I have been on pred 6 yrs now. Finally managed to taper to 6 mg just over a week ago. (Taken me nearly a year to drop half a mg.) Previously I had problems with episodes of night vomiting which I thought were adrenal but wasn’t sure. This was nearly 2 years ago - I started Omeprazole and it didn’t happen again. Until last night! I had a dreadful episode - woke at 2am, nausea , wretching severely every 10-15mins for an hour then vomited about 4 times. Cold sweat and dizzy if I tried to stand. Had to lie in bed with a jug! Hubby was an angel.
My question is - is it worth trying to get GP to swap me to enteric coated Pred? If they agree what time should I take it as I know its slower to absorb. Had been fine until last night. Feel rather delicate today. Thank you for any advice.
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Temeraire
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Do you really think it is the pred? If it were, surely it would be every night?
Have you ever looked at what you had eaten/drunk the evening before such an episode?
I used to have similar episodes, could set the clock by it, starting about 2,45 (we ate relatively late) and always the same pattern, not just vomiting, D&V until my gut was empty and then it stopped. I was referred to an immunologist as it was felt they were typical of an allergic reaction to SOMETHING, possibly in food. She agreed on the allergic reaction but said it wasn't worth testing as there were 10s of thousands of potential culprits. I suspected heavier red wines, possibly in combination with other high histamine foods. It never happened with white wines or light reds such as are produced here in South Tirol. The immunologist suggested I try taking antihistamines if I was going to drink such wines! She was serious she said - because I said they tell us not to drink and take allergy meds!! She was right - it worked!
I took loratidine for several years and then decided to see what happened without but I kept a pack by the bed, On a very few occasions I have had a recurrence and woken between 2 and 3 with the familiar churning stomach, I have taken a double dose of loratidine - and it has subsided within about half an hour, I have fallen asleep for a couple of hours and woken feeling fine.
If you were toswitch to e/c, they take about 4 hours to get into the system so taking them shortly before bed should work well, similarly to the Lodotra I use which you take at 10pm to be released all at once in the stomach at 2am and be in the system by 4am. e/c will be absorbed from the lower gut after 4 hours or so and be absorbed more slowly, rising slowly to a high level, plateauing and falling slowly over a period of a few hours, rather than the sudden peak of ordinary pred which then falls in the same way.
Thank you for that. Very interesting. When it stopped after starting Omeprazole I assumed it was gastric after all. I haven’t changed diet since. I thought EC would help my stomach. It is tricky knowing what to do. Will see and keep diary. Thanks again.
I have the same symptom. Mine has been diagnosed as Diverticulitis episodes within Diverticula Disease. I am on 5 mgs of Pred. I have been put on Buscopan and Lansoprazole. I believe that my Adrenal function is a factor. I have been on Entric coated Pred for years. My diagnosis is PMR/LVV /GCA since 2016, initially just PMR.I watch what I eat and have small portions. I am due to see my Endocrinologist again soon. The biggest positive impact has been diet. For me ,triggers are, spices, baked things, leaves, cooked tomatoes, wine, the list grows - carbs and acidic food. Nausea is a common occurrence, I have more control over the vomiting. I have had Adrenal insufficiency when I had tapered low for PMR alone, 4 years ago. Your last vomiting episode sounds very like Adrenals struggling. This must be checked out.
Thank you - very interesting and relevant. It must restrict your diet greatly. I will phone GP on monday. It did scare me. I think enteric coated may be worthwhile if they agree at least. Lots to consider. Thanks again.
could be a bug/virus going round? I think it’s easy, when you have P.mR, to relate everything to it & the pred…you’ve only got to read a few posts here to see that! If you didn’t have pmr, what would you have thought? Oh I must have eaten something bad…or caught something when out with a crowd, etc etc?! Just a thought!
Hello Temeraire.
Sorry to read about your problem.
I agree with PMRpro Ambassador’s opening remarks and would like to add a couple of supporting points.
Last March, Drugs.com published the following statement.
“It takes approximately 16.5 to 22 hours for Prednisone to be out of your system. 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 x half-life for a drug to be completely eliminated from your system. This is (5.5 x 3) 16.5 hours to (5.5 x 4) 22 hours for Prednisone.”
Thus, if you take your dose of prednisolone at say 8.00am, then 18 hours later at 2.00am during the night on the following day, your blood stream should contain almost no residual prednisolone because it should have been washed out of your system.
If your problem was caused by prednisolone, then I would have thought that it would have happened soon after ingestion by gastric irritation or later in the morning at the peak blood level time point which occurs somewhere between 0.9 to 3.5 hours after ingestion.
Just to clarify, the prodrug prednisone is metabolised into prednisolone, after it has been absorbed from the intestine and as it passes through the liver and into the general circulation. The two compounds are thus essentially the same drug. They certainly have the same pharmacokinetic profiles. That is their absorption, distribution, metabolism and elimination profiles are the same.
Prednisone is the precursor to prednisolone. Prednisone is processed in the liver to make prednisolone which is the active form. The only difference is how long it takes to get into the system, prednisone takes about an hour longer and if you have liver disease then prednisolone is felt to be less of a strain on the liver.
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