Got to see the new neuro today. He seemed personable, though not particularly cluster-informed. I did expect that, and only hoped he would be amenable to my suggestions. And he was. He allowed a prednisone taper, increase in lithium, and added gabapentin to help with co-morbid migraines and sleep.

However... I was on the way to pick up my prescriptions at the pharmacy when I got into a bad car accident. Everyone is okay, if banged up, but the car is totaled. I never made it to the pharmacy. However, I remembered a really old prednisone script I'd never taken from years back. So I took the first day's dose, which amounts to 24 mg. (I didn't notice the instructions to spread them out, so I just took 24 mg all at once.)

The taper I do have is for 24 mg (split doses) day 1, 20 mg day two, 18 mg day three, 12 mg day 4, 8 mg day 5, and 4 mg day 6.

What I'm wondering is, does this sound like a reasonable pred taper for cluster HA? It may be some time until I can get back to the pharmacy, so I'm dearly hoping this will be a reasonable approach for now. The neuro has me increasing my lithium dose, which I will be able to do with the current supply.

Any concerns, kicks-in-the-butt, ideas?

Duly noted. I do have the rest of the dose-pack until I can get to the pharmacy. Have you been precribed 80 mg to start, all at once?

Quote:

Yes. Whenever I've been on prednisone, I was always told to take it once per day, right on waking in the morning. It most closely mimics the body's production of adrenalin (which it is replacing when going through prednisone therapy).

My prednisione tapers have started at 70 or 80mg a day, decreasing as per Brew's post with the dose being taken all at once in the morning too.

This was one of the more thorough articles I found on lithium toxicity. Obviously you are looking more at the Chronic toxicity then the acute as I doubt you'll be chugging a whole bottle at once!

Joe

Lithium is a medication used to treat bipolar disorder (manic depression). This article focuses on lithium overdose, or toxicity.
•      Acute toxicity occurs when you intentionally or accidentally swallow too much of a lithium prescription.
•      Chronic toxicity occurs when you slowly take a little too much of a lithium prescription every day for a while. This is actually quite easy to do, as dehydration, other medications, and other conditions can easily interfere with lithium in your body and cause it to build up.•      Acute on chronic toxicity occurs when you take lithium every day for bipolar disorder, but one day you take an extra amount (as little as a couple of pills or as much as a whole bottle).
Symptoms
ACUTE TOXICITY
After taking too much lithium you will have symptoms such as:
•      Diarrhea
•      Dizziness
•      Nausea
•      Stomach pains
•      Vomiting
•      Weakness
You may also have some of the following nervous system symptoms, depending on how much lithium you took:
•      Coma
•      Hand tremors
•      Incoordination of arms and legs (ataxia)
•      Muscle twitches
•      Seizures
•      Slurred speech
•      Uncontrollable eye movement (nystagmus)
Heart problems may occur in rare cases.
CHRONIC TOXICITY
You will likely not have any gastrointestinal symptoms. Symptoms that may occur include:
•      Increased reflexes
•      Slurred speech
•      Tremors

In severe cases, you may also have nervous system and kidney problems such as:
•      Kidney failure
•      Memory problems
•      Movement disorders
•      Problems keeping salts in your body
•      Psychosis
ACUTE ON CHRONIC TOXICITY
You will likely get some gastrointestinal symptoms and many of the severe nervous system symptoms listed above.

Good luck with the new regimen. The prednisone always worked for me at 60 and then taper down.  In recent years I've had to start at 80 though and taper longer while something else ramped up.

After day one of pred, I've had two days' PF. Wooooo! Yes. I know this won't last, but I'm hoping that ramping up lithium will kick in soon. I'm only at 300 mg/day so far.

I never understood the ramp up on lithium (or verapamil, for that matter). It takes long enough to build up to therapeutic levels. If you were to become toxic, it would only be slightly. You could always back off if needed. The end result in my eyes is a few additional weeks of needless suffering.

I've never heard of lithium being prescribed for blood pressure.

The manic portion of bipolar disorder, and sometimes for ALS, yes.

"What's all this fuss I hear about prescribing lithium for blood pressure?"

"That's bipolar. Not blood pressure. Bipolar."

"Oh. Well that's different. Nevermind."

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wimsey1 wrote on Dec 27^th, 2012 at 8:43am:


I am SO glad someone brought this up!

When using the standard dose pack of methylprednisolone, going for the suggested 80 mg is like 100mg to 120mg of prednisone. Not a real good idea unless under direct supervision when it hits your bloodstream.

Occasional use isn't going to do that to you. It's prolonged overuse that will get you into trouble, as in avascular necrosis.

Sounds all kosher to me.

All going well your Lithium is likely to kick in at around 900mg. All literature I have seen supports tapering L in and out gradually.

Excessive bathroom visits will go away and most likely so will the tremors.

Because of your current dose you neednt be worried about your blood test just yet. Check with your doc but I did my first one 2 weeks after reaching therapeutic dose. Then monthly and by now quarterly.

The tests are nothing to be paranoid about. Its like regular ECGs when you are on Verapamil. Its just that for some reason doctors are shit scared of prescribing Lithium. My neuro made me sign a disclaimer after I put a gun to his head for a prescription!