MEDROL DOS PAKS
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I  get a lot of referrals of patients on Medrol Dos Paks that don't respond
as well as one might expect; they subsequently respond to normal doses of
prednisone. I wonder if the dosage in the Pak is a little low or it is
tapered too fast. Have you seen much of this? I will try Medrol, however in
the next patient I see that fails to respond to appropriate prednisone.
Appreciate your always helpful remarks.

Hal Rehbein
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Glad you asked. I was wondering the same thing. One could write for 2
Medrol Dos Paks and take the same dose 2 days in a row (alternating packs
qod) , this would double the treatment period!   

Diane Thaler
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I have not found Medrol Dose-packs to be helpful. The drug is tapered =
too rapidy without consideration of how long it actually might take for =
steroids to be effective. I think it is better to see (or at least plan =
for) the patient to show improvement before tapering the dose.=20
In using prednisone I vary my choice of initial dose, but a typical =
course starts at 40mg of prednisone for one to three days, and tapers =
over 10 to 14 days,depending on the condition I am treating. For more =
serious problems, such as vasculitis, I may keep the patient on a =
specific dose and re-examine every few days to see response before =
tapering further. Beyond three weeks of prednisone over 10mg a day, I =
become aware of the need for more careful taper to avoid iatrogenic =
hypoadrenalism.
 
Jerry Eisner
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