How does dexamethasone differ from prednisolone?
Posted , 3 users are following.
just read about treatment with dexamethasone helping with covid 19 and it sounds similar to prednisolone. How do they differ?
0 likes, 13 replies
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Notes on How does dexamethasone differ from prednisolone?
Anhaga AllyCD
Edited
It is about 6 times stronger.
AllyCD Anhaga
Posted
Thanks anhaga, that gives me what I was looking for. There seem to be a multitude of medications out there for inflammatory diseases and unfortunately experience has taken away the implicit trust I used to have in my gp.
Anhaga AllyCD
Posted
I saw a discussion about this somewhere and apparently because of its strength it would be inappropriate to use for a disease like PMR because it would be too hard to titrate the dose finely enough to manage the taper.
AllyCD Anhaga
Posted
can understand that. Presently trying to return to 4.5 mgs before flare happened due I am convinced by stress of covid and implications for those dependent on me. Managed 5.5 mgs so going slowly back down.
Anhaga AllyCD
Posted
Stress doesn't help us, does it? Hope you and family are all adjusting, and that your taper is successful , but don't push it.
I have recently got to zero pred, not long enough yet to be sure I'm going to be okay but so far so good. In order to get here from 2 mg I had to do each step of the dead slow plan twice over. So one day new dose, six days old dose, repeat before going to one day new dose, five days old dose and so on. It took over a year to get from 2 mg to zero; at the end, the last three months, I treated zero as the new dose!
AllyCD Anhaga
Posted
trying not to push it. After flare when covid and drop to 4 mgs coincided, added 5 mgs to the 4.5 where I had been comfortablefor a week and then dropped to 7.5 for another week. Having read I could drop back without tapering I nonetheless dropped slowly to 6 mgs and 2 weeks later to 5.5. All seemed fine but 4 days later those familiar aches are returning. Was hopeful I would achieve the 4.5 again but PMR seems to have other ideas. So frustrating. Thanks for listening, trying not to moan at home!
Anhaga AllyCD
Posted
When I had a flare I did the same, dropped slower than we're told we can, and stopped just above where the flare developed. Those were the days when I was first trying to work my way down to zero from 1.5. My doctor told me to use up my tablets, stop and see what happened. Well I had enough tablets to get there by dead slow method, provided I hit no snags. But I did. And, stupidly, tried a second time. I ended up with a genuine flare, and I think went up to 7 mg (5 mg above 2) and actually tapered down from there, not dead slow but nevertheless spending a few days at each level and going slower as I got back to 2.5. I was stuck around 2-2.5 for the next couple of years, so PMR was definitely not in remission, but I'd found my "lowest best dose". My doctor was contrite and made sure I always had enough 1 mg after that, and every once in a while I'd try a taper again. I had PMR in 2014, diagnosed and started pred 2015, and have been without a pred dose of any amount for a couple of weeks, but I was doing dead slow taper with zero as my new dose, so haven't had a significant pred dose for a couple of months. Seem to be okay but it's hard to tell sometimes what with osteoarthritis and injuring my knees!
Onward and downward! 😄
AllyCD Anhaga
Edited
thank you Anhaga. Your words 'genuine' flare made me stop and think harder. What I am presently experiencing is nothing like the sudden stiffness and pain at the onset 3.5 years ago. It is an ache with heavy limbs and extreme tiredness. So.... I will continue with the 5.5 using pain killers if necessary and see what happens! Good luck with knees and osteoarthritis - if not one thing then another. I have put trying to move house with my 98 year old mother and 40 year old autistic son on hold until covid decides what it is going to do - seems sensible!! Will let you know how I get on and thanks again
EileenH AllyCD
Edited
Just to give a bit of detail - 40mg of pred would be the same as 6mg dexamethasone. It is what is called a longer acting steroid - half life is longer and antiinflammatory effect lasts longer so often it means the dose must be adjusted. But the starting dose for PMR would be 3mg - how do you reduce that slowly? And pred fits nicely with 1x daily dosing for most - and that improves compliance: "I take my pred with breakfast every morning" is easy to remember!
Anhaga EileenH
Posted
Dexamethasone sounds like it might be a good starting medication for GCA, switching over to pred at an appropriate stage?
EileenH Anhaga
Posted
Not sure - I'm sure there is a good reason why they don't use it.
Anhaga EileenH
Posted
Actually just found a paper which says 10 mg dexamethasone should be given intravenously as initial treatment for GCA where vision loss is occurring.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3333461/
EileenH Anhaga
Edited
Interesting paper - seems some of the things we have been saying have been out there in the medical literature for 30 years!!! Like age where you can get GCA and duration of PMR ...