Time taking steroids vs amount?

There has been some recent discussion on another forum about this and some think that it is the cumulative amount that is meant to matter in the end. I do not have a link to the medical info but Professor Dasgupta relatively recently said something about the total number of grams of steroid people have taken since commencing treatment is a key factor- with the critical amount being a total in excess of 10gs (cf. mgs). This may be debatable however as some say they have certainly taken more than this over many years without substantial side effects while others appear to have several side effects on lower doses. It is also notable that recently the Mayo Clinic has published research stating that at lower doses anyway side effects my not be as bad as people have previously suggested. Others should be able to post relevant research links although I think whatever they conclude there seems to be a diversity of personal/anecdotal experiences and perspectives about this comparison.

Best wishes

The most common cause of suppression of ACTH is the use of glucocorticoid medications to treat a large variety of illnesses. Glucocorticoids are steroid hormones that act like cortisol. They include cortisone, hydrocortisone, prednisone, prednisolone, dexamethasone, as well as intravenous, intramuscular, inhaled and topical “steroids.” All of these medications have an effect on ACTH because the pituitary is producing this hormone in response to the body’s need for cortisol. When the cells in the pituitary recognize any of these drugs, they sense that there is cortisol present and therefore produce less ACTH. This ACTH suppression from glucocorticoid medication can be very temporary, prolonged, or permanent depending on the dose, potency and length of use of the medication. For example, a few days of prednisone will not produce a significant problem, but several weeks of prednisone at a dose of 10 mg will diminish the cortisol level and the ability to fight a stressful situation. Recovery of the pituitary-adrenal response after use of a suppressive dose for more than one month will take about one month. Generally, this one for one recovery time is typical up to about 9 to 12 months, when recovery will often take up to a year or may not occur at all.

Hi,

Any amount of steroids causing the side effects. Higher douse, more intense the side effects.

I am diabetic and before steroids my level of sugar was maximum 7.0. When on steroids I gave 27.0. it does not matter if the dose was 15mg/day and presently is 3mg/day. Additional effects like "bigger" face of more body is observed.

Good Luck

CW

I suppose it depends on how you look at in many ways. Some of the side effects are due to shorter-term high doses, others are felt to be due to the long term cumulative dose. But for a lot of people the side effects can be minimal.

The cumulative dose has been mentioned - with Dasgupta in the UK saying that 10g total has some magic significance. I have been on pred for over 8 years, I don't know exactly how much, my records are not detailed enough, but it has to be well over 20g. I gained weight - I have lost it all again by a consistently low carb diet. This has also helped me avoid developing pred-induced diabetes. My bone density has remained at a similar acceptable range level the entire time (without having taken any medication besides calcium and vit D) and I have no sign of cataracts at all. As far as we can tell I have no pred-related side effects, certainly none that bother me. Even my skin is in good condition - which I put down to avoiding the use of soap which just strips the skin's natural oils. Bruising is mostly due to me being on anticoagulant therapy, not the pred, Others have a less favourable story - especially if there are pre-existing conditions such as cataracts or diabetes but even then the stories vary.

A great deal depends on the dose you are settled at - this study 

"Polymyalgia Rheumatica and Steroid Side Effects: New Findings  August 18, 2017: 

Except for cataracts, side effects in PMR patients treated with glucocorticoids and non-PMR patients were not statistically different, new research finds"

finds the sort of dose used in PMR (usually up to 20mg max, reducing to a lower maintenance dose) does not actually cause significant problems that would not have been experienced by a comparable population without pred. 

What any dose above about 7.5mg will do is the dreaded "adrenal suppression" - but that is also misunderstood. The suppression is because the body produces cortisol naturally, equivalent to about 7.5mg. So the feedback set-up signals no more is needed - to reduce the effect of excessive amounts on the body. There's enough so no more is produced - like lighting a wood stove in the living room where the thermostat is stops the central heating boiler making more heat. 

The downside is that the adrenal glands then are less able to produce spikes of cortisol to help you deal with sudden excessive stress. This isn't generally too much of a problem until you get below 7.5mg-ish when the feedback set-up has to wake up and trigger production of cortisol to top up the dose for other purposes. This is why you should carry a steroid card with you so if you are ill/injured and unable to tell the healthcare professionals you are n long term pred they can see and deal with you appropriately.  Providing you reduce the pred dose slowly enough most people find the function returns OK, but it must be slow. The longer you have been on pred, the longer it takes to settle down. But it isn't just the adrenals - it is a range of other factors. Every time the dose is changed it has all to readjust again and settle down - until the next time. The smaller the steps down and the longer the gap between, the less you will notice the effects.

What is your diagnosis?

rachel, I am a 80 years young been a diabetic for over 55 years. Does Pred have side effects, yes, but life without Pred was horrible, I can live with the side effects. Been on Pred now for about a year and half. I live a quite normal life thanks to Pred. Thinking positive and smiling. 🙂