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Crohn's Disease Forum » General IBD Discussion » Given one 20mg Prednisone pill, bad restlessness


03-19-2015, 11:35 AM   #1
Steve_in_orlando
 
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Given one 20mg Prednisone pill, bad restlessness

Hi. I'm a bit of a nervous wreck here. Yesterday my new GI doctor prescibed me a month's worth of 20mg prednisone to take in the morning and 10mg to take a night because of a bad flare up. Had never taken pred. before. Felt great at first but then felt too great and got increasingly restless and anxious; fidgeting like mad. Mania I wonder? I already have high anxiety and panic attacks so I didn't take the 10mg pill prescibed for night time. Just can't handle the jitters.

I did not take any prednisone today so far but am worried it's dangerous to do so without tapering, even though I had only ever taken the one pill. Have hip soreness and some pain, but that might be because I slept in my recliner. Also have some mild facial flushing and residual anxiety.

What do I tell my GI doctor when I call. What about my GP, is there nerve pills I can take if I simply must continue prednisone?The flare up wasnt causing a total blockage, just worse than I've had before because of it lasting a week at that intensity instead of only a couple days.
I aleady take prozac daily so am concerned about adding anymore pills to my regimen. Afraid of withdrawals!
03-19-2015, 12:11 PM   #2
Cat-a-Tonic
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Hi, welcome to the forum. Taking one pred pill and then stopping shouldn't cause you any trouble. You only need to worry about tapering when you've been on pred for longer than a week or so. So please don't worry about that - you haven't had pred in your system long enough to cause any withdrawals or trouble in that regard and you don't need to taper after just one pill.

Before you call your doctor, you may want to write down everything that you want to say and ask. It sounds like you're quite nervous right now, and that might make you forget what you want to say (I write down all my questions for my doctor as well, as I find that my mind tends to go blank the second he walks in the exam room or picks up the phone).

Pred can cause mania in some cases, yes. Euphoria is also a potential side effect of pred - that may be what you experienced when you said you felt "too great." Pred can also interfere with sleep and sort of generally make you feel wired and jittery. The side effects should ebb with time as you taper down the dose. However, if you feel that the side effects are too much for you, I agree it's best to consult with your doctor and ask what your other options are. There is another steroid that is a bit milder and less systemic, it's called Entocort (or the generic is Budesonide). That might give you fewer side effects while still getting the flare up under control. So perhaps ask your doctor if that one might be better suited for you, or if there's anything else that he recommends. Good luck!
03-19-2015, 12:18 PM   #3
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You're a life saver. I'll ask him for that. Thank you very much.
03-20-2015, 06:47 AM   #4
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The first course of prednisone I had made me kind of euphoric, then later I developed severe insomnia and restlessness. The side effects came on gradually for me though, building up over a few weeks. But when they got unbearable, my doctor was able to prescribe me medication to help me sleep and calm me down, and after that my time on prednisone was much more peaceful. So don't give up on the idea of prednisone right away. It may take a bit of trial and error to manage the side effects, or you may find side effects change over time.

Some people aren't able to manage the side effects they get from prednisone, and I know there are special warnings for people with mental health problems, because prednisone really can have very significant effects on your thoughts and mood. But as Cat said, there are alternatives, so let your doctor know if any side effect - mental or physical - is getting too much. Once you've been taking prednisone more than several days, while unlikely to be dangerous, stopping suddenly might make you feel quite ill, so it's important to monitor your symptoms and keep in contact with your doctor so that any problems can be dealt with without making things any harder for you than they need to be. But prednisone can be very effective, so it's worth trying.

Also the pain and facial flushing you mention may be from the prednisone you took yesterday, as it stays in your system a while, but it will all quickly settle down.
03-22-2015, 08:41 PM   #5
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The first course of prednisone I had made me kind of euphoric, then later I developed severe insomnia and restlessness. The side effects came on gradually for me though, building up over a few weeks. But when they got unbearable, my doctor was able to prescribe me medication to help me sleep and calm me down, and after that my time on prednisone was much more peaceful. So don't give up on the idea of prednisone right away. It may take a bit of trial and error to manage the side effects, or you may find side effects change over time.

Some people aren't able to manage the side effects they get from prednisone, and I know there are special warnings for people with mental health problems, because prednisone really can have very significant effects on your thoughts and mood. But as Cat said, there are alternatives, so let your doctor know if any side effect - mental or physical - is getting too much. Once you've been taking prednisone more than several days, while unlikely to be dangerous, stopping suddenly might make you feel quite ill, so it's important to monitor your symptoms and keep in contact with your doctor so that any problems can be dealt with without making things any harder for you than they need to be. But prednisone can be very effective, so it's worth trying.

