Urgent Question -Prednisolone

[Nevasayneva]

I've been advised by NHS 111 to use my rescue kit.

The instructions for the Prednisolone 5mg say to take six tabs once daily for 5 days.

I'm confused ...

should I really take all 6 in one go?

Sounds like an awful lot!

[Carnival567]

The answer to that is yes. Fortunately they are very small tablets.

[Nevasayneva in reply to Carnival567]

Thanks

[Nevasayneva in reply to Nevasayneva]

Thanks

[leo60]

Yes! And take them with food and as early as possible in the mornings!I hope you feel better soon xx

[Nevasayneva in reply to leo60]

Thanks

[Annie31]

Yes as Carnival has said - individual dose is 30mg per day for five days as part of a rescue plan. I had to take 30mg per day in hospital for five days only but it was a 30 mg tablet so I only had one to take. The pills come in varying dosages so that people can be weaned off steroids gradually over a longer space of time if they've had to take steroids regularly over a lengthy period. You've just been given the lower dosage ones thats all.

[Hidden]

Yes, 6 tablets or 30mg is a normal dose of oral steroids during an exacerbation or flare of lung disease. Pred doses vary depending on purpose and can be anything from 1mg right up to 100mg, but treatment doses are most commonly between 5mg and 60mg. Bod takes 40mg a day when she has a bad infection. Other strength tablets are available, but 5mg tabs are the ones most commonly used as it’s easier to vary the dose if required.

Unless advised otherwise, pred should be taken in the morning after food, partly to protect the stomach, and also to reduce any insomnia, which is the most common side effect of steroids.

[santisuk in reply to Hidden]

"Yes, 6 tablets or 30mg is a normal dose of oral steroids during an exacerbation or flare of lung disease".

Steroids are not recommended as a routine inclusion in rescue meds for bronchiectasis

[Hidden in reply to santisuk]

I’m well aware, just didn’t see the need to clarify further under the circumstances: I’ve found that ‘lung disease’ is a broad term that means different things to different people on here depending on what diagnosis someone has, and if the OP has been prescribed steroids as part of their rescue pack, then it’s reasonable to assume it’s an appropriate course of action for their particular lung disease. The question was is 30mg an abnormally high dose when prescribed steroids as part of a rescue pack for an exacerbation. The answer to that regardless of lung pathology or whether steroids are routine for a particular condition remains no, it’s not. A dose of 30mg or more would still be the standard dose prescribed in both ncfbe and cf, and despite it not being routinely recommended for an exacerbation in either of those groups, I know for a fact that many of those patients do keep a course of steroids in the cupboard. They just don’t start them without medical agreement.

[santisuk in reply to Hidden]

If that medical agreement were by a bronchiectasis specialist I would not disagree with it. Trouble is that GPs and even many standard non-specilist pulmonologists do not understand that treating a bronchiectasis exacerbation is not the same as a COPD one. For avoidance of doubt the British Thoracic Society Bronchiectasis in Adults Guidelines 2019 concluded:

"Do not routinely offer inhaled corticosteroids to patients with bronchiectasis without other indications (such as ABPA, chronic asthma, COPD and inflammatory bowel disease).

Do not offer long-term oral corticosteroids for patients with bronchiectasis without other indications (such as ABPA, chronic asthma, COPD, inflammatory bowel disease)."

The BTS Guidelines are evidence based and the panel researching and preparing the guidelines could find no evidence from examining the various clinical studies that have been carried out that steroids improve the results in those bronchiectasis patients who have none of the other allied lung complaints. However I acknowledge that in the case of steroids for short term treatment of bronchiectasis exacerbations they say that they found no studies and thus they remain silent on the subject. Personally I would not take them, even for a stubborn exacerbation, without consulting my bronchiectasis specialist

[Hidden in reply to santisuk]

I’m sorry, I still don’t understand the point of your comments, or the relevance to LClinton’s question. This question and my reply were both relating to oral steroid use in (what I assume to be) COPD, so talking about ncfbe was and remains irrelevant for the OP’s purposes. For what it’s worth, I’ve read the guidelines from start to finish and dipped into them quite a few times since on top, so as I said originally, I’m well aware that neither oral nor inhaled steroids are routinely recommended unless someone has ABPA or a comorbidity indicating it would be appropriate, the reason for that being that ncfbe is believed to be neutrophil driven, and neutrophils show little response to the anti-inflammatory effects of corticosteroids. The fact that GPs are so woefully ill-informed about ncfbe is another matter entirely.

