prednisone vs dexamethasone

[Guest guest]

I know this question isn't Xolair related but since most members here

are so familiar with evil candy I figured you were the best people to

ask. Has anyone switched from prednisone to dexamethasone? My dr needs

an accurate cortisol level so he switched me from 40mg of pred to 6.5

of the other. Is it just a straight change? Is one steroid any better

than the other? Is there a possiblity that the new one will control my

asthma any better? Is it any safer? Thanks!

[Guest guest]

>

> I know this question isn't Xolair related but since most members here

> are so familiar with evil candy I figured you were the best people to

> ask. Has anyone switched from prednisone to dexamethasone? My dr needs

> an accurate cortisol level so he switched me from 40mg of pred to 6.5

> of the other. Is it just a straight change? Is one steroid any better

> than the other? Is there a possiblity that the new one will control my

> asthma any better? Is it any safer? Thanks!

>

I don't know exactly what the difference is but I can't take

Dexamethsone (Decadron)

I HATE THAT STUFF!!! It is SUPER EVIL CANDY for me. My mental state

goes completely bonkers, I turn red all over and then break out all

over in steroid acne. The doctor had to give me Xanax to calm me down

after taking that stuff.

UGH! I have it on my medical records as one medication that I am

extremely allergic to.

When I got a Decadron shot several years back, there was no way to get

it out of my system but to let it wear off.

If you have no choice but to take it, ask for it in pill form. At

least you can control the amount of the drug in your system that way.

Doug

Group founder

[Guest guest]

Why would you be able to get an accurate cortisol level with decadron versus

pred? Let me ask my pharmacy buddies. We use it for brain swelling so it does

have a slightly different effect although does diminish inflammation. In Canada,

lung dx is treated with pred when a steroid is needed, never decadron.

----- Original Message ----

From: <pirates_ej@...>

Sent: Thursday, March 6, 2008 10:25:53 AM

Subject: [ ] prednisone vs dexamethasone

I know this question isn't Xolair related but since most

members here

are so familiar with evil candy I figured you were the best people to

ask. Has anyone switched from prednisone to dexamethasone? My dr needs

an accurate cortisol level so he switched me from 40mg of pred to 6.5

of the other. Is it just a straight change? Is one steroid any better

than the other? Is there a possiblity that the new one will control my

asthma any better? Is it any safer? Thanks!

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[Guest guest]

-

Both are corticosteroids. My BRIEF google expedition on this topic

didn't turn up anything helpful, so I'm hoping or Fran can

provide better information for you.

- thanks for reminding all of us that we need drugs that are

frequently used to combat brain swelling. How thoughtful of you!

Addy

Group co-owner

Resident Smart (when I'm not letting Terry or Ron sub for me)

>

> I know this question isn't Xolair related but since most members here

> are so familiar with evil candy I figured you were the best people to

> ask. Has anyone switched from prednisone to dexamethasone? My dr

needs

> an accurate cortisol level so he switched me from 40mg of pred to 6.5

> of the other. Is it just a straight change? Is one steroid any better

> than the other? Is there a possiblity that the new one will control

my

> asthma any better? Is it any safer? Thanks!

>

[Guest guest]

,

I don't know the complete answer to your question, but I can comment on

part of it. I am an ICU nurse and we occasionally have patients who are

being screened for adrenal insuffiency (Cushing' syndrome) that must

have the cortisol level checked. The lab test we do is called a

Cosyntropin stimulation test. We give those patients decadron instead

of pred or other steroids if the doc feels they must have steroids, as

it does not interfere with the cortisol level accuracy. I have no idea

why decadron does not affect the cortisol level as it is a steroid like

prednisone, but that is what our lab people say is OK.

As far as the diffence between the two drugs, the only thing I know is

that decadron is more potent mg for mg than prednisone. I think it is

something like about 5 mg of prednisone is the same as less than 1 mg of

decadron, which is why your dose is so much lower. Decadron also has a

longer half life in the body than prednisone. We use decadron mainly

for brain swelling also, like 's hospital. Most patients with

respiratory disorders get prednisone. Not really sure why-good

question. I'll have to try to ask one of the attending docs.

>

> I know this question isn't Xolair related but since most members here

> are so familiar with evil candy I figured you were the best people to

> ask. Has anyone switched from prednisone to dexamethasone? My dr needs

> an accurate cortisol level so he switched me from 40mg of pred to 6.5

> of the other. Is it just a straight change? Is one steroid any better

> than the other? Is there a possiblity that the new one will control my

> asthma any better? Is it any safer? Thanks!

