Reduction of Predisolone after a flare up.

[Suffolklady]

Hello. Just wondering when I have a flare and up the dose by double as instructed by my Rheumatologist ( with illness not pain to support the system ) then reduce back again to the original dose how long does it take for body to adjust physically and blood test wise? Had bloods taken two weeks ago and had a rough week so upped my dose from 4mg to 8mg for about a week and now I’ve got to have a complete retest of bloods (don’t know why having it Friday will fine out then) I only reduced back to 4mg yesterday and wondered if the 8mg would still be in my system?

[DorsetLady PMRGCAuk volunteer]

I think a dose of Pred only stays in your body for about 24hours. But a blood test is to test the level of inflammation in your body - not the Pred.

So if 8mg has cleared the inflammation that had built up causing your flare then your ESR reading SHOULD now be lower. However, sometimes the ESR readings lag behind - which is why we always say -symptoms are the key.

[Suffolklady in reply to DorsetLady]

Thank you for that info I see where you are coming from. I kind of want to be at the same stage when I had the last test taken that’s why I ask. There’s a reason I need to have another test but I’m not sure why. My thyroid was seemingly okay but was asked to up it by 25mg and I’m not sure instigated the retest. I asked the phlebotomists to do a T3 test with the thyroid which they never seem to do. I will know Friday. Thank you for your reply.

[DorsetLady PMRGCAuk volunteer in reply to Suffolklady]

Please let us know how the test goes - and how you feel.

It’s doubly difficult when you have more than one illness to cope with.

[Suffolklady in reply to DorsetLady]

I will thank you very much

[PMRpro Ambassador]

It isn't the pred itself that is in the system - it is the effect. The higher dose should have reduced the inflammation - and so the blood markers should have fallen. How quickly they fall varies though - also depending on whether there as anything else besides PMR raising them.

[Suffolklady in reply to PMRpro]

Hi PMRPro I hope you are feeling better.

I seem to remember in a previous post about Predisolone affecting the blood result for the thyroid and you thought I would feel better on a higher dose? Did I dream that?

[PMRpro Ambassador in reply to Suffolklady]

Pred suppresses the TSH level - so when tested it may look OK when in fact it would be higher without you being on pred. Many GPs will then assume that because the TSH isn't raised you should be on a lower thyroid dose and tell you to take less. Which in fact is not what would be best.

[Suffolklady in reply to PMRpro]

My thyroid was borderline under active so he gave me the minimum dose of 25mg but I never noticed any change in the was I felt. For unknown reason it’s been put up to 50mg but I have not spoken to anyone yet but the receptionist said the reading was normal so I will have to wait and see. I did have a large shot of steroid on Friday in my head I expect that might nee to be mentioned too. So much to remember and when you live in a brain fog it’s a juggling act. Thank you for explaining that for me.

[PMRpro Ambassador in reply to Suffolklady]

I know there are quite a few people with a/i disorders who do better with higher doses of thyroxine. Some doctors treat a/i patients as hypothyroid even if they don't appear to be and get good results. i.e. treat the patient and not the labs.

[Suffolklady in reply to PMRpro]

Absolutely. I will await the extra thyroxine and see how I get on? I wondered if my T4 was being convert to T3 so I asked if the phlebotomists could add that to the test request but it looks like it’s normal. Had many thyroid tests but never has T3 checked.

[Soraya_PMR]

Are these blood tests for inflammatory markers? Or are they for Mr Fowler your Endo? Possibly cortisone levels?

[Suffolklady in reply to Soraya_PMR]

When I saw Mr Fowler my Endo, he requested extensive blood, thyroid included as I was feeling very tired even pre PRM hair loss, poor nails etc so he requested that also ESR, Full blood count I forget the rest. I had the blood test having been on 4mg then I become generally unwell and upped the dose as advised so it wasn’t due to pain. Then yesterday I reverted back to the 4mg feeling better but I got a call from the doctor to have the entire blood test taken again and to increase my thyroxine to 50mg. There’s obviously a problem but until I see the phlebotomists I won’t know why I need them done again. Yes cortisol levels were taken last time so I don’t know if they will do another check.

[Soraya_PMR in reply to Suffolklady]

Well I’m glad you’re feeling better. P’raps just let the phlebotomists know about dose change, she can always note it in case it might affect results.

Pred does affect the thyroid and T3 T4 conversion. (I’m beginning to think it upsets the whole endocrine apple cart!)

[Suffolklady in reply to Soraya_PMR]

Well I never had T3 checked ever although there was a slight hypothyroidism I just had a very low dose of thyroxine even before I had PMR never noticed any difference when I took it still was always incredibly tired. The GP never pass any more comment and no more investigation. Never realised it might affect the thyroid readings. It’s so complicated.

[Hidden in reply to Suffolklady]

I am glad you brought this up. I am having a blood test on 12/6. I am going to do "fasting" thyroxine blood test to see what happens. I read somewhere that it should be done that way anyway.

[Suffolklady in reply to Hidden]

Funny you said that Poopadoop I read somewhere too about that so on my last blood test I had I had no medication at all. It was a 9am appointment so I waited to get home before I had the cocktail It was required no Predisolone as I was having an Adrenal test (that’s why it was a nice early app) but with what I read I thought I’d not have a levathyrizine either. I now have to up to 50mg?

[Hidden in reply to Suffolklady]

But maybe that's a true reflection. Mine always flickers around but they just put no action reqd. It will be interesting to see what happens with this one.

[Suffolklady in reply to Hidden]

Yes they do flicker around but they say normal no Action. It was only when the Doctor said it’s up to you, you can have 25mg Levo’ that I did.

