Pred take at night... | Arthritis Information

Hi all, I have been really nauseated for quite a while. I blammed MTX. The last 2 weeks I dropped off 5mg and only took 10mg MTX. The nausea has been only a little better but PMR "muscle hurt " has increased... MTX was working better than I had thought!

I saw my Rheumy today and my ESR 25, CRP 22.2. I was not surprised, I have been hurting.

I now have a new routine ... changes to when I take my medications.....

Stay at 5mg Pred ... take at night!!! ( should not upset sleep, his words!!!)
I already take Mogadon Sleeping Tabs, so here's hoping.
.
Plaquenil 200mg......take at night
Panadol Osteo........ take every 8 hours
Tramadol SR 100mg................keep taking every 12 hours
Endep 25mg......... take 25mg in morning.. and ( I take 2 x 25mg at night now)

MTX.......................go back up to 15mg
Nexium 40mg can take more than 1 a day if needed.

Have main meal at Lunch time.

Also I need to make an appointment with Osteoporosis Professor in Melbourne.
Rheumy says he will probably want me off Pred./// here we go again.

I guess time will tell how the meds changes will work, better ?.. here's hoping!!

Hugs to all, Lyn

Lynn

RickF and Eileen have been trying to respond to your message. Rick mentioned he was trying to direct you to the BSR Guidelines issued June 2009 to be found on www.pmr-gca-northeast.co.uk. Guidelines under Useful Information.

I think it is because you have been advised to take a 'split dose'.

Can I also ask Lynn that you check everyone of your tablets with a Chemist (Pharmacist) as you are on Metho. Over here a very close friend of mine, whom I had instilled the mantr, "always check new prescriptions or things you want to buy over the counter with a Chemist" before you take them, they no more about drugs that other medics. Luckily she did, she was prescribed tablets and when she checked the Chemist refused to issue to prescription and rang her GP. What she had been prescribed were totally incompatible with Metho.

Or have I just taught my Granny to suck eggs?

Lynn

I knew there was something missing from that list of drugs - where is the Folic Acid?
Hi Mrsuk, Rick and Eileen and all,

Thanks for directing me to the Guidlines, I have had a quick look and have not quite found the info that you are directing me to read?

I do take Folic Acid 5mg .. 5 nights a week.. None on day before or the day I take MTX.

Re " split dose"... No, I am taking the full 5mg at night, Rheumy's orders. Only been 2 times and I have not noticed any difference.

Re seeing Chemist: I will do that, thank you!! I knew I should do that But.. Pred head excuse.

I did do a Drugs Interaction on Drugs.com and a couple of Warnings came up. The adverse reactions were there but I thought the Drs' knew of these and I just had to watch for anything different..

I will talk to the Chemist on Monday..

Thanks again, I appreciate your replies..as always.

Any advice to get rid of this nausea waves, feeling hot and clammy, small heart palpations in chest and head.... enough!

Hugs to all, Lyn

Hi Lyn!

I'm sure you know this really - but it might help others too!

I'd absolutely NOT assume doctors knew anything about drug interactions (bit harsh, but at least you are safe that way round!).

The pharmacist should know their stuff (met some who don't) so always ask, even if you've asked before. And if you sense the pharmacist is being a bit woolly or evasive - go and ask another one. Strangely - or maybe not - specialist nurse practitioners often know more about where caution is required even if they don't know about the broader picture. There are arrogant types who think they know it all in every field - let's not be the victim! Know your medications, what they are, what they look like, what they do and what NOT to do with them. Keep an up-to-date list with you at all times and show that patients are not all as thick as mince (to use a Scottish expression)! MrsUK declaims: Knowledge is POWER! She's so right.

BTW Lyn - are your steroid tablets enteric coated? Just wondered...

cheers all,

MrsE

Hi all - me again!

Talk about Pred brain - knew there was something else:

If you always use the same pharmacist to fill your scripts they will very often keep a record of your "drug history" and this makes it easier for them to pick up on a mistake of any sort - dose, interactions and so on. If you go to the one round the corner this month and the one at supermarket X next and then try out supermarket M the next no-one has any chance of tracking anything!

BTW - I know this applies in a different way in the USA as you don't necessarily have a totally free choice of pharmacy, but you can make sure you always use the same branch and not go to several, although they may all be from the same company they don't necessarily know what another branch has dispensed.

MrsE

Glad others were able to post. I still can't post what I was trying to write, but if you were able to find the BSR guidelines, be sure to read para 5, where it addresses slow reduction.

If I read you right, you dropped Pred from 5mg to 0mg overnight. Probably why you're in so much pain. Normally when a patient gets down around the 5mg level, they have to decrease dosage very, very slowly. Like 1/2 mg drops or alternate day doses. We have to remember that after having been on Pred for awhile, our adrenal glands aren't making the body's natural hormone - or cortisol. It takes time for the adrenals to get working again and that's why we have to slowly reduce the dosage of Pred.

Hope you start feeling better soon.
RickF2010-08-20 10:20:47Hi Rick - I understood that Lyn dropped from 15 to 10mg of methotrexate because of her nausea (not her steroids which she's also trying to reduce). I might be wrong but I'm sure Lyn will correct us once Oz wakes up!

MrsE

Lyn

Checked on Methotextrate and the following was found in the 10 most common side effects

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Nausea, vomiting, diarrhoea

Speak to your doctor who may reduce the dose.

Now I don't know if the following will work, but it does for morning sickness. Two Arrowroot biscuits before you put your feet over the bed to get up. With a drink of weak tea or water.

Old wives tale, but they knew what they were talking about.
Thanks Mrs E, Mrs UK and Rick for your advice etc.

I do go to the same Chemist but do not always see the same Pharmacist. There is one Pharmacist that takes time to explain when to take the new medications but I have not seen him for a while. I found out yesterday he is only working 3 days a week and I will go see him.....( been going to do this for months, just need a push , hard!!

My 5 mg Pred is enteric coated but the 1mg Pred is not. I will ask about that when the time comes to reduce again , if ever!!!

Rick, I very slowly reduced Pred over 5 months to go from 4 mg to zero. From 2 to zero was awful and I only continued with the reduction : cause I had to for my bones and I was hoping it was taking time for my adrenal to kick in. Wrong I had to go back up to 5mg in January and here I stay..

Mrs Uk was right it is the MTX I dropped 5mg off..

I am now back on 15mg MTX , taking Pred and Plaquenil at night and another Endep in am.

I am not as nauseated in the morning, last night I was clammy, hot and nauseated about 30 minutes after I took all my meds.

On a positive note: I am not as stiff in the mornings altho I am very " sore" around lunch & dinner time. A couple of Panadol Osteo helps.

Thanks again, gentle hugs to you!!! Lyn

Mrs UK, thanks for the morning sickness info. I used to do that 40 plus years ago. AND it DID WORK.. xx