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My neuro wanted to try the mestinon first, because prednisone is a two edged sword. After a few weeks she started me on a regimen that ended up at 60mg a day for several months and started tapering off. I am now at 10mg and still going down.
What can I say? It worked very well for my myasthenia. But it aggravated my blood sugar, made my skin easily torn and bruised, made me more aggressive and made my wife harder to get along with. 😉 It hasn’t affected my bone density but it often can.
I think I’m on the right track for myself: high dose prednisone concurrent with immunosuppressants, then tapering off the prednisone after the immunosuppressants have had time to work. Cellcept, for instance, may take from 6 months to a year to take effect.
Overall the benefits have definitely outweighed the side effects. But as they say, your mileage may vary.