Unavoidable Drug Rash?
November 25, 2010 1:47 PM Subscribe
Is Prednisone the best solution for my drug rash and, if so, how much?
I must take narcotics while I await surgery and I've developed a pretty uncomfortable drug rash as I've gradually become allergic. My doctor has tried several pain meds and settled on the least offensive but I still suffer a rash even even with 30mb Prednisone plus Zyrtec and Benadryl every day. You're not my doctor, but could I do anything better to minimize the uncomfortable rash? Is this the best dose of Prednisone?
I must take narcotics while I await surgery and I've developed a pretty uncomfortable drug rash as I've gradually become allergic. My doctor has tried several pain meds and settled on the least offensive but I still suffer a rash even even with 30mb Prednisone plus Zyrtec and Benadryl every day. You're not my doctor, but could I do anything better to minimize the uncomfortable rash? Is this the best dose of Prednisone?
Response by poster: I think it's reasonable to consider that others might have faced this situation had had other ideas.
posted by Mertonian at 2:03 PM on November 25, 2010
posted by Mertonian at 2:03 PM on November 25, 2010
You need to talk to a doctor.
Overly-high doses of prednisone can cause heart palpitations.
Prednisone over a very long period of time (not sure how long you would be taking it) can cause loss of bone density / osteoperosis.
posted by Year of meteors at 2:03 PM on November 25, 2010
Overly-high doses of prednisone can cause heart palpitations.
Prednisone over a very long period of time (not sure how long you would be taking it) can cause loss of bone density / osteoperosis.
posted by Year of meteors at 2:03 PM on November 25, 2010
As someone who has dealt with hard-core narcotics, and who has been prescribed Presnidone a couple of times over the years, I would say: listen to your doctor, or ask your doctor these questions.
Presnidone is a pretty heavy-duty steroid. I'm sure your doctor is taking everything into consideration.
posted by KokuRyu at 2:05 PM on November 25, 2010
Presnidone is a pretty heavy-duty steroid. I'm sure your doctor is taking everything into consideration.
posted by KokuRyu at 2:05 PM on November 25, 2010
Best answer: I would also say, don't worry about the long-term side effects of Presnidone. You'll be taking them for only a few weeks or at the most a few months, right? Unpleasant in the short term, but really no big deal.
posted by KokuRyu at 2:06 PM on November 25, 2010
posted by KokuRyu at 2:06 PM on November 25, 2010
Response by poster: I see my doctor almost weekly, thank you.
posted by Mertonian at 2:11 PM on November 25, 2010
posted by Mertonian at 2:11 PM on November 25, 2010
Best answer: Also, please do not begin to decrease your prednisone dose on your own, higher dose steroids must be tapered down carefully per a schedule to avoid an adverse reaction.
posted by Asherah at 2:21 PM on November 25, 2010
posted by Asherah at 2:21 PM on November 25, 2010
Response by poster: Is 30mg a higher dose? I know about the adrenal glands concern.
posted by Mertonian at 2:27 PM on November 25, 2010
posted by Mertonian at 2:27 PM on November 25, 2010
Best answer: Yeah, you'll be fine. The long-term side effects come from CONTINUOUS long-term use -- i.e. the side effects will subside very quickly after you cease intake.
FYI my dad has been on prednisone for YEARS (for myasthenia gravis), and while the side effects he suffers are undesirable, they're certainly tolerable compared to the condition being treated.
posted by randomstriker at 2:32 PM on November 25, 2010 [1 favorite]
FYI my dad has been on prednisone for YEARS (for myasthenia gravis), and while the side effects he suffers are undesirable, they're certainly tolerable compared to the condition being treated.
posted by randomstriker at 2:32 PM on November 25, 2010 [1 favorite]
Have you tried any topical cortisone creams like aristocort, elocon, etc? That has helped with my medication related hives and excema in the past. I'm surprised they chucked you straight on to prednisone to be honest.
posted by smoke at 2:39 PM on November 25, 2010
posted by smoke at 2:39 PM on November 25, 2010
Best answer: I'd like some more information. For what problem are you taking pain medications? What pain medications have been tried? What pain medication have you settled on? What is the rash like (location, appearance, itchiness)?
I say this because this sort of allergy to all pain medications is pretty unusual. That doesn't mean it's impossible, of course, just unusual.
