Expert: donna lloid - 7/30/2001

Question
Donna,
      I am 28yrs with a horrible disease called rheumotoid arthritis.  I am  very concerned with my health right now.  I am 21weeks pregnant, and I am taking 40mg per day of prednisone.  I spoke with my rheumotologist and now after 5 months he is stating he never told me to take so much. Only 20mg per day.  I would never go and take more of this medicine than told too.  I don't even want to be on this.  I have been on this for 3yrs.  I don't want this medicine to affect the birth of my newborn.  Help me and tell me what to do... If need be I will stop taking prednisone as we speak.  My health means nothing compared to my baby.  I am very upset and worried.  Help me to lead me in the right direction.  Nobody can see to give me a straight answer.  

Very worried......

Answer
dear linda,
prednisone therapy in high doses should only be used when a condition is flaring or is critical.  the only time a patient should be subjected to the risks and adverse effects of prednisone is when it is the "less of two evils" or in when the the ailment is causing more danger than the large doses of prednisone can induce.
the list is too long to cite here but the main ones that come to mind are potassium loss, osteoporosis, vertabral compression fractures, glaucoma & ect.
as for usage in pregnancy, there have not been adaquate human reproduction studies
done with corticosteroids, the use of these drugs in pregnancy & nursing mothers  requires that the possible benifits of the drugs be wieghed against the potential hazards to the mother, embryo or fetus. infants born of mothers who have recieved substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.
this is very important linda, you cannot stop taking prednisone "cold turkey" or abruptly. if this were done it would be a trauma similar to someone ripping an adrenalin gland from your body, with the potential to cause stroke, convulsions ect.
my personal advice to you linda is to begin the process of weaning off of this drug starting tomorrow. if now taking 40mg per/day then reduce it to 30mg tomorrow, take 15 mg in the morning and 15 mg in the evening or 10-12 hrs apart.  continue this dose for 5 days then drop the dose to 20mg per/day in two-10mg doses, continue the 20mg dosage for the next 4 days, then drop to 10mg per day taken in 5mg dose twice a day for 3 days (if your tablets are 10's split them or request the 5 mg tabs) then go to one 5mg tablet a day in morning for 2 days then 5 mg tablet every other day until third time taken on the alternate day then you can stop completely.
a doctor shouldn't consider prednisone as an option for you during pregnancy except as a life saving effort.
following the birth of your baby if you find it necessary to go back onto the predisone I would request that my doctor consider ADT (alternate day therapy).  this is a dosing regiman of twice the daily amount is taken every other morning.  the purpose of this is to provide a person requiring prednisone for long term treatment the benificial effects of cortociods while minimizing certain undesirable effects.
and if the doctor puts you on a regular regiman of prednisone the large dosage should only be long enough to get problem under control, then it should be lowered to a much lower dosage for maintenance purpose.
I hope this information is benifical to you linda.  please let me know how things are and feel free to contact me with questions anytime.  I will always be  straight-foward and promise that I will only give answers that I have researched and verified properly.
good luck to you & your baby linda
sincerely
donna