Kickas.org Forums Treatments, Drugs and Alternatives AS Pharmacy Prednisone Burst Advice/Precautions/Recomdations?

I’ve been given this “Prednisone Burst” Rx:

5mg X 5 (for first 4 days)
5mg X 4 (next 4 days)
5mg X 3 (next 4 days)
5mg X 2 (next 4 days)
5mg X 1 (last 4 days)

This is my first Prednisone Burst.

I would just like to know of any advice, precautions or recommendations through personal experience you might have?

Ie:
1) Long and short term effects of the “burst”?
2) Drug or NSD interactions?
3) Can you take while on "Anti-TNF" or other biologics?
4) When to take? (morning or at night etc)
5) Supplements to take during burst (calcium etc)?
6) Physical changes?
Though vain, one of my concerns is gaining addition weight permanently on my face. I’ve always had a fatter face (even when I was skinny in my youth), and the idea of it getting even fatter scares me! Temporarily I can accept if it can put out the flare.

I’m a 33 year male who has suffered from chronic spine pain for the last 10 years. After numerous attempts with different treatments (physiotherapy, chiropractic, intramuscular stimulation, botox injections etc.) failing; I’m finally seeing a Rheumatologist whom believes I have AS/Spondyloarthropathy (although I am in the small group who is HLA B27 negative). I will be beginning treatment (DMARDS – not sure the specifics) soon, but till then I was given the Prednisone Burst Rx to be taken after my SI-joint MRI (which I just had).

Drugs I currently take:

- Tylenol 3
- - - the codeine was one of the few pain killers that use to worked without making me feel high
- - - lately it does little to help with my pain

- Advil (Ibuprofen)
- - - 600mg/dosage
- - - used to supplement the Tylenol 3’s when they are not enough (which has been frequently in the last few weeks)

- Effexor XR
- - - 150mg daily
- - - on for past 9 years for Anxiety and Depression
- - - I have probably not needed them for the past 5 years, but they are very difficult to come off (terrible withdrawal symptoms). One of my pain doctors I have seen said it might be wise to get my chronic pain managed before attempting to come off these since chronic pain really over taxes your neurotransmitters in your brain, making it increasing difficult to come off these.

- No Starch Diet (+ no dairy)
- - - during Christmas I was in so much pain and in despair that I began this diet after reading the articles in the home page (it was the only thing I could do independently since all my doctors were on holidays)
- - - within 2-3 days, my pain was halved! I was so excited!
- - - - - unfortunately this relief plateaued immediately, and then soon began to regress to my current painful state
- - - I have continued on the NSD for almost 2 months now
- - - - - Although my pain has come back, I have at least been able to lose 20lbs (which is amazing in itself). This has been great since my pain has left me largely unable to be as active as I use to be; and the pounds have crept on over the years.


Any help and advice is very much appreciated.

Very Sincerely,

- Buddha

I'm usually only on pred for the 6 days, once I did 10 days.

That 10 day taper was while on humira, but I started the pred the day after the humira shot and didn't take a humira shot until a few days after the pred ended, so don't remember the advice of my rheumy regarding that shot.

I'd call your rheumy and ask about your biologic and how to handle.

I've always taken all of my other drugs and supplements while on the pred.

The only short term side effect I get on pred is flushing, just the first few days, but to me that's very minor. It also keeps me pretty awake on the higher doses the first day or two, but again, I don't mind it, I just use the energy.

Mostly it just makes me feel really good. Really good.

Good luck with it!

Sue, thank you so very much for you personal experience on it.

Just to be clear:
you took a humira shot
-> then started the 10 day prednisone burst the next day
-> then had the next humira shot (a few days after the pred ended.

If this is correct, I assume it should not interfere with any biologics.

I'm seeing my rheumy next Monday. Only then will i know what my course of action will be.

I might just wait till Monday to ask if I should do the prednisone burst; but I've been in so much pain the last few days/weeks, that I have been totally unproductive (which saddens me:( ).

I have taken them many times. With the burst, you should not get
any effects like the moon face. Take them early in the a.m.. That is when your body is making cortisol and you get fewer side effects taking them at that time. I never had to stop taking other meds when I have taken the pred bursts or Medrol dose packs, etc.

It should make you feel much better. I am sorry you are having such a hard time.

Blessings.

Thanks Possi!

strong- these two ladies gave good advice...

I HAVE gotten so much relief from from Pred.

good luck

Yes, that is what I did, per my rheumy's advice. If the Humira had worked better that time, I wouldn't have needed the pred. Normally the Humira kicks the flares butt, but sometimes the flare is just too strong, as was the case this one time.

Thank Lon and Sue22 for the responses.

I just went to my Rheumy yesterday. Instead of the initial dosage that I put up in the opening post, he instead prescribed this:

100mg (single morning dose) x 3days
-> 50mg (single morning dose) x 3days
-> 25mg (single morning does) x 7 days

Is 100mg/day not alot?, especially since this is my first prednisone dose ever to my recollection?

The Rx was sent electronically directly to my pharmacy. I wonder if there is a mistake? I'm going to call the rheumy tomorrow morning just to make sure before I begin.

Also is going from 25mg/day to nothing okay? The initial Rx had my starting at 25mg, and tapering gradually form there. This time I'm stopping at 25mg after 7days at this dose. Just wondering if this is safe?

- Buddha

Strong- your dose seems high. But I would call your doctor. I am on a daily 5mg. which seems to keep m eon my feet.

when I am on the high point of a Red. taper, I understand what it feels like not to have pain. so wonderful

The 100mg does seem a bit higher than usual. My prednisone bursts are normally 40mg for five days then 20mg for five days. 40mg helps quite a bit more than the 20mg though and I don't think any less than that would do anything much at all in my case. A friend of mine is doing a burst starting at 80mg though, so it could be right, but good to check with your doctor.