STEROID TAPER - PREDNISOLONE AND BUDESONIDE

[Songbird69]

Hi All!

Hoping for some advice here.

I have been taking 1mg Prednisolone for a few months now, with no issues.

As I have abdominal issues (Crohn’s flare, atrophic gastritis and hydrogen SIBO) and my Gastro put me on a short course of Budesonide with a taper from 9mg, 6mg to 3mg over a period of about 9 weeks. Each time I reduced the dose, I felt dreadful fatigue necessitating sleeps in the day. I didn’t connect this with the steroid taper until now, having been three days without any Budesonide. Apart from the fatigue, I am feeling nauseous today with aching stomach, and no appetite. I assume this is because my adrenal glands are below par.

I have been prescribed Budesonide previously without any issues, but this was way before PMR and Prednisolone.

I am wondering whether to just grin and bear all this for a few days when hopefully there will be an improvement, or whether it would be worth increasing the Prednisolone to compensate and how long to do this for, and at what level.

Sorry this issue is off-piste but any help would be very much appreciated.

Thank you.

[DorsetLady PMRGCAuk volunteer]

I assume this is because my adrenal glands are below par

Highly likely…. and a small increase of Pred might sort you out. Would also say the course of Budesonide probably confused the adrenals somewhat.

Maybe try 3mg for a few days and see if that helps, if not you might need to go up to 5mg for a week.. and then back down to 2mg perhaps.

Not off piste at all… but do make sure you don’t feel any worse, and if you do then ring 111 or 999 and explain situation and say you are concerned you are having an adrenals crisis.

Hopefully that won’t be necessary, but do keep us updated please.

[Songbird69 in reply to DorsetLady]

Hi DL,

Thank you very much for your help. . May I ask how long the window of time I have to increase the Pred and reduce to the level I am currently on without having to have a slow taper?

If I try 3mg for a week, then 2 for another week, is it feasible that I could then reduce straight back to 1mg, assuming there are no more issues?

[DorsetLady PMRGCAuk volunteer in reply to Songbird69]

Yes -in the flare protocol we say you can stay at increased dose for up to 14 days without impacting on subsequent reduction.

But think I’d go back to 1.5mg rather than 1mg -gives a little more leeway… but of course the choice is yours. See how you feel.

[Songbird69 in reply to DorsetLady]

Thank you. You’ve been really helpful. 😊

[PMRpro Ambassador]

If it is an adrenal problem I think it might be advisable not to be too hasty in going back down again.

[Songbird69 in reply to PMRpro]

I take your point. Thank you. I’ll be careful.