Ms 2008-09-16 09:18:45
In an article I posted here (at least on the sinusitis NG, not sure about
the other two) about Chronic Sinusitis, that I found on Medscape, the author
recommended a course of prednisone, for severe chronic sinusitis, and we had
a discussion about that.
Yesterday I saw an ENT, who prescribed me some. Except it isn’t prednisone,
but methylprednisone( generic for Medrol), in the “Medrol Dose Pack”.
What is the difference between prednisone and methyl-prednisone? Difference
in efficacy? In strength?
I never like the “pack” dosing, as was discussed with the “Z-pac” dosing for
the antibiotic zithromax. I find that it restricts the individuality of
dosing for the particular patient from the doctor. (Of course, the doctor
could prescribe the “pack” and suggest a different dosing than that on the
pack, but usually it is just “use as directed”.)
In the article about chronic sinusitis, the writer doesn’t suggest a
recommended dosage for the prednisone, but does write that “one possible
dosage regimen was suggested as follows: 20 mg. twice per day for four days,
followed by twenty mg. twice per day, then stop”. (Sounds a little abrupt to
me–wouldn’t it be better to reduce gradually between 40 and 20mg daily, and
after the 20 mg reduce gradually to 0?) I also believe I read somewhere
dosages like 40 or even maximum 60 mg daily for a week straight, then
gradually taper to 0. (What dosages have patients here had, or doctors
The Medrol dose pack, however, is a very quick taper. It starts at 24 mg the
first day (six 4mg tablets), and reduces that number by 4 mg each day (one
tablet less per day). The sixth day 4 mg, and nothing more after that. Seems
a lot less, and finished faster, than the courses I have seen recommended
for prednisone. Is Medrol stronger than prednisone?
I guess it probably has to do with being very cautious, due to the possible
harmful side effects of oral steroids? But is it too little, tapered too
fast, to do much good? Is it enough to help severe cases of
inflammation–starting at only 24 mg for one day, then so quickly tapering
off to nothing? Have many doctors and patients found the “Medrol dose pack”
effective, or have they found other dosage regimens of oral steroids more
effective for severe chronic sinusitis?
I do feel slightly better today (second day on the pack), so I hope it’s
working. I hope the taper isn’t too quick to really help me get over this.
For an antibiotic I suggested Biaxin (clarithromycin), as I had taken it
successfully before, and I also recently read that it has anti-inflammatory
properties, as well as its antibacterial effect. (I even read that some docs
have prescribed it to patients with severe arthritis to take regularly, for
its anti-inflammatory effect. If many were doing that though, I would
suppose that it would lose efficacy as an antibiotic, due to resistance
developing to it among the microbes. It would also be highly expensive for
those users, if they did not have prescription insurance!)
The doctor concurred, but prescribed Biaxin XL rather than regular Biaxin
What is the difference between the two? Both are 500 mg per tablet, take
twice per day. Both are clarithromycin. Is it just a scam to charge more for
the med (I don’t know if the XL versions costs more, just guessing, both
inexpensive with my insurance), by putting two letters after the name, so
that people will think it is more powerful than the plain version? (Kind of
like the letters GT or something after a sportscar name, make it sound
faster and more powerful?) (OT-joke–Dr. G (sinusitis NG), perhaps you
should sue them for using “XL” after the name, like in a product of yours?
😉 ) But seriously, is there any difference? (I was prescribed it for ten
days, includes one refill though.)