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MS
Posted: Tue Dec 21, 2004 2:58 pm
 
"computernewby" <somewhereovethe@rainbow.com> wrote in message
news:fvmdnXI_teFp61XcRVn-sQ@comcast.com...
[quote:8b20262fcd]I am only addressing pack dosing here.

Both drugs you mentioned come in a pack because the majority of the time
that is the appropriate dose.
[/quote:8b20262fcd]
Really? How is that known? I have seen many different recommendations for
this, and each patient's condition is different.

Or is that the "pack" is a clever marketing tool, seems easier to deal with
for both doctors and patients, for the former not to have to think about the
best dosing for the individual, just give him the "pack". For the patients,
med all pre-counted by day, you don't have to think about counting them from
the bottle, and remembering which day you are on, etc.

But I think it probably is a negative as far as individuality of dosing.

Prednisone comes in a "pack" as well? How does that "taper" work? The same
dosage as the Medrol pack--starting at 24 mg the first day, dropping by 4 mg
every day until 4 mg total the sixth and last day?
 
MS
Posted: Tue Dec 21, 2004 6:50 pm
 
"iJah" <iJahSpamSucks@sbcglobal.net> wrote in message
news:ve2hs01n81uhpcbaipgqk3ji0ud21vue6r@4ax.com...

[quote:2006f3048e]But, because prednisone was/is the only thing that seems to be able to
control my inflammation,
[/quote:2006f3048e]
Somewhat OT from the topic of this post.

I forgot your history from other posts. Do you have chronic inflammation in
nose and sinuses? Is that what often makes it hard to breathe?

Does it feel like there is some kind of anatomical blockage? If so, have you
considered sinus and/or nasal (turbinate, septum, etc.) surgery? You might
wish to consult an ENT about it. (More than one, if you seriously consider
it. Good to get 2nd, 3rd, 4th opinions about it, before having someone cut
inside your head! Certainly not a cure-all, but has helped some people.
 
MS
Posted: Wed Dec 22, 2004 2:11 am
 
"iJah" <iJahSpamSucks@sbcglobal.net> wrote in message
news:ve2hs01n81uhpcbaipgqk3ji0ud21vue6r@4ax.com...

[quote:8fc825aa72]I've also been on about three or four courses of prednisone starting
high, 50-60mg and tapering off very slowly over the course of 21 days
or so. While these where quite effective, the initial high dosages
really had a severe psychological impact on me. Very high
anxiety/restlesness/agitation and insomnia.
[/quote:8fc825aa72]
Seems to be a heavy course, probably more than usually prescribed.

At the opposite end of the spectrum is the Medrol dose pack, that I am
taking, probably about the lightest course of oral steroids that is
prescribed.

If anyone else reading has ever been prescribed a course of oral steroids
for severe chronic rhinosinusitis, I would be interested in hearing what the
course was like-how it started, how it tapered off, etc. And how did it help
you? Negative effects you experienced?

Also, from doctors who have prescribed them, and pharmacists who have filled
prescriptions, what have you found to work well for your chronic
sinusitis-rhinitis patients.
 
MS
Posted: Thu Dec 23, 2004 1:21 am
 
I saw another article on the web about using a short course of steroids in
sinusitis treatment, in conjunction with antibiotics. The URL:

http://www.medscape.com/viewarticle/494246


(You might have to register with Medscape to view the article. Or try
"Bugmenot".)

I just read a little so far, I will read the whole article.

They used still a different type in the study, betamethasone. The study took
place in So. Africa, so I don't know if that's one they use there, and not
here in the US. Is it about the same as the others mentioned?

The patients received a very small dose of it, only 1 mg per day for five
days. (Is this med much stronger than the others mentioned?).

In this case they were testing acute sinusitis. Two groups, both infected.
Both taking the same antibiotic at the same dosage. One group also took the
steroid course mentioned above, the other had placebo instead. It seemed
there was a significant improvement in the group that had the steroid.
 
