Solumedrol and prednisone

September 12, 2009 at 4:26 pm


[COLOR=black]Let me give you my answers to your questions, and then give you some additional information. [/COLOR]

[COLOR=black]IVIg did not really work and you are not dealing well with the Solumedrol/prednisone. Another possibility is to try plasmapheresis. Search for my name and you well find a fair bit of information and experience in dealing with plasmapheresis. It also sounds like you have done just one thing or another, that is, IVIg, then glucocorticoids, but not the two together. If so, you and your neurologist might consider a combination therapy, in which you try two or three things together. It will take a long time to get the mix right, but it is worth a try. I have to use a combination therapy, and even after two years, we are still tinkering with it. My particular therapy is three 1.2-volume-exchange plasmapheresis treatments spaced every 6 weeks, ~2.3 mg/kg/day of azathioprine, and prednisone, starting at seriously high doses and tapering slowly down to nothing (I just recently reached that goal and we are in the watch and evaluate mode, to see if I might need to start some prednisone again). [/COLOR]

[COLOR=black]Now, for the additional information. Sorry if part of it is a bit technical, but these details are important for understanding what it going on. Prednisone and Solumedrol are both in the class of hormones known correctly as glucocorticoids. Actually, prednisone is what is called a pro-drug, which is something that the body converts into the active agent. In this case, prednisone is converted by the liver to prednisolone, the active agent. Solumedrol is the brand name for methylprednisolone. It is similar chemically to prednisolone (as you might guess from the “methyl”). Methylprednisolone is a bit more potent than prednisolone.[/COLOR]

[COLOR=black]You don’t say how much Solumedrol you are getting. My guess is that you are getting a big dose. Unfortunately, the same side effects you are getting with Solumedrol, you would also get with the equivalent dose of prednisone. I suspect your neurologist is trying a variant of the “pulse steroid” protocol. I think the most common version starts with 500 mg of Solumedrol once a week for a month or until symptoms stabilize, then tapering down by 100 mg each month until the symptoms start to worsen, then bumping the amount back up. Are you still getting the same amount now that you were 4 months ago? Are you also taking oral prednisone along with the Solumedrol? Your neurologist should be able to e-mail what doctors call a tertiary provider (typically an expert at a teaching hospital, for example, Dr. Gareth Parry at the University of Minnesota) for details and consultation.[/COLOR]

[COLOR=black]Your doctor is wise not to leave you on prednisone long term. As you have discovered, there are nasty side effects. The ones you mention are short-term effects. Long term effects include cataracts; osteoporosis; diabetes; avascular necrosis, in which the head of the femur or humerus starts to decay; and other subtle changes. You really don’t want those. [/COLOR]

[COLOR=black]It is possible to deal with many of the side effects, although just how well is completely individual. For example, to reduce the rate of bone loss, you can take Fosamax or a related drug along with calcium and Vitamin D3. For stomach upset, you can take Pepcid or a related drug. While you can’t prevent cataracts, the surgical treatment and vision changes are tolerated well by most people. If the insomnia is terrible, there are sleeping pills. We know how to treat diabetes, so while it may suck to become diabetic, it is something that you can deal with. I am not saying you or anybody should stay on prednisone. You shouldn’t. However, if absolutely nothing else works even in the slightest, it may be the devil’s deal you have to accept.[/COLOR]

[COLOR=black]I hope your vacation goes well.[/COLOR]