The differences between Prednisone, Prednisolone, and Medrol.

[Admiral06]

jwb43, When you take prednisone, it must first be metabolized in the liver to its active form, prednisolone. And while oral prednisone and prednisolone are used interchangeably, the latter (for obvious reasons) is more readily absorbed by the body.

Medrol, is a brand name for methylprednisolone, which is actually nothing more than prednisolone with a methyl side chain attached. This side chain increases the activity of the prednisolone by approximately 20%, which lowers the required dose by this same amount.

A study of the side effects of each form indicates they are all virtually the same, but different individuals often find one better than the other.

I also strongly suspect that different doctors favor one form over the other merely because they have had more experience with it.

[SheffieldJane]

Thank you for that helpful clarification Admiral06.

Sending best wishes for a peaceful Christmas and a healthy happy new year to you and yours. SheffieldJane. ⚓️

[Admiral06 in reply to SheffieldJane]

Thank you for the season’s greetings SheffieldJane and I wish the same to you and those you care about.

I am also very pleased to report that I have been blessed with a recent improvement in my health that came just in time for Christmas. As I mentioned in one of my posts, I discovered that a potassium deficiency was responsible for muscle fatigue, elevated blood sugar, and periods of irregular heartbeats. Since these symptoms began in mid October, I lost 11 pounds and with it went a good deal of muscle tissue.

Subsequent to correcting this problem, I feel well again and am beginning to steadily increase my level of activity. I have also reduced my daily dose of depo-medrol from a median of 10.3 mg to 7.7 mg with no symptoms other than some morning dizziness.

My experience with PMR, however, is that it is like a roller coaster ride with fewer ups than downs.

While I have no idea how long my good fortune will last, it feels so good to feel good again that that I am literally euphoric.

[SheffieldJane in reply to Admiral06]

Thank you for being a beacon of light and hope in a stormy sea Admiral06. I envy you the euphoria, best bit of all this, if and when it alights. I had 6 weeks of it when I started Prednisalone and achieved so much ( some of which I still have). Season's Greetings to you and yours, have a very happy new year!

[PMRpro Ambassador]

The main reason for being on one rather than another is the country you live in and what is approved and stocked by the pharmacies.

In the UK the oral form is traditionally prednisolone, because that is the stuff the NHS negotiates a discount for on the grounds of turnover volume. It also works faster as Admiral06 says and there is less problem if the liver isn't working as well as it should. If you are given injections or infusions then it is methyl prednisolone because that is the soluble form.

In the USA they tend to use prednisone or methyl prednisolone (Medrol) and prednisolone isn't used as much. In fact - I don't think I've come across a US member of the forums on prednisolone.

Here in Italy there is methyl prednisolone as both oral and injected forms - it is not possible to obtain prednisolone at all, it isn't approved and isn't stocked. The only other form available is Lodotra, a special formulation of prednisone with a timed release coating.

[Admiral06 in reply to PMRpro]

PMRpro, Thanks for your knowledge on this subject as well as all of the others you have discussed since I joined the group. Merry Christmas to you and may you enjoy good health in 2017.

[jwb43]

Thank you very much for very informative reply. I have never tried anything other than methylprednisone. So it will be interesting to find out if there's any differences for me. Seems like it would be easier on your liver to take the one that does not have to be metabolized through the liver

[Admiral06 in reply to jwb43]

Good luck jwb43, I think the most important thing right now is about finding a minimum daily dose (of any form) that relieves your symptoms. And while I can't remember who said it, there are two parts to PMR. One is learning to live with the steroids, and the other is learning how to get off of them.

Merry Christmas to you and may you feel better in the coming year.

[jwb43 in reply to Admiral06]

Thank you very much. I am off work for the next couple weeks for Christmas shutdown and I'm going to try starting on some prednisones to see if the pain really goes away with a higher dose. If it does not then it's not PMR.

[PMRpro Ambassador in reply to jwb43]

You may not be 100% pain-free on even a higher dose - everyone is a bit different and some people find they are never totally pain-free. You can't say it isn't PMR just because more pred didn't do that.

[jwb43 in reply to PMRpro]

If it does not make me pain free or at least very low what is the use. My pain meds can do that. And from all the comments on the sight no one ever really gets cured and off the pred.

[PMRpro Ambassador in reply to jwb43]

Then you obviously haven't read enough posts on the site - although the people who have got off pred and are getting on with life are mostly too busy to be here! They also often find it difficult to be reminded of what was a dark period for them. There are people on the site who have recovered from PMR and GCA and no longer require pred but remain to help offer advice: Dorsetlady and Celtic are two of them.

There is no cure for PMR, pred is not a cure for PMR, we take it to manage the symptoms and allow a decent quality of life in the meantime. For about 75% of patients the underlying autoimmune cause of PMR burns out in between 2 and 6 years or so. No-one can know in advance whether they will be a 2-year person or, like a few of us, one of the 25% who take even longer or never get off pred.