>

[Guest guest]

I don't know the difference between Prednisone and Decadron, but I

cannot take Prednisone, terrible side effects. I also have Lupus and

I can take a Decadron injection every two months and it helps me both

with Lupus and with my Asthma. So, I guess it just depends upon the

individual. I don't think either is good for us, but sometimes we

have to do what we have to do to keep going.

> >

> > I know this question isn't Xolair related but since most members

here

> > are so familiar with evil candy I figured you were the best

people to

> > ask. Has anyone switched from prednisone to dexamethasone? My dr

needs

> > an accurate cortisol level so he switched me from 40mg of pred to

6.5

> > of the other. Is it just a straight change? Is one steroid any

better

> > than the other? Is there a possiblity that the new one will

control my

> > asthma any better? Is it any safer? Thanks!

> >

>

>

> I don't know exactly what the difference is but I can't take

> Dexamethsone (Decadron)

>

> I HATE THAT STUFF!!! It is SUPER EVIL CANDY for me. My mental state

> goes completely bonkers, I turn red all over and then break out all

> over in steroid acne. The doctor had to give me Xanax to calm me

down

> after taking that stuff.

> UGH! I have it on my medical records as one medication that I am

> extremely allergic to.

>

> When I got a Decadron shot several years back, there was no way to

get

> it out of my system but to let it wear off.

>

> If you have no choice but to take it, ask for it in pill form. At

> least you can control the amount of the drug in your system that

way.

>

> Doug

> Group founder

>

[Guest guest]

- thank you for that explanation!

Addy

Group co-owner

> >

> > I know this question isn't Xolair related but since most members

here

> > are so familiar with evil candy I figured you were the best

people to

> > ask. Has anyone switched from prednisone to dexamethasone? My dr

needs

> > an accurate cortisol level so he switched me from 40mg of pred to

6.5

> > of the other. Is it just a straight change? Is one steroid any

better

> > than the other? Is there a possiblity that the new one will

control my

> > asthma any better? Is it any safer? Thanks!

> >

>

[Guest guest]

Thanks for the info. THey are testing for adrenal problems so that would make

sense I guess. Has anyone had severely low potassium from prednisone? Since

November I have been in the ICU 4 times with it and have been able to stay out

for the last while only because I have a home health nurse coming daily to draw

a potassium level. I have a PICC line for a continuous potassium infusion, I am

taking 12 potassium pills a day, and am on 4 potassium sparing drugs. And my

levels are still low enough most days that they would keep me in ICU if I were

to go to the hospital. THe drs can not figure out why my body is not able to

hold on to any potassium at all. I have one last aderenal test on Monday and

then the drs are saying I will need to be admitted to the hospital to be taken

off the steroids completely to see if they can get answers. I am on 40 mg of

pred a day. Is there any kind of standard on how quick the taper would be? I

don't have any more sick days so a weekend would be

ideal if that is long enough. Thanks!

<shuttsgirl@...> wrote:

,

I don't know the complete answer to your question, but I can comment on

part of it. I am an ICU nurse and we occasionally have patients who are

being screened for adrenal insuffiency (Cushing' syndrome) that must

have the cortisol level checked. The lab test we do is called a

Cosyntropin stimulation test. We give those patients decadron instead

of pred or other steroids if the doc feels they must have steroids, as

it does not interfere with the cortisol level accuracy. I have no idea

why decadron does not affect the cortisol level as it is a steroid like

prednisone, but that is what our lab people say is OK.

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[Guest guest]

Wow. I am betting it is some sort of adrenal/kidney disfunction. Tapering from

40mg pred daily can take weeks depending on how long you have been on and how

brittle your asthma is. I hope you have some good internal med/internist people

working on this for you. Did you have this problem before you were on pred?

ps I thought pred had a longer half life than decadron which is why we give pred

QD and decadron more frequently??? At least we do this with our brain tumour

patients....

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[Guest guest]

I have been on at least 40 daily for about 8 years. I frequently have to go up

to 80 and taper back down due to flares. I still have asthma symptoms daily. My

old pulmo took me off Xolair after 4 months due to not seeing results. I am

currently looking for someone else to prescribe it since I read here results can

take a year to see.

