PMR and corticosteroid nasal spray
Posted , 4 users are following.
Hi,
I have recently started using a prescription corticosteroid nasal spray for allergies. I know I will need this for at least 6 weeks (so much in bloom right now) and perhaps longer. Do you happen to know if there are issues with long term use of this when on prednisone?
I have been on prednisone about 15 months and am just getting down to the 5 mg level (again, after a relapse in December).
My doctor said there is no problem taking both (but he knows very little about PMR) and the pharmacist also assured me that I could take both (not sure if he fully realizes that I will probably be taking prednisone pills quite long term).
I am awaiting an appointment to an allergy doctor (probably about 3 month wait here in Canada) and I suspect I have an allergy to something like mold or dust as I have allergy symptoms year round now so there is a chance I will be on nasal spray a long time.
Spring is lovely here - but so much pollen in the air!
0 likes, 9 replies
EileenH
Posted
We get periods with tons of pollen - after winter spring happens in about 2 weeks and everything blooms at once! I imagine Canada must be similar. So far I haven't had a real problem - but we have Sahara sand this week into the bargain!
Have you seen my reduction scheme? "Dead slow and nearly stop"? Here it is if you are interested!
My reductions are VERY slow. I use the following pattern to reduce each 1mg:
1 day new dose, 6 days old dose
1 day new dose, 5 days old dose
1 day new dose, 4 days old dose
1 day new dose, 3 days old dose
1 day new dose, 2 days old dose
1 day new dose, 1 day old dose
1 day old dose, 2 days new dose
1 day old dose, 3 days new dose
1 day old dose, 4 days new dose
1 day old dose, 5 days new dose
1 day old dose, 6 days new dose
By that stage if I feel OK I feel safe to go all new dose. I suppose you might be OK starting and stopping at "1 day new, 4 days old" but I was terribly sensitive to steroid withdrawal pain so I err on the safe side. Once you get to the "everyday new dose" - if you feel OK you can start on the next reduction, no real need to spend a month at the new dose.
This avoids steroid withdrawal pain - which is so similar to PMR pain that you often can't tell which is which and some of us suspect that many flares are NOT the PMR returning but problems with steroid withdrawal. Using a scheme like this also means you can stop immediately if you have any problems - you might be fine at one day old dose, 2 days new (lower) dose but not at a 3 day gap - but you have dropped your dose a lot and that is the idea. It also isn't as slow as you would think - you can reduce at a rate of about 1mg/month on a continual basis.
all the best
Eileen
mrsmop
Posted
The Ophthalmologist told me that the oral equivalent of the ocular steroid, would be a much higher dose, which is why the topical steroid is better. Whether the nasal spray is similar, I don't know. I have found that Hospital Pharmacists have a greater knowledge than those on the High Street
Light
Posted
Can I ask one more thing...?
I have been on varying high and low doses of preds (oral) for 8 years, and after reducing from 20mg, am currently reducing from 12.5 to 10mg daily, by going alternate days (so far so good). Over the years this has first been for RA and more recently for PMR.
My major problem now are my eyes. I have contracted an RA offshoot called keratitis, an extreme dry-eye syndrome. My eye doctor put me on pred drops along with a lubricating eye gel and tear drops (plus a twice daily drop called Restasis to stimulate the tear ducts that needs to be taken long term...)
My work is on the computer and involves large amounts of reading (whose doesn't?) and this has become a torment for me.
He took me off the preds drops after ten days but in desperation, after two further weeks, I have gone back on them twice daily, one week before my next visit is due.
I know that taking long-term cortisone eye drops is dangerous, but I wonder if you happen to know whether my increase in eye problems over the last week could be affected by my recent reduction in preds daily pill dosage?
It's a bit complex, I know, but Mrs CJ's post above, talking of corticosteroid (prednisone) allergy nose spray, made me wonder if the same might be true for corticosteroid eyes drops.
Any clue?
mrsmop
Posted
EileenH
Posted
You need a super optician/eye doctor! Have you got "computer only" glasses? That I find makes a mega difference - far better than trying to use vario-focals. The specs I was given for computer-only when I first got PMR, not recognised so no pred but dry eyes, now also function for reading when I can't manage without and holding the book closer. Although my distance prescription has remained near enough the same, the same can't be said for the rest! But I haven't updated them - I move my specs up and down my nose! I have distance, computer, sunglasses - all slightly different but they all come into use and it saves me spending an arm and a leg on variofocals. In fact - it is beginning to be thought that variofocals just might be a factor in many people being unsteady so I'll be sticking to my way I think!!
Eileen
Light
Posted
About 3 or so months ago I stared on cortisone drops x2 day for ten days, reducing to x1 for another week and then to every other day for the next week and then to stop.
But a new ophthalmologist referred by my rheumy because he understands RA-related eye problems took me right off them and put me on the other three lots of drops & gels. But two weeks later or so, I was back in agony and so he put me on a different type of cortisone drop, less percentage, which relieved the pain somewhat and again was slowly reduced.
I'd been off them altogether for about three weeks and it felt like everything was very slowly getting fractionally better.... and then suddenly a slide-back. That's when I prescribed the drops for myself again, yesterday, starting at x2 for 3 days, with a plan to reduce the same way but quicker...
I'll be seeing him again in just over a week. Each time I go, he checks the tearing rate of each eye and the first time it had improved slightly.
Eileen, the problem isn't really with my eyesight so much as with extreme burning, stinging, and itching, and microbe filaments that attach themselves to the cornea and make me feel as if I'm feeling a thousand onions non-stop while sitting in your Saharan sand storm (or as it sounds like it must feel – but probably a lot worse). It happens with focused vision, looking into the screen, but even on paper, reading or any detailed work which means the eyes aiming at spot for a while.
But i will ask him about special computer glasses. Right now, I've inverted my screen image to white on black and it seems to bring some slight relief. Makes everything look very eerie though!
EileenH
Posted
I haven't had any repeat since being on pred - and am considering trying out lenses again since I have 6 months worth on the shelf still within date (I think). I do find I need to to look away from the screen far more often than I used to. Don't know anything about the filaments you mention - but the rest sounds horribly familiar.
mrsmop
Posted
I suffer from photophobia because of my eye condition but it is also a side effect of Methotrexate. Having said that, I wear photochromic specs inside and a very dark tint outside unless it is very dull and not rose coloured tints!
Photophobia is a side effect of several drugs and I can't remember whether or not Pred is another.
Good luck with your next visit Light. Another idea for your visit, is to ask for Minims eye drops. They are the single use, preservative free eye drops. The Ophthalmologists might use them in the clinic you attend. I have to use them because I am allergic to so many things but one of the Ophthalmologists that I see, told me that some of the ingredients cause problems in most [or many] people.
Google minims single use eye drops and you will probably recognise the boxes!
Nefret
Posted
The only time someone has questioned my steroid load was a new nurse at the asthma clinic. She definitely didn't want to give me a repeat prescription for a new inhaler, but when I asked her what she wanted me to do she said she didn't know! I had to work hard to convince her that I needed it. Not one other person has so much as mentioned steroid loading to me. It didn't worry me particularly as I was aware of the situation before it started, but someone not knowledgeable would have found it a problem I think.