Oral prednisolone vs IV.

A forum to post questions, answers and discussion about general medications not specifically for multiple sclerosis, such as prednisone, painkillers, etc.

Oral prednisolone vs IV.

Postby whiteflag » Fri Aug 05, 2011 4:06 pm

Hi all, I'm new here.

I keep hearing of oral prednisolone vs IV, such as IVSM.

I was dx'd with ms in 2004 and have had minor symptoms since then until now - my first major flare-up - and I'm going to need some steroids.

I'm wondering how people take oral prednisolone, and is that similar to oral methylprednisolone? I know of 20mg prednisone/prednisolone tablets, but I keep reading that some people opt for 1,250mg oral prednisolone per day instead of 1g IV.

Thats an extreme amount of tablets per day. Is this correct?

Also I've read that ppl take the oral pred over 3 weeks, then again I've also read that its taken as the IV would be taken i.e - over 3-5 days. Which is correct?

Pls help, thank you.
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Postby CureOrBust » Fri Aug 05, 2011 6:56 pm

Hi, I have had MS for 15 years (5-10 of those misdiagnosed with a peripheral neuropathy). My previous diagnosis was for a condition (CIDP) which prednisone was the standard course for a relapse. In the 15 years I have never had IV steroids.

When I have a relapse, I find that 3-4 days of 75mg (3 x 25mg tablets as a single dose in the morning) is enough to resolve the relapse. My GP said he is happy for me to not taper if I am on this dose for less than 5 days.

Using Oral steroids has really been a godsend for me in that I can control when and where I take them, and I can be travelling or virtually anywhere; ie I do not have to go to hospital or be near a nurse or home.

I have always wondered if IV steroids would give even better results, but I'll never know...

The only side effects I have had is that the steroids make it harder to sleep (and hence I take in the morning) and because I have taken them for so long and often (from previous mis diagnosis), I have lower bone density, for which I have been on Fosamax, which helped greatly.

If you think this may be a lot of tablets, in Aus we get 25mg ones, but when I went to the UK, the biggest I could get were 5mg. So to get 75mg I had to swallow 15 tiny tablets!

I have heard some enormous doses, even in oral form, but the 75mg works for me, and I think its the range of "standard" dosing by weight (ie 1mg per kg) I read somewhere.
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Postby fifig » Sat Aug 20, 2011 9:13 pm

I've done oral and IV.

The oral, even in a small dose (50mg), makes my stomach ill.

I tried IV just after Christmas and didn't sleep for 4 days, ate everything in sight but it dealt with the relapse very effectively. However, I'm not sure if I'll voluntarily do it any time soon; some people do it every 6 weeks as a preventative ...
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Postby kibibikel » Sun Aug 21, 2011 6:04 pm

Hey there,
Sorry to hear about the bad flare up. In the past 4 months I have had a 3 day course of IVSM 3 times for flare ups. The last time I had a tapering dose of the oral prednisone as well. There is definetely pros and cons of both from what I have noticed.
The IVSM (1g) worked effectively and quickly, but it does suck to have to go to the hospital to have the meds given. The taste that it leaves in your mouth srsly sucks too, so bring gum! Lol.
The prednisone like fifgi said does do some pretty wicked things to your stomach so you can get your doctor to prescribe omeprazole which will help coat your stomach so it doesn't effect you as much. You will have to take a lot of pills. Most doctors from my understanding won't do the oral for a flare up because the typical course is for 1gm. If you are in Canada you can get them at 50mg strength so you'd still be taking 20/day (also very nasty tasting lol). The only other thing that I found with the prednisone is I had some pretty intense moments of "roid" rage. Haha which was not fun for anyone lol
All in all, I think I prefer the IV, its quick and effective and seemed to do the job really well.
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Postby Froggie » Mon Aug 22, 2011 12:19 pm

Hi there-

I've done both the IV Solu-Medrol and oral prednisone as well. The Solu-Medrol was administered when I was hospitalized in 2000 with optic neuritis followed by another three/five days (can't recall exactly how long) of IV steroids at home, then oral prednisone. I was hell on wheels and felt like an East German athlete! I think back then the doctor was being a little zealous with the amount I was taking, especially since nothing showed up in the bazillion tests they gave me. When I was officially diagnosed with MS in 2009, I did the IV again in the hospital and given a tapering dose of prednisone. I've also taken just prednisone for a couple of flare ups as a tapering dose. I was given Pepcid for stomach upset, which seemed to help. When I was on the IV steroids, I got this lovely metallic taste and I always had ice cream or some sort of juice to lessen it.

Hope you feel better!
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Re: Oral prednisolone vs IV.

Postby MrsK » Tue Sep 20, 2011 10:14 pm

My husband is having his first pulsing steriods (prednisone) next week by IV. He is still undiagnosed but whatever he has is similar to MS. The problem is that he's an insulin dependent diabetic and I believe the steriods are going to play havoc with his sugar levels. Are there any diabetic MS patients who have had this?
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Prednisolone and diabetes

Postby MarkW » Thu Sep 22, 2011 3:18 am

Hello Mrs K,
I hope a specialist diabetic pharmacist in the clinic checked this out for you. If not please ask before your husband takes the steroids.

MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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Re: Oral prednisolone vs IV.

Postby MrsK » Sat Oct 01, 2011 5:10 pm

Hi, his treatment is being coordinated with his neurologist and his endocrinologist. He had the IV pred. Wed, Thurs and Friday last week and it is now Sunday. So far it's looking good - he can lift his legs higher holding on to the walking frame and has managed to lift his legs without using his hands when getting into and out of the car. His blood sugar is through the roof though and he's been telephoning his endocrinologist before every meal to give her readings and receive instructions on how much insulin to take.