Also the pain and facial flushing you mention may be from the prednisone you took yesterday, as it stays in your system a while, but it will all quickly settle down.
Haven't gotten to talk to my doctor yet, but am wondering what else I should tell him when I do.

I definitely seem to be sensitive to coming off of medicines and they seem to leave my system pretty quickly. I know with Prozac, if I miss one dose or wait even four or so hours past the time I usually take it, it effects me, even though a pharmacist assured me it has a long half life. I once tried to get off Prozac and it was a nightmare; traumatized me so bad I am loathe to try to reduce the dosage in any way. Took days to get back to feeling normal again.

This is my great concern with these steroids. 20mg made me manic-like after one dose, so how will I respond even with a milder steroid like Entocort over days and weeks when a lot will have built up in my system? The idea of having that kind of panic for days as my body gets rid of it is terrifying, and of course after that period of time I'd be tapering, which means I would still be on it to some extent.

My feeling is I will have to taper extremely slowly as many others seem to require, but won't I still be dealing with severe anxiety? And then I read that some people develop steroid dependence because their body stops making the cortisone(?) altogether. Wouldn't this mean I'd be manic for the rest of my life because I can't stop taking it lol. Of course there must be psyche medicines to deal with that eventuality, but those are serious business.

This makes me wonder if I should ask the doctor to try Humira or Remicade instead. It sounds silly but the risks of seizures and life-threatening infections seem far less frightening to me than high levels of persistent anxiety.

I have been passing gas and have pooped a bit over the last four days, so perhaps I don't have bad enough swelling to warrant anything stronger than the Pentasa I take now (dosage is 1000mg every six hours)? Perhaps I just have fecal impaction in my small intestine (I had been eating a lot of rice and bananas right before this big flare up, in a misguided attempt to improve my health.), in which case time and fluids will solve the problem?

The doctor wants me to go for a small bowel follow through, with the barium drinking and everything. I don't feel it wise to ingest so much chalky substance if I have any obstruction, because I know it's very difficult to expel once it's been sitting in there. So what should I do with that issue.

As a footnote, I also took 5mg of prednisone yesterday night and today I have begun feeling fatigued, but not in an overly negative way. Could I be so sensitive to removing the prednisone after only having taken it twice?
03-23-2015, 06:50 AM   #6
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Steve - try not to worry! Prednisone has scary side effects, but many of the worst ones (for example, steroid dependence) don't usually develop unless a person is on a high dose for many months, and even then, not everyone will get every side effect.

When you talk to your doctor, tell him your priorities. If anxiety is the main thing you are looking to avoid, make sure he knows that so he can take it into account when deciding on your treatment plan. Though your doctor will also be prioritising avoiding the seizures and infections you mention too.

As for the barium test - I can say from experience that if you had a small bowel obstruction, you'd know about it! Isn't faecal impaction something that usually occurs in the large intestine? With faecal impaction, you would only be able to pass liquid bowel movement as liquid is all that can pass the impaction, so if you're passing reasonably solid bowel movements, any kind of obstruction seems unlikely.

Again, try not to worry! Your doctor should help you figure all these things out. You don't need to think too much about all the "what if's" as your doctor is also responsible for making sure dangers are avoided wherever possible while still trying to get your disease under control.
03-23-2015, 01:09 PM   #7
Cat-a-Tonic
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Steve, yes, in some cases people can become steroid dependent. However, that usually involves the person being on steroids long-term (as in many months or even years). And tapering is designed to prevent steroid dependency - the body naturally makes its own cortisol, so when you're on steroids, the body can relax what it's doing. As you slowly taper down the dose of the steroid, the body begins to produce its own cortisol again. And, with Entocort - the highest dose is 9 mg per day. The body naturally makes about 7.5 mg of cortisol per day. If Entocort were fully systemic then you may have some risk of dependency - however, Entocort has a special coating on it and is released in the terminal ileum/colon area. It's mainly topical. My doctor did explain to me that it is a bit systemic, so you may be getting a small amount like .5 or 1 mg in you systemically, but the majority of it is topical and not systemic. So I don't know if it would even be possible to become steroid dependent on Entocort. I personally was on it twice, for 7 months the first time and then 8 or 9 months the second time, and I never had issues with dependency. So please try not to worry about that too much!
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