MS
Posted: Thu Dec 23, 2004 1:24 am
 
"Matt Beckwith M.D." <beckwith@wchsys.org> wrote in message
news:1103770824.620242.110170@c13g2000cwb.googlegroups.com...
[quote:d6a1042643]Steroids shouldn't be prescribed twice a day like that. All the pills
for a particular day should be taken at the same time.
[/quote:d6a1042643]
The Medrol dose pack comes with directions to spread them out over the day/

[quote:d6a1042643]Yeah, this doesn't make a lot of sense. A more typical regimen would
be 60 mg daily for 3 days, 40 for 3 days, 20 for 3 days, then stop.
[/quote:d6a1042643]
It isn't too abrupt to go from 20 mg to nothing? Wouldn't it be better after
the 20 to go to 15, 10, 5, then perhaps 5 every other day then perhaps half
a 5 tablet every other day, or something like that, very gradual withdrawal?
 
Matt Beckwith M.D.
Posted: Thu Dec 23, 2004 8:08 am
 
[quote:0a31fe6b7b]It isn't too abrupt to go from 20 mg to nothing?
[/quote:0a31fe6b7b]
No.
 
Matt Beckwith
Posted: Sat Dec 25, 2004 10:00 pm
 
MS wrote:

[quote:d8b08e7b0e]The Medrol dose pack comes with directions to spread them out over
the day/[/quote:d8b08e7b0e]

Yes, I recall that. It's another good reason not to use it. It's not
bad to spread them out, but it just won't work as well for the things
we usually prescribe steroids for (such as poison ivy and asthma) when
the dose is spread out.
 
MS
Posted: Sat Jan 01, 2005 4:41 pm
 
"Matt Beckwith" <beckwith@wchsys.org> wrote in message
news:1104030047.237953.69160@c13g2000cwb.googlegroups.com...
[quote:f1eafb5947]MS wrote:

The Medrol dose pack comes with directions to spread them out over
the day/

Yes, I recall that. It's another good reason not to use it. It's not
bad to spread them out, but it just won't work as well for the things
we usually prescribe steroids for (such as poison ivy and asthma) when
the dose is spread out.
[/quote:f1eafb5947]
Why does it not work as well when the dose is spread out? Or is it to help
the body not to become dependent on it? I mean--if you put a constant level
of extra steroid in the bloodstream, the body's adrenal glands might start
making less of its own--but if you only put it in once per day, where the
level in the bloodstream of the added steroid doesn't remain constant, the
body's own glands are less likely to decrease production? (Just a guess, on
the reason for once per day dosing.) Of course, in the few days fast taper
dosage of a Medrol dose pack, I don't know if there is much risk of that
(the body decreasing its own cortisone production) in any case.

What do you think the rationale is, from whoever created the "Medrol Dose
Pack" (which has become a common way for doctors to prescribe steroids, I
guess because it's easy, they might think patient dosing compliance would be
easier with such a "pack", and less risky than longer courses), to spread
out the dosing like that, rather than the once per day dosing, which is
perhaps more commonly prescribed by doctors who don't use "the pack".
 
Matt Beckwith
Posted: Sun Jan 02, 2005 10:34 am
 
MS wrote:

[quote:cb878667fc]Why does it not work as well when the dose is spread out?
[/quote:cb878667fc]
Because the level that's achieved in the blood stream is lower.

[quote:cb878667fc]What do you think the rationale is, from whoever created the "Medrol
Dose
Pack" (which has become a common way for doctors to prescribe
steroids, I
guess because it's easy, they might think patient dosing compliance
would be
easier with such a "pack", and less risky than longer courses), to
spread
out the dosing like that, rather than the once per day dosing, which
is
perhaps more commonly prescribed by doctors who don't use "the pack".
I don't know.[/quote:cb878667fc]
 
James Stein
Posted: Sun Jan 02, 2005 3:50 pm
 
"Matt Beckwith" <beckwith@wchsys.org> wrote in message
news:1104680084.919756.227410@c13g2000cwb.googlegroups.com...
[quote:eb22071aba]
MS wrote:

Why does it not work as well when the dose is spread out?

Because the level that's achieved in the blood stream is lower.