And there's a much more common effect, which is that of opiates causing pruritis (itchiness). But treating pruritis with prednisone is unusual. And tolerance to pruritis tends to develop quickly.
posted by nathan v at 3:17 PM on November 25, 2010
I say this because this sort of allergy to all pain medications is pretty unusual. That doesn't mean it's impossible, of course, just unusual.
And there's a much more common effect, which is that of opiates causing pruritis (itchiness). But treating pruritis with prednisone is unusual. And tolerance to pruritis tends to develop quickly.
posted by nathan v at 3:17 PM on November 25, 2010
Response by poster: It's not pruritis, Nathan. My GP and docs at immediate care readily recognized it as a "drug rash," ostensibly from taking Aleve with Oxycontin. I no longer take the Aleve but the rash continues, though not as bad. It's all over except my face, thankfully, and appears identical to the severe, raised hives pictured in a Google image search. It's worse with some narcotics than with Oxy, seems enough to say about that. They're aggravated by heat and constrictive clothing, even loose-fitting ankle socks. The topicals are a good idea, just what I was looking for in asking here. I'd need a lot of it but in desperate moments on the larger areas they could be a blessing. I have to take the meds, along with nerve blockers, for a compression of a blood vessel on my trigeminal nerve. The condition is "Trigeminal Neuralgia," also known as "The Suicide Disease" and the most painful condition known to medicine. Please don't suggest that I cut back on meds. I would like nothing better but that is simply not an option if I want to live.
posted by Mertonian at 4:23 PM on November 25, 2010
posted by Mertonian at 4:23 PM on November 25, 2010
Best answer: I am not particularly knowledgeable here, but just chiming in as somebody taking narcotics: some side effect hassles were greatly decreased for me when I started using a fentanyl patch. Have you tried tinkering with the delivery method?
posted by kmennie at 4:36 PM on November 25, 2010
posted by kmennie at 4:36 PM on November 25, 2010
I don't know squat about Prednisone but there are a lot of other antihistamines out there. He's only suggested you take the two most common OTC meds. Ask you doctor to suggest something else. If he has to talk to a specialist, do that.
Benadryl and Zyterc are pretty good though.
posted by chairface at 5:21 PM on November 25, 2010
Benadryl and Zyterc are pretty good though.
posted by chairface at 5:21 PM on November 25, 2010
Best answer: Go see a dermatologist! I used a topical cream for a drug rash and it worked really well. (Also, sorry about the condition - I had a friend with cluster headaches and it's no joke. Good luck with the surgery!)
posted by yarly at 5:40 PM on November 25, 2010
posted by yarly at 5:40 PM on November 25, 2010
Best answer: I think 30 mg is a moderate dose, but I also think that the relative terms of high moderate low are somewhat dependent on what condition the Prednisone is being used for. When you ask whether this is the right dose, are you bothered by the Prednisone? THere are longterm side effects, as others have mentioned, but there are also short term effects that some people find intolerable. It's a 'messy' drug in that it affects many body systems, including the brain. If you are tolerating it alright though, I would say stick with it until your surgery. I've been on higher doses for similar amounts of time and had no ill effects, except the annoying shortterm side effects that I knew would go away and which were not as bad as what it was treating.
Like others have said, the taper is key. Even though you're taking 'only' 30 mg, you will still need to taper, especially due to the somewhat prolonged amount of time. Failure to taper can lead to adrenal insufficiency (see http://en.wikipedia.org/wiki/Adrenal_insufficiency ; also see the entry for Prednisone).
And last, still stressing that I think you'll be fine taking the Prednisone until your surgery, I would definitely recommend seeing *another* specialist about your rash, like a dermatologist, or ask your primary care doc who they would recommend. [I had a surgery-related rash experience recently too, and the only two things my surgeon seemed to be able to prescribe was oral Prednisone (seemed a little too much for a small, though persistent, rash) or topical hydrocortisone (completely ineffective)....when i talked to my primary care doc, she had some alternatives in between, which included the topical steroids others have mentioned. they worked great without the prednisone side effects...i don't really blame the surgeon though -- he doesn't specialize in treating rashes..] I would especialllllllly recommend seeing someone else if this rash/reaction to pain meds + need for pain meds becomes a longterm thing. But I hope your upcoming surgery gives you a little break...best of luck!
posted by Tandem Affinity at 5:45 PM on November 25, 2010
Like others have said, the taper is key. Even though you're taking 'only' 30 mg, you will still need to taper, especially due to the somewhat prolonged amount of time. Failure to taper can lead to adrenal insufficiency (see http://en.wikipedia.org/wiki/Adrenal_insufficiency ; also see the entry for Prednisone).