It is a nephrologist that is currently trying to treat my low potassium. I was

also seeing a endocrinologist but she was out of ideas. Depending on my cortisol

test Monday they will admit me under the care of a pulmo. I'm really hoping it

doesn't take weeks to taper! I hope they will decide that I can do it as an

outpatient although that also scares me a bit if I have a hard time with it. Is

there any kind of chance of tapering in only a day or two? I have never been

successful of getting below 30 on my own before I have to go back up due to

severe flares, but hoped that maybe in the hospital they had tools to help. I

have only had the potassium problem since November. Does that make sense that

prednisone would suddenly cause such a significant problem after so long?

Initially all the drs kept telling me it was impossible that was the problem

because it is so marked but now they are changing their story so I just don't

know... I really appreciate everyone's knowledge and

support on this list!!! Thanks!

<carrie72583@...> wrote:

Wow. I am betting it is some sort of adrenal/kidney disfunction.

Tapering from 40mg pred daily can take weeks depending on how long you have been

on and how brittle your asthma is. I hope you have some good internal

med/internist people working on this for you. Did you have this problem before

you were on pred?

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[Guest guest]

,

I went back after seeing your post to look up the half life to be sure,

and decadron is listed as a long acting steroid with a half life of 36

to 54 hours. Prednisone is listed as an intermediate acting steroid

with a half life of 12 to 36 hours. Like you, I do see decadron given

more frequently though, usually every 6 hours IV for ICU patients. We

usually give IV Solumedrol 125mg every 8 hours for patients with

respiratory failure and then taper down from there, switching over to

daily oral prednisone when they are off the ventilator and able to take

oral meds.

I don't know why we give the decadron more frequently. Maybe it takes

more to get the anti-inflammatory effect for neuro patients than is

needed for respiratory problems? Just guessing there. I've seen

decadron just given as a once daily dose though for patients with

endocrine problems, but it's always more frequent for neuro patients. I

normally rarely float to the neuro ICU, so it's not my area of

expertise, I usually work in a large surgical trauma ICU.

When they are trying to figure out adrenal endocrine issues, I've seen a

whole bunch of different tests ordered, from just a single cortisol

level to checking saliva cortisol levels, to dexamethasone suppression

tests, plus the other test I mentioned in my previous post It's so

very complicated! I also would bet there is some kind of kidney problem

involved for too. , I wish you the best of luck. The low

potassium levels sound very serious and that is one huge amount of

potassium you are having to take. I hope they can figure out what is

wrong. I think it will take much longer than a weekend to come down on

your pred, unfortunately.

>

> Wow. I am betting it is some sort of adrenal/kidney disfunction.

Tapering from 40mg pred daily can take weeks depending on how long you

have been on and how brittle your asthma is. I hope you have some good

internal med/internist people working on this for you. Did you have this

problem before you were on pred?

>

>

> ps I thought pred had a longer half life than decadron which is why we

give pred QD and decadron more frequently??? At least we do this with

our brain tumour patients....

>

>

> Be smarter than spam. See how smart SpamGuard is at giving junk email

the boot with the All-new . Click on Options in Mail and

switch to New Mail today or register for free at http://mail..ca

>

>

[Guest guest]

, you are in our prayers as the doctor search to find the cause of your low

potassium.

I will add the doctors that they will be given wisdom to find the cause.

Adah

<pirates_ej@...> wrote:

I have been on at least 40 daily for about 8 years. I frequently have

to go up to 80 and taper back down due to flares. I still have asthma symptoms

daily. My old pulmo took me off Xolair after 4 months due to not seeing results.

I am currently looking for someone else to prescribe it since I read here

results can take a year to see.

It is a nephrologist that is currently trying to treat my low potassium. I was

also seeing a endocrinologist but she was out of ideas. Depending on my cortisol

test Monday they will admit me under the care of a pulmo. I'm really hoping it

doesn't take weeks to taper! I hope they will decide that I can do it as an

outpatient although that also scares me a bit if I have a hard time with it. Is

there any kind of chance of tapering in only a day or two? I have never been

successful of getting below 30 on my own before I have to go back up due to

severe flares, but hoped that maybe in the hospital they had tools to help. I

have only had the potassium problem since November. Does that make sense that

prednisone would suddenly cause such a significant problem after so long?

Initially all the drs kept telling me it was impossible that was the problem

because it is so marked but now they are changing their story so I just don't

know... I really appreciate everyone's knowledge and

support on this list!!! Thanks!

