Good Morning All, Just looking for advice on a depo-medrol injection and what I now do with my 15mgs a day of normal prednisilone tablets.
Yesterday - at short notice - I had a depo-medrol injection of 125mgs. The hospital kindly arrange this for me as I have had a relapse for the last month and I have been struggling to get over it. At the same time going on holiday - today! However the nurse who injected yesterday wasn't sure what I should be taking as my normal 15mgs a day. My question is - having gone up from 5mgs a day to 15mgs in the last month, due to the relapse, what do I now take have been giving the booster of 125mgs yesterday?
I know normally I would be a reduction of 1mg per month but do I miss a few days because of the huge whack - i was surprised to be given 125mgs of prednisilone in one go - and then go to 14mgs? Any advice as always most welcome.
Kind regards,
Ian
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Stkeyna
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There was a discussion on this treatment 10 months ago, on here, started by Admiral 06. It includes a link provided by PMRPro. If you google your question it pops up. Good Luck! This really should have been explained to you, you could ring and ask to speak to your prescribing doctor.
Hi, Much appreciated! The hospital did me a favour because of short notice. However yes...once again lack of communcation I suppose. Anyway feeling a bit better and off I go on hols!! Best, Ian
Why do they do these things and not tell the patient what to do?
You could probably safely drop to 10mg right away but the depot will now release over the next 3 weeks and get less and less as time does on - Admiral discusses that doesn't he? In fact, somewhere there is a graph of the equivalent amounts per day. It should make it easy to reduce but don't go too wild as you don't know what level you need for this relapse, if that is what it really is.
I wouldn't worry greatly - has it worked? Enjoy your holiday!!!!!
Much appreciated once again! Yes interesting point you make about relapse and if that's what it was. Nine years now of GCA - you get so punch drunk with drugs and the illness also your brain dealing with it all that you sometimes feel like you are on some out of control 'illness' roundabout. Particularly when you step up the prednisilone. Then you get into the back and forth questioning mode of is it the illness or the drugs that's making me feel ill/whoozy etc?
Anyway feeling a bit better thanks and taxi awaits so off I go - all crossed!! Here I come New York!
Not sure how you expect me to know - if Admiral06 didn't find them though, I doubt they exist!
However, the biovailability of injections, like i.v. pred, is 100%. Bioavailability of oral pred varies from person to person depending on many factors so there is no definitive figure.
There is a graph showing what the dose looks like over time on the original article but not one that compares it to oral Pred. I think that with oral Pred it depends on each individuals' absorption rate as PMRPro says above, not everybody absorbs 100% of the dose.
You are brilliant, thank you so much. I understand much more now with what you’ve been able to explain. My GP has agreed to administer another 80ml D-M Iv so, soon I hope, some relief.
You need to tell your GP that the dose can be reduced but not the interval between injections. But in my case 120 worked great whereas 100 didn't. The cululative dose is still much lower than if you'd taken say 5 pred daily over the same period.
As I've mentioned in a related post, I've had terrible problems because my rheumy originally only let me have the injections every 6 mths and then when I begged him, 3 months which was still hopeless. I was just yo-yoing with symptoms.
I am sure I was also suffering from adrenal problems between injections but my concerns were dismissed when my GPsent me to A&E and they did a simple electrolite blood test, which I'm not sure was enough to make a conclusion but I had to trust them, they're Doctors. After that I presented my rheumy with the info from the link above in the Dasgupta paper and my own experience of when the effect wore off and symptoms returned, and got him to agree to the schedule set out in the paper. Well almost, in the schedule it said initially every 3 weeks whereas we did every 4 weeks. You can taper the dose but not extend the interval between doses.
I've just been reading various posts, spurred on by info from PMRPro and Poopadoopy, which concludes that ANY dose of steroid can lead to AI and effects can last up to 3 years after discontinuing steroids. eg this one
It is beginning to be clearer to me now, Tangocharlie. The big task then is to encourage my gp to spend the time it will take to educate himself to this point. Between three Rheumatologists who have seen me over the past six months not one has been willing or able to give me the time to educate me, so I've been feeling frustrated. Thank goodness for this site.
In your last paragraph you refer to 'AI' - what is this?
Two of the rheumatologists who saw me explained that reducing the dose with D-M is too difficult, that it can only be lowered or increased by 40ml. One said I will need one every 3-4 weeks, the other offered me one, like you, only every 6 months without any explanation.
I presumed that as from the early Janyary date the 80ml iv in early January I was able to go on for 14 weeks without a flare, that I was doing far better on the 80ml; that because when I had the 120ml iv last September, the flare came after 5 weeks. I can see there is still much I don't yet understand.
I had asked the first rheumatologist who didn't approve of the D-M iv why, he siad because it can't be managed as well by the NHS.
The D-M does come in units of 40, so to give me 100 last time they just did 2 and half units and 'threw a bit away' from the 120 dose as the nurse put it - which I guess isn't a totally accurate dose. By AI I meant adrenal insufficiency. I can see it is slightly more hassle for the NHS to do injections every month but that's no worse than monitoring other conditions that need regular follow up eg B12. I had to physically print off all the info on DM injections and give it to my rheumy and ask him to read it. But I still get doctors and nurses saying things like ;you can't have more than 2 a year;, I just roll my eyes and if I can be bothered I correct them. It's disspiriting to know more about something than the experts who are treating you. They work so well, have fewer side effects than Pred and a lower cumulative dose, I really can't understand why depo-medrone is not more widely used, it's just ignorance and arrogance from doctors and it makes my blood boil!
PS I'm in Leeds, England, where we have some of the top brains in PMR. Yet none of them are at all knowledgeable about D-M. In fact my rheumy was dangerously wrong about only having the injections every 6 months.
GPs can prescribe D-M injections but they are usually reluctant to go against anything the Gods aka Consultants say. What a mess, keep fighting your corner. I once learned on a sales course, 'Be like a 2 year old asking if they can have an icecream, and if the parent says no they keep saying 'Why?' and don't give in until they get what they want. So be a 2 year old!
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