Following further conversation with others with an ncfbe diagnosis, I have edited this reply, but still come back to not understanding the relevance of picking me up about ncfbe when LClinton wasn’t talking about ncfbe and I’ve already clarified the context of my use of ‘lung disease’.

[cofdrop-UK in reply to santisuk]

I don’t understand the point of your comments either. The poster was simply concerned about taking 6 5mg in one go. As they are in this person’s rescue pack, I think we can assume it is not for BE or BE alone. Cx

[Hidden in reply to santisuk]

I really don’t understand why you have challenged Charlie_G so strongly, introducing an issue which was not the subject of the question which he was attempting to answer.I have ncfbe. My consultant co wrote the guidelines which you quote. Therefore I agree that oral steroids are not recommended in ncfbe exacerbations unless the patient also has asthma or an element of copd.

However, this was not the point of the question

I understood the question to be related to dosage in copd and it was this that he was answering.

Other members obviously understood that the question was related solely to dosgage and their answers reflect this.

If members cannot answer a question without their use of terminology being used to criticise them, I for one will be loath to use my keyboard.

[sassy59]

Feel better soon LClinton. Xxx

[peege]

Yes but 5mg is a very low dose so 6 per day is normal in this instance. Be sure to take it as early in the morning as possible with a little food, inform your gp and reorder a new prescription asap.

[2greys]

I have to take 40 mg/day, that is 8 x 5mg tablets/day for 5 days and then reduce it by one tablet per day after that. So my course runs for a total of 12 days, with just one tablet taken on the twelfth day.

[hypercat54]

Yes that is a normal dose. I hope you feel better soon.

[stamford1234]

That's usual. Hope you feel better soon

[gingermusic]

Yes six a day all in one go

[silvertears]

Yes take All 6 in one go

[Sops]

Yes, they are tiny and they do work

[Feeder]

Yes you should take them all at once. Hope you soon feel better.

[Feeder]

Yes you should take them all at once. Hope you are soon feeling better.

[Med75]

I have always been advised to take 8 x 5mg daily for 5 days when I have a flare up, as others have said the earlier in the morning & with food is best advised. It’s not my first go to medication when needed I try increasing my inhaler intake ( as advised by GP ) if that isn’t helping it’s prednisolone.

I have recently been diagnosed with eosinophilia asthma after suffering asthma attacks for many years & needing to use my rescue kit more & more I was referred to a consultant chest physician, I had several tests resulting in the diagnosis.

[B0xermad]

Definitely yes 6 in one go ,I take 8mg x 8 from rescue pack in the morning when having an exacerbation

[helenlw7]

Yes you should. My hospital actually says 40mg for the rescue pack.

[ElsaC]

Yes - is the short answer.

[Mrbojangles]

Hi L,I too am on Prednisolone and started on 20mg which required 4 tablets in one go.

Apparently they only come in 5mg size.

I checked at the time with my pharmacist for verification.

Stay safe....

[Patk1]

Yes&take v early as can keep u awake

[starskyd]

Yes you need to take all 6, and continue for 5 days or as recommended.

[COPD123491]

Yes. That is the dose I take when I have an exacerbation.

[consul1]

Short answer is yes, 30 mg daily is normal dose, unfortunately they do not suit me as they kept me awake, illusinate and the shakes, but my partner took them for a long time with not side effects .Hope they help you !

[Jackieshep57]

Yes, always best to take in the morning with or after food.

[Hidden]

That is probably correct. When I go into hospital, at least once a year, with respiritory failure here in Spain I am given 80 mg of prednisone for the first 4 days then down to 60 for a few days then 60 etc. At home if I am bad I start with 60 mg for 6 days then work down, 45 then 30 the 15 then 10