Wednesday and Thursday nights were very worrying though as he had a bout of angina as well as some tummy upset. He does have a history of heart disease and has had 2 quadruple bypasses plus a stent in the past but it's ages since he had any sign of heart problems, so the angina took us both by surprise.

The neurologist said it might take 2-4 weeks for the prednisolone to take full effect and we are to let him know what happens.
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Re: Oral prednisolone vs IV.

Postby MSmomMarch2011 » Sun Oct 23, 2011 6:40 am

Hi -
I found this thread when researching around on oral prednisone vs IV... And I'm so glad it was here!
I have been prescribed 1250 mg in the am and 1000mg in the early afternoon... That's 13 and 12 tabs (50mg tabs). It wasn't till I heard much concern from the pharmacist that I started freaking out about this decision...

Day 1 was yesterday... And so far so good... Maybe some minor side effects... Definitely had the bad taste in my mouth... Got a headache, and my hips ached. Not sure how much of that was from the steroid, our from my other issue, or Betaseron.

Which brings up another question. Do I still take my dmd while on prednisone?
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Re: Oral prednisolone vs IV.

Postby CanuckChick » Wed Oct 26, 2011 8:27 pm

I was on IV Solumedrol for my first episode of optic neuritis many years ago. 15 years and no symptoms later, I had a massive episode which also began with optic neuritis. This time I was prescribed 1g of pred. Yes, you read it right. A gram per day. I took 100 pills per day for 10 days and then 3 weeks of tapering. I went to several pharmacies and only one was able to fill the prescription in two batches. Crazy. Don't know how much it helped. I got the fabulous puffy face and screaming joint pain. Not looking forward to next time.
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Re: Oral prednisolone vs IV.

Postby jackD » Wed Nov 09, 2011 11:24 pm

Good info.

jackD

N Engl J Med. 1992 Feb 27;326(9):581-8.

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis.

The Optic Neuritis Study Group.
Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR, et al.
SourceDepartment of Ophthalmology, University of South Florida College of Medicine, Tampa 33612.

Abstract
BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period.

RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95).

CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.Comment in
N Engl J Med. 1992 Feb 27;326(9):634-5.
PMID:1734247[PubMed - indexed for MEDLINE]
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Re: Oral prednisolone vs IV.

Postby dbatman1 » Sun Sep 02, 2012 11:40 am

I was dignosed with MS in 2006.
MRI's are inconculsive, but have had optic noritius and other MS systoms (which could possibly minic other diseases also)
Spinal tap was negative.
Have had minor flare ups, mostly leg pains.
Was on Avonex for 3 months (terrible side effects), quit and went to Rebif, for the past 10 months.

Just recently got out of the hospital with a major flare up of hives. Horrible, completely covered legs and minor spots over arms and face.
Spent 3 days in the hospital on IV steriods, went home and completed a 12 day steriod pack.
Doctor took me off the Rebif, believed I was having a recaction to the medication.

Now, after 5 days of completing the steriod pack, I feel like crap.
I am shaking, blurred vision (can hardly read), swollen ackles and knees and pain in the knees.
My head feels fuzzy and cannot concentrate.
My appatitie has increased....Booooo :sad:

What is going on with me?
Am I having a bad reaction to the amount of steriods? or possible overdose?

Want to feel better...feelig frustrated!!!!
Any thoughs?
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Re: Oral prednisolone vs IV.

Postby lyndacarol » Sun Sep 02, 2012 11:53 am

Welcome to ThisIsMS, dbatman1. Your final words in this post were "Any thoughts?" Here are mine.

Steroids (the complete name is glucocorticosteroids) cause a rise in glucose (a.k.a. blood sugar). In response to the increase in glucose, the pancreas secretes more insulin.

I believe this excess of caustic insulin damages the blood vessels and then initiates inflammation and the immune system. By the way, insulin can cross the blood brain barrier. I believe the steroids are the source of your recent symptoms.
My hypothesis: excess insulin (hyperinsulinemia) plays a major role in MS, as developed in my initial post: http://www.thisisms.com/forum/general-discussion-f1/topic1878.html "Insulin – Could This Be the Key?"
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Re: Oral prednisolone vs IV.

Postby dbatman1 » Sun Sep 02, 2012 12:18 pm

Lyndacarol,
Thank you for the reply. :-D
It is good to talk about the issues with other people besides my spouse.
Other symptoms I am experiencing is craving sweets (all the time) and lack of energy.

I have a doctor appt. Tuesday, what test do you think should be done.

I am concerned.
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Re: Oral prednisolone vs IV.

Postby lyndacarol » Sun Sep 02, 2012 2:46 pm

Dbatman1,
My ideas on insulin involvement in MS are unique to me. I have found no scientist or doctor or ThisIsMS member who shares my ideas. I am not a doctor. I simply try to find an explanation for symptoms through my limited understanding of human biology.

Since you are craving sweets and lack energy, it seems likely that your body is starving for energy and is craving it in the form of glucose (sugar). (Energy is produced in the mitochondria found in every cell, when the fuel is burned. The body can use two forms of fuel: fats or glucose.) Insulin "unlocks" the cell door and allows glucose to enter where it can be burned; insulin is not necessary for fats to be used. If the pancreas is producing too much insulin, the cells become insensitive to the insulin and do not allow it to open the door for glucose. (This is called insulin resistance.) If your diet supplies enough fats, your cells can use this alternative fuel.

You asked, "What test do you think should be done?" As always, I suggest that a "fasting blood insulin test" would be a good idea – this test became available about 1960; it is one of the least expensive blood tests. The optimum test result would be lower than 3 UU/ML; mine has never been lower than 9. I suspect that yours would also be elevated. (This test is not the same as the glucose test which is used to diagnose diabetes.)

All the best to you.
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