And last, still stressing that I think you'll be fine taking the Prednisone until your surgery, I would definitely recommend seeing *another* specialist about your rash, like a dermatologist, or ask your primary care doc who they would recommend. [I had a surgery-related rash experience recently too, and the only two things my surgeon seemed to be able to prescribe was oral Prednisone (seemed a little too much for a small, though persistent, rash) or topical hydrocortisone (completely ineffective)....when i talked to my primary care doc, she had some alternatives in between, which included the topical steroids others have mentioned. they worked great without the prednisone side effects...i don't really blame the surgeon though -- he doesn't specialize in treating rashes..] I would especialllllllly recommend seeing someone else if this rash/reaction to pain meds + need for pain meds becomes a longterm thing. But I hope your upcoming surgery gives you a little break...best of luck!
posted by Tandem Affinity at 5:45 PM on November 25, 2010
Best answer: In reviewing this, I found this page. Wow! Everything you've ever wanted to know about the medical treatment of drug-related rashes. Take a look if you're not prone to med student syndrome.
30mg of prednisone is a reasonable dose (enough, not too much) but as others have said, topical steroids are most commonly seen as more appropriate than systemic (oral) steroids. The exception to this is when there is systemic involvement-- so if there are some other, allergy-related symptoms you're suffering but haven't mentioned, oral prednisone may be appropriate. Systemic involvement can mean a life- or limb-threatening reaction, however, and so if there are other symptoms that you're not mentioning, then I hope dearly that you're not paying any attention to what People on the Internet (like me) are saying :)
There are other, non-pharmacological treatments for hives. Damp cool cloths pressed onto bothersome areas are helpful. Oatmeal or corn starch baths are helpful for some. Some people might find relief in acupressure or homeopathic remedies (although I'm distrustful of those myself).
Regarding the medications: it sounds like you and your doctor agree that Aleve was the offending agent, but if you started any other medications at a similar time, I would recommend maintaining a high level of suspicion. Anti-convulsants (aka mood stabilizers, aka who knows what they really do) are frequently given for management of trigeminal neuralgia, and are some of the most common causes of allergic drug reactions. If your pain is not being managed effectively, I urge you to speak to your doctor, because there are more options (like if you weren't on something like gabapentin, that could probably be done; and if Aleve helped, acetaminophen probably would too).
Finally, please excuse me if I'm saying a bunch of stuff you already know. You sound very well informed, and I'm sure you've looked elsewhere for as much information as you can find.
posted by nathan v at 10:35 AM on November 26, 2010
30mg of prednisone is a reasonable dose (enough, not too much) but as others have said, topical steroids are most commonly seen as more appropriate than systemic (oral) steroids. The exception to this is when there is systemic involvement-- so if there are some other, allergy-related symptoms you're suffering but haven't mentioned, oral prednisone may be appropriate. Systemic involvement can mean a life- or limb-threatening reaction, however, and so if there are other symptoms that you're not mentioning, then I hope dearly that you're not paying any attention to what People on the Internet (like me) are saying :)
There are other, non-pharmacological treatments for hives. Damp cool cloths pressed onto bothersome areas are helpful. Oatmeal or corn starch baths are helpful for some. Some people might find relief in acupressure or homeopathic remedies (although I'm distrustful of those myself).
Regarding the medications: it sounds like you and your doctor agree that Aleve was the offending agent, but if you started any other medications at a similar time, I would recommend maintaining a high level of suspicion. Anti-convulsants (aka mood stabilizers, aka who knows what they really do) are frequently given for management of trigeminal neuralgia, and are some of the most common causes of allergic drug reactions. If your pain is not being managed effectively, I urge you to speak to your doctor, because there are more options (like if you weren't on something like gabapentin, that could probably be done; and if Aleve helped, acetaminophen probably would too).
Finally, please excuse me if I'm saying a bunch of stuff you already know. You sound very well informed, and I'm sure you've looked elsewhere for as much information as you can find.
posted by nathan v at 10:35 AM on November 26, 2010
This thread is closed to new comments.
This is a question answerable only by your doctor. Prednisone has plenty of unpleasant side effects of its own.
posted by Inspector.Gadget at 1:53 PM on November 25, 2010