean39702

    Posted

    I've often wondered myself.  Four years into PMR and still on 7 mgs Pred😡
    • jean39702
      jean39702 constance.de

      Posted

      Hi Constance.  From what I've learned about this process, four years is not so unexected.  I think Eileen has indicated it can be 2 to 5 years and some of us may meed a small maintenance dose for life.  I'll be happy to get to a nice low dose.

      Keep smiling.

      I should clarify that my question related to the length of effectiveness of a single dose reducing over time.  I know it can happen with other medications.

    • constance.de
      constance.de jean39702

      Posted

      Sorry!  I realized that a minute after I had sent it.  Brain fog and age, you know!?!
  • EileenH
    EileenH jean39702

    Posted

    I THINK it is something that has been mentioned somewhere - that some people become tolerant of the dose with time but I'd understood it more in the sense of needing more rather than maybe more often (if you see what I mean).

    But it could also be the inflammation/pattern of the autoimmune part changing couldn't it? Just trying to get my head around it.

    • jean39702
      jean39702 EileenH

      Posted

      Much appreciate you trying to get that great  "head" of yours around it Eileen.

      I truly have a sense that it's happening to me.  I'm currently playing with split doses at different time intervals to see if it helps.  Haven't found the ideal mix yet.  I suppose it could be the pattern of inflammation changing. However, it would be nice to know if I truly am dealing with the effectiveness petering out on me.  

       

    • EileenH
      EileenH jean39702

      Posted

      I spent about 8 or 9 months on Medrol (methyl prednisolone). I'd been fine on prednisolone as dished out in the UK until I got a new prescription - instead of being in blister packs they were loose tablets, 5mg and 2.5mg enteric coated. The 5mg ones didn't work at all - I had a flare within a couple of days. The same dose of 2.5mg ones worked fine but of course I got through them very fast. It was my stock brought back here so no way of replacing them and I had to go to the rheumy I used to see here.

      The standard stuff here is Medrol. I hated it from the first week - told him so but he was so convinced it was better than plain pred. Not that there is any other option here, you can't even order pred specially. Slowly my pain returned, despite increasing the dose. And it took longer and longer to work in the morning, until mid-afternoon - in the end to get any benefit I was taking it at night and 20mg. Didn't really help the PMR but I had superb side effects! Eventually the GP suggested we try Lodotra - straight from 20 to 15mg and had the same miracle as originally with pred in the UK.

      So - now my brain is in gear - did you change to a different manufacturer? A generic with a different recipe perhaps, that works differently in your body?  Or it might be worth asking the pharmacy what other options there are - can you get prednisone as opposed to prednisolone for example or another intermediate acting steroid such as deflazacort? Hydrocortisone also works but it is short-acting acting and you would have to take it twice a day - the pred advantage is you can usually get away with a single dose per day.  Dexamethasone lasts up to 2 days - so you might manage with a dose on alternate days.

      It might well be worth trying a different substance for a while if you can. Although the doctors I told about this hadn't come across it before so looked surprised.

    • jean39702
      jean39702 EileenH

      Posted

      Unfortunately, I can't do anything re: changing meds at this point.  I'm away from the frozen North and in Panama until mid-March.  :-)   I'll continue to monitor things and play around as much as possible with timing, without upsetting the apple cart.

      At the moment my split is 7mg in the evening around 9 pm, then another 4mg around 8 am.  All symptoms remain under control until 6 pm or so when minor/moderate pain, stiffness and fatigue.  Not so bad I guess.  I'm also cognizant of the fact that I'm adjusting to a new climate and tropical life style.  Althoough, this was happening before I left Canada.

      By the by, all my non-PMR pains seem to have melted away in the heat. (Hope I didn't just jinx things by admitting that).

    • EileenH
      EileenH jean39702

      Posted

      Shame the PMR pains didn't go too!

      Might it be better the other way round? The small dose at night and the bigger one in the morning - that seems more logical to me.

    • jean39702
      jean39702 EileenH

      Posted

      Seemed logical to me as well and I tried it.  Got up in pain in the morning and the higher dose at breakfast didn't relieve it.  Then I remembered what you said about how hard it is to get things under control if the inflammation has taken hold.

      Ah, the mysteries of it all.

      Gotta go for now.  I'm going to observe the goings on at the local women's bridge club.  I played 1st year university bridge eons ago.  I've met a few of the card players and think I might want to study up and join in.  What better way to get to know how to survive in Panama.  Any way I have a reservation on the Boca Chica Bridge Babes Bus.  In other words, a neighbour is picking me up in 30 minutes.

  • noninoni
    noninoni jean39702

    Posted

    It makes sense that your body would get used to prednisone and you would need more just when you are hoping you would need less.  We get so lectured to about the importance of reducing, that we may reduce a little too far.

        But that thought made me look up the half life of prednisone because I was curious about the effectivness of it on a daily basis.  This is what I found out:  "The plasma elimination half-life is 1 hour whereas the biological half-life of prednisone is 18—36 hours."  In other words,it is eliminated from your blood plasma quickly but it works a lot longer.  Elsewhere I found another measure: the "elimination half life" is 4 to 5 hours, and it will be out of your system completely in 16 .5 to 22 hours.  There is a whole field called "pharmacokinetics" where they look at this sort of thing for different medications.   

           So in my mind I see a chart of the daily effectiveness of prednisone- a curve going up for 3 hours or so and then headed downwards.  If it doesn't go downward enough, we can't sleep.  If it goes downward too steeply, it is very painful to get up.  So then I imagine splitting the dose and taking it twice a day-say, if you are on 7mg, take 5 mg for breakfast, and 2 mg for lunch.  Haven't tried it, but it might work to smooth out the effectiveness during the day while allowing us to sleep and to awaken with less morning pain.  --just an idea.  

          

    • maid_mariane
      maid_mariane noninoni

      Posted

      Hi Noninoni

      I have been splitting my dose since the 2nd week on prednisone. At first I split it morning noon and night till I started to level out then went to majority in the morning then a dose at supper to manage evening pain. I occasionally when I over do it I need a Tylenol 3 but much less now.

  • artfingers
    artfingers jean39702

    Posted

    I'm currently playing around with the split dose amounts.  I'm at 8mg Rayos (coated pred) and 4 mg at 8am and 4 mg at 10pm was making my sleep somewhat restless starting at around 2am when I would wake up. So I'm trying 3 mg at 10pm and 5 at 8am.  This is my third day trying it and I am sleeping better so we shall see.
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