The entire point of taking pred is that for most of us it makes a big difference to what we are able to do. Within 6 hours of taking 15mg of pred I could walk downstairs normally, not like a toddler, 1 step at a time. I walked back up with a cup of tea in my hand - not crawling up on hands and knees. I could toilet myself properly, could get up off the toilet without help. I could turn over in bed without having to plan the process, one step at a time. I could get OUT of bed and dress myself. For the first time for months - and the pain was much better.

Obviously - if the pred DOESN'T make a noticeable difference, then it may not be PMR and there is probably little point in taking it. The fact you say pain-killers work for you suggests it may not be PMR, for most of us they make no or very little difference. But don't be misled - painkillers come with their own side-effects, including addiction and gastric damage depending on what you are taking. If you have high levels of inflammation then pred often reduces that, whatever the cause, and unmanaged inflammation in the body over long periods causes other damage, to the cardiovascular system (blood vessels and heart) and can even increase the risk of some cancers.

[HeronNS in reply to jwb43]

Not true. There may be no "cure" as such, but in fact the majority of ppl with PMR recover in the sense that the disease goes into remission and they can wean completely off pred. You won't see them here, because they are well again - except for a few kind souls who check in regularly to help the current crop of sufferers.

On the other hand, if non-steroid painkillers work for you, you may not even have PMR. The other pain meds have little or no effect on standard PMR.

Merry Christmas! 🎄

[jwb43 in reply to HeronNS]

Thank you all for your replies very helpful. That's my dilemma painkillers to help and there's a lot of things that seem like it's not PMR and then many things that seem like it is. I'm grateful for all of you who stay on the side and give advice Merry Christmas and a Happy New Year to all of you

[Admiral06 in reply to jwb43]

jwb43, My PMR symptoms began this past summer as moderate knee and hip pain, but soon intensified and spread to the shoulders, thighs, buttocks, elbows and hands. At first I could control the pain with Ibuprofen but eventually this was no longer effective .

As a consequence of passing a 6 mm kidney stone, I had a small supply of Percocet 7.5-325 in the medicine cabinet. To help with the pain, I took 800 mg of Ibuprofen plus one half Percocet each night at midnight. This helped me get to sleep, but when it wore off 3-4 hours later I was barely able to roll out of bed and I couldn't raise my arm high enough to turn on the light switch. One more dose of the above pain killers got me through to morning. While this heavy duty cocktail did help with the pain, I doubt very much if it was sustainable.

For me, the primary symptoms of PMR were the facts that it was far worse at night, I could not roll over in bed and I couldn't lift my arms up from my sides.

Good luck with the diagnosis and Merry Christmas.

[PMRpro Ambassador in reply to Admiral06]

There are rheumatologists who would take your comment about night pain as a red flag it might be ankylosing spondylitis - where the pain is typically worse at night, improves with gentle exercise, is relieved by other pain-killers and can present looking just like PMR and will show a distinct improvement with pred but the patient finds it very difficult to reduce the dose.

[Admiral06 in reply to PMRpro]

Thanks for the info PMRpro. When I was being diagnosed, one of things my physician did was to ask me to bend in several directions. He then manipulated my legs and asked if it caused pain. When I asked what he was doing, he said "making sure it's not AS". I hope this was sufficient.

As for tapering, my median depo-medrol serum level is now an estimated 7.7 mg and I have gone as low as 5.4 mg on the last day of the pulse. Because Upjohn Pharmaceuticals determined 5.3 to be the withdrawal level, I am spiking the injectable dose with oral medrol to smooth the curve and stay above this point.

This week's pulse is as follows: 15.0, 11.4, 10.3, 7.7, 6.3, 4.8, and 4.4. I will spike the 4.8 with one mg of medrol to bring it to 5.8 and add one more to the final day to bring it up to 5.4.

So far I have experienced little more than morning dizziness, but I have a long way to go!

[PMRpro Ambassador in reply to Admiral06]

I think most UK rheumies might have sent you for at least an x-ray! An MRI/MRA would be better. However...

[Admiral06 in reply to PMRpro]

PMRpro, I will ask again, but I never had back pain as a symptom. The worst was my shoulders and thighs, and the last symptom to resolve (after taking steroids) was morning stiffness in my hands.

[Topherb304]

I have ulcerative colitis (diagnosis 14yrs ago) and I find that prednisone has worked best for my condition! I ended up getting hooked on opioid pain meds in my early stages and by the time my Dr cut me off I was addicted and couldn't stop! Mainly because of the side effects actually helped my situation especially the constipation part because it made me normal if that makes any sense. After I was unable to get my pain meds I became a heroin addict for about 8 yrs! I didn't think my addiction was bad because I only snorted it. Well I found out the hard way that was not the case! I went through hell getting detoxed off that satan of a drug! I've been clean for a lil over a yr and I still crave the drug! If it weren't for meetings I would've went back to it! Anyway my ulcerative colitis has been more active than ever now and I've tried everything!