[AndrewT]

Dear Suffolklady,

I don't have your 'Condition', I have ANCA Vasculitis, however- to answer your question, in general terms. Prednisolone releases Slowly, into your System, over a period of 'Hours, or Days'. In other words 'Yes', there IS, a Strong likelihood, that the drug level WILL remain 'high'. When I reduce Prednisolone, after a 'Flare'- or other such Problem- I do so over a week, or more. As regards Blood Tests I'm, rather surprised, that 'They' want Tests done so soon after your 'Reduction'. I agree with Soraya_PMR, I WOULD tell the Phlebotomist, about this, when you have the Bloods 'Done'- maybe ask Him/ Her to make a 'Note', on the Form.

I hope that his has been, some 'Help', Suffolklady. Take care and 'Keep Well'.

AndrewT

[Soraya_PMR in reply to AndrewT]

“Prednisolone releases Slowly, into your System, over a period of 'Hours, or Days'.”

Hours yes. I’d dispute ‘days’.

Clearance from the body can be slower in those with liver disease and post menopausal women.

[DorsetLady PMRGCAuk volunteer in reply to AndrewT]

Just found this _ it is an US site, but still relevant

"You could expect a dose or prednisone to be out of your system in 16.5 to 22 hours.

The elimination half life of prednisone is around 3 to 4 hours. This is the time it takes for your body to reduce the plasma levels by half. It usually takes around 5.5 half lives for a drug to be completely eliminated from your system.

Other factors that can cause variation to the elimination time include:

1. How much and how often you have taken the drug.

2. Your metabolic rate – a slower metabolism will increase the time a drug remains in your system.

3. Your age and health – older age and poor health will generally increase the time the drug stays in your system.

4. Body mass – generally the bigger you are the longer a drug will remain in your system.

[Suffolklady in reply to DorsetLady]

That’s really interesting to read thanks for sharing. These are all the questions that are good to know but never discussed at the Rheumatologist I learn so much more here than with the professionals.

[Soraya_PMR in reply to DorsetLady]

Really useful DL, there are often questions about this, remember where it is for next time!!!

[DorsetLady PMRGCAuk volunteer in reply to Soraya_PMR]

If only!

[Soraya_PMR in reply to DorsetLady]

😂

[PMRpro Ambassador in reply to AndrewT]

Sorry Andrew, that isn't true.

Plain, non-coated pred is absorbed within 1-2 hours depending on what else is in the stomach, reaching its peak in the blood in under 2 hours. Enteric coated pred may take anything from 4 to (exceptionally) 8+ hours as it passes all the way through the stomach and is absorbed lower down the gut so again stomach contents also play a role. The half life of prednisolone is 2-3 hours, prednisone 3-4 hours (longer because it must be processed in the liver to form the active prednisolone first). The entire dose taken would be excreted from the body in about 5 half lives - so under any circumstances within a day or so. The only thing that would lengthen those times is abnormally slow gut motility.

What does last into days is the anti-inflammatory effect which lasts between 12 and 36 hours for prednisone and prednisolone. Other corticosteroids such as dexamethasone have longer durations of all the timings but it is rarely used so isn't applicable here. The fact most people notice the missing of a dose within hours is a conformation of those facts.

[AndrewT in reply to PMRpro]

Thank you PMPpro, I have learned 'Something' today. I still think it, a good idea, that Suffolklady tells her GP, about the increased 'Dose' though. Thank you, once again, for the information PMPpro.

AndrewT

[Suffolklady]

Thank you Andrew yes I will tell them I had a few days of increased Predisolone. Yes I don’t know anything only that I was required tomhave a repeat blood test. I will ask more questions on Friday the phlebotomists at out surgery is a real nice person and will soon tell me if there anything amiss. Take care yourself.

[composition]

I keep reading where some of you are on 5, 8, and so forth mg. of Prednisone.... why am i on 20 after a flareup?? I see the rheumatologist this a.m. and also endocrinologist as my cortisol level was way low before I even started this journey, then glucose went up. I've only fought this since the fall, but it seems every thing that helps also brings another issue to deal with. Determined not to let it get me "down" as that's not my style, but boy, I wish there was an answer. I do deal with other issues like MGUS and bence jones protein, but all of those are just watch--anemia--had 2 IV injections of iron before the holidays and now the blood work is heading south. Guess I am a whining old lady at 77, maybe just to this group? is that allowed? I won't whine to husband and people I'm with daily.

[Jackoh in reply to composition]

Haven’t got any answers composition but no you are not just a whining old lady!! - retain,y not whining and certainly not old at 77!, It’s good to share our frustrations and problems on here as there always seems someone has had it, knows about it, or is in the middle of it! We need that opportunity to “let rip” - keeps us sane!!

[PMRpro Ambassador in reply to composition]

Same reason I am on 15mg after a flare up, and that after 15+ years! PMR makes its own rules and it is difficult to argue with them.

And part of the reason the forum is here is to help protect others who haven't got the insider knowledge from our whinges ...

[Suffolklady in reply to composition]

I was told by the ‘professionals’ to double the dose and as I’m on 4mg I take 8mg. Never been on as much as 20mg only 15mg Max at the start of my ever continuing journey.

[composition]

bummer, just returned from the rheumatologist and she said it is a difficult case because of other issues and I cannot remain long term on 20 mg, cannot take the metho...? so I am taking Leflunomide with the 20 mg. prednisone for 1 month, then start backing down the Prednisone but keeping on the Leflunomide. I hope this works. It is her 2nd choice for something other than steroid and I'm not sure there is a 3rd choice, so I will take a deep breath and keep my fingers cross with some prayers thrown in .