<carrie72583@...> wrote:

Wow. I am betting it is some sort of adrenal/kidney disfunction. Tapering from

40mg pred daily can take weeks depending on how long you have been on and how

brittle your asthma is. I hope you have some good internal med/internist people

working on this for you. Did you have this problem before you were on pred?

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[Guest guest]

, it sounds like you're going through a really tough time. I

assume that since you are under the care of a nephrologist, he has

ruled out renal (kidney) causes for your potassium loss. Did he do a

complete evaluation of your kidneys? Do you know if you have RTA

(renal tubular acidosis)? That is a common cause of large potassium

losses but is usually treated with IV bicarbonate rather than high

doses of potassium.

If you do have RTA, a common cause of that is side effects of

medications like bronchodilators (I know you're on those for your

asthma); NSAIDS like Alleve, ibuprofen, Vioxx and Celebrex; and some

blood pressure meds, but not prednisone to my knowledge. RTA can also

be caused by cysts in the kidneys, which can be detected with

ultrasound.

I don't know that you'll be on a prolonged prednisone taper since

you're switching to dexamethasone. The dexamethasone would replace

the prednisone so it may be possible to carry out the switch over a

period of several days or even less.

Sending a hug and wishing you some clear answers and a smoother

course soon - Fran

> Wow. I am betting it is some sort of adrenal/kidney

disfunction. Tapering from 40mg pred daily can take weeks depending

on how long you have been on and how brittle your asthma is. I hope

you have some good internal med/internist people working on this for

you. Did you have this problem before you were on pred?

>

>

> Recent Activity

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[Guest guest]

For three months the drs have all been telling me that problem is with my

kidneys. I am certainly losing the potassium that way. I have critically low

levels in my blood and critically high levels in my urine. THey have not done

ultrasounds or anything. Just lots of blood tests and urine tests. They come

back mostly normal except for the potassium so they are wondering if prednisone

is masking something and changing the labs. I have noticed significantly

increased asthma symptoms since changing to the dexamethasone. I hope I can make

it until Monday morning when they will run the cortisol level. I'm thinking I'll

have to go back to the pred right after the draw though in order to gain control

over the flare.

tiredofsteroids <sitesee@...> wrote: , it sounds like

you're going through a really tough time. I

assume that since you are under the care of a nephrologist, he has

ruled out renal (kidney) causes for your potassium loss.

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[Guest guest]

Thanks so much! It is amazing to me how much this has affected my life! I am

used to the asthma and diabetes and other stuff but this has just really knocked

me out! I am out of sick days at work due to all my ICU stays so I go to work as

long as I can in the day and then go home and sleep until the next morning.

Except for when I am constantly waking up to vomit which is due to the low

potassium but then it also makes it worse. It is such a vicious cycle!!! Thanks

again to everyone for all of your posts and help!!!

Adah Voigt <asthmatic50@...> wrote: , you are in our prayers

as the doctor search to find the cause of your low potassium.

I will add the doctors that they will be given wisdom to find the cause.

Adah

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[Guest guest]

Sorry, I doubt very much you will be able to come down

fast without a major increase in your symptoms. There

is nothing really they can do in hosptial to prevent a

flare that you could not do at home (unless there are

triggers at home that are not present in hosptial).

The only real treatment other than loads of albuterol

and brochodilators is some form of systemic

corticosteroid.

If you have been on 40mg for 8 years in all likelihood

your own adrenals are not producing any cortisol at

all. I got down to 5mg and my adrenals were still too

sluggish for me to come off completely.

I am betting this problem may have been exacerbated by

the long course of pred since basially you have a nice

case of Cushings secondary to pred. Do you have the

other side effects?

I am hoping your nephro can get to the bottom of this.

Let us know what your cortisol test shows. I think you

would probably feel very unwell if someone cut your

pred dose completely in a couple of days...Perhaps

Fran can comment more on this.

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[Guest guest]

Oh, my goodness! This sounds similar to what my husband went through

for years and years due to gross ignorance of many doctors and a very

respected hospital that totally missed the boat.

My husband has a condition that's called HYPERALDOSTERONISM

(sometimes called Conn's Disease) - we found out through a

cardiologist about 1-1/2 years ago. I'd have to look it up again to

really explain it but it kind've crosses over two specialties -

endocrinology and nephrology. One of the major symptoms is very low

potassium despite taking gobs of potassium and potassium sparing

diuretics and no diuretics at all. He's never been on much steroid

so that was not the cause - we believe it's an heredity condition.