What do you think the rationale is, from whoever created the "Medrol
Dose
Pack" (which has become a common way for doctors to prescribe
steroids, I
guess because it's easy, they might think patient dosing compliance
would be
easier with such a "pack", and less risky than longer courses), to
spread
out the dosing like that, rather than the once per day dosing, which
is
perhaps more commonly prescribed by doctors who don't use "the pack".
I don't know.
[/quote:eb22071aba]
Because prednisone is easier to wean off of when the doses are spread
throughout the day; and weaning off of prednisone is a great pain in the
ass.
 
Matt Beckwith
Posted: Sun Jan 02, 2005 6:36 pm
 
James Stein wrote:

[quote:9d6cdc0481]Because prednisone is easier to wean off of when the doses are spread

throughout the day; and weaning off of prednisone is a great pain in
the
ass.
[/quote:9d6cdc0481]
That can't be the reason, since the low doses involved in the Medrol
Dose Pak are nothing one would ever have to wean off of.

It's not uncommon for a patient with an asthma exacerbation to get 20
mg daily for 5 days then stop suddenly, for example (though I
personally never prescribe it that way).
 
James Stein
Posted: Sun Jan 02, 2005 9:07 pm
 
"Matt Beckwith" <beckwith@wchsys.org> wrote in message
news:1104708985.819112.238140@c13g2000cwb.googlegroups.com...
[quote:35ebe757b2]
James Stein wrote:

Because prednisone is easier to wean off of when the doses are spread

throughout the day; and weaning off of prednisone is a great pain in
the
ass.

That can't be the reason, since the low doses involved in the Medrol
Dose Pak are nothing one would ever have to wean off of.
[/quote:35ebe757b2]

I have no idea what the doses in the Medrol Dose Pak are. I was simply
commenting on my own experiences weaning off of prednisone, and have found
that smaller doses throughout the day make it easier for me to wean than a
single large dose every 24 hours. (I've been on it for ulcerative colitis.)
 
habshi
Posted: Tue Jan 11, 2005 7:18 pm
 
What is the harm in giving someone with say tennis elbow , a
week's course of prednisolone as a trial ?
 
Don Brady
Posted: Wed Jan 12, 2005 12:50 am
 
On Wed, 12 Jan 2005 00:18:03 GMT, habshi@anony.com (habshi) wrote:

[quote:9a0dfb15f2] What is the harm in giving someone with say tennis elbow , a
week's course of prednisolone as a trial ?
[/quote:9a0dfb15f2]
I'm sure this is said tongue-in-cheek, but just in case anyone misses the
irony, let me note it.

Obviously this is a drug with risks and side-effects, so you would not use it
for something minor. Also, "trial" means that it succeds, you would keep on
using it, which would again not apply to anything

I guess the opinion being expressed is that sinusitis is too trite for oral
steroids. I would say that there are cases where it is appropriate for
sinusitis on a temporary basis..
 
bobbie sellers
Posted: Wed Jan 12, 2005 9:41 pm
 
habshi@anony.com (habshi) wrote.

[quote:3d985ffdd4]Why are we so worried about a weeks' trial of steroids ?
Asthmatics use it . Those with polymyalgia can use it for months.
Lot of backache is cured with it . I have a bit of tendinitis in my
right two finger tendons from typing and will take prednisolone for
two or three days and it cures them for six months or so .
[/quote:3d985ffdd4]
I believe if you investigate you will find the corticosteroidal
agents may suppress your immune system. After all the inflammatory
process causing your pain is an immune system function. With that
immune suppresion on a repeated basis the chances of contracting
other illnesses may go up. I used such medications for asthma
in the 1980s and developed several problems including finally
Chronic Fatigue with Immune Dysfunction. Such immuno-suppresant
medications should be used sparingly IMO.

Other treatments and exercises for your condition would seem
to be indicated but since I am not a physician nor a physical
therapist I cannot be certain of that. Consultation with a
physician, preferably one who is expert in treatment of such
disorders would seem advisable.

later
bliss -- C O C O A Powered... (at california dot com)

--
bobbie sellers - a retired nurse in San Francisco

It is by the beans of cocoa that the thoughts acquire speed,
the thighs acquire girth, the girth become a warning.
It is by theobromine alone I set my mind in motion."
--from Someone else's Dune spoof ripped to my taste.
 
 
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