His blood pressure could run 240 over 120 and flipped out wretched

docs who PUT HIM ON TERRIBLE ANTIHYPERTENSIVES AND MADE HIM WORSE AND

WORSE.

The test requires someone who really knows what they're doing - you

should be prone for 30 minutes before blood is drawn and should be

fasting and no caffeine or stimulating substances for a day or 2 in

advance of testing. Even a professor at a medical school and our lab

screwed up on doing it right. Read up about it and demand

appropriate care.

Because you've been on steroids that could interfere with test

accuracy - that's something that will need some careful orchestration

so I strongly recommend learning about it yourself.

My husband also has asthma but not as severely as I do so is not on

xolair which I am. It sounds to me like you are REALLY a strong

candidate for Xolair as long as your IgE is at the appropriate levels

and you do not react (adversely) to the Xolair. The steroid

treatments are causing trouble you don't deserve and shouldn't have

to go through with other treatment out there. Like the turtle,

Xolair can be very slow but for many it does finally get there!

> ,

>

> I don't know the complete answer to your question, but I can

comment on

> part of it. I am an ICU nurse and we occasionally have patients who

are

> being screened for adrenal insuffiency (Cushing' syndrome) that must

> have the cortisol level checked. The lab test we do is called a

> Cosyntropin stimulation test. We give those patients decadron

instead

> of pred or other steroids if the doc feels they must have steroids,

as

> it does not interfere with the cortisol level accuracy. I have no

idea

> why decadron does not affect the cortisol level as it is a steroid

like

> prednisone, but that is what our lab people say is OK.

>

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[Guest guest]

OK, their belief that it's in the kidneys definitely makes the most

sense. BUT - you should have renal ultrasound to see if you have

cysts in your kidneys, which can be a cause. Beyond that.....do you

live anywhere near a medical school? I think you really deserve to be

re-evaluated by a medical school nephrologist and endocrinologist.

It's not that they can't ever miss anything, as a previous poster

pointed out, but they are likely to add a much needed increased level

of expertise and experience compared to specialists practicing in the

community. Also, with a difficult case like yours they would put

their heads together with other medical school specialists and this

is definitely a case of two (or more) heads are way better than one.

Fran

, it sounds like

you're going through a really tough time. I

> assume that since you are under the care of a nephrologist, he has

> ruled out renal (kidney) causes for your potassium loss.

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[Guest guest]

One of the most frustrating parts of all of this is that I am being seen at a

major teaching hospital. The first time I was admitted I started at a community

hospital and they took me to the University. I was having major heart problems

due to the low potassium so they put me in the cardiac ICU for just over a week.

When there was no easy diagnosis they decided I must be abusing diuretics and

released me. I kept losing the potassium (since they didn't fix it) and ended

back in ICU a few days later at another hospital. That is how I found out that

they suspected me of causing the problem. I also found out that the diuretic

screen was negative. Duh. I never took any diuretics. The whole time I was at

the University they told me everyday that a nephrologist would come see me but

that never happened. Now I am under the care of the chief of nephrology and was

being seen by the chief of endocrinology. Both are pretty much out of ideas. I

do know that they have consulted each

other on my case which I appreciate but I sure hope someone hurries and figures

something out!

tiredofsteroids <sitesee@...> wrote: do you

live anywhere near a medical school? I think you really deserve to be

re-evaluated by a medical school nephrologist and endocrinologist.

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[Guest guest]

I am pretty sure that my drs looked into this initially but my blood pressure

has not been high. My heart rate is running in the 130-140 range though. Do you

think that could be related? It has only been this high since the whole

potassium problem started.

instdesgn1 <instdesgn1@...> wrote: My husband has a condition

that's called HYPERALDOSTERONISM

(sometimes called Conn's Disease)

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[Guest guest]

OMG, I can't believe the diuretics issue. It does sound like you're

in an appropriate setting at the teaching hospital, in spite of their

initial gaff. You can see how seriously they are taking your

situation by the fact that you're now being cared for by the chiefs.

You might ask them if they're consulting with other specialists at

other medical schools. Hopefully they're doing that.

Fran

do you

> live anywhere near a medical school? I think you really deserve to

be

> re-evaluated by a medical school nephrologist and endocrinologist.

>

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