"Joel"  wrote in message:
My daughter was just diagnosed with systemic Lupus and the doctor started her on 40 mg Prednisone per day. He said she would have to be on it for at least 5 -6 weeks and then Plaquenil.
I have a few questions:

She is taking the Prednisone 20 mg twice a day, when is the best time
of day to take it?
Best time to take pred is first thing in the morning, before 8 AM.... if it is to be one single dose;  with the split dosages she is prescribed then she should take it just before 8 AM and 4 PM
(because they are both the times when our bodies naturally secrete cortisol into our systems from our adrenal glands).

Is 40mg a good dose, or could she get by on less like 20mg?
She could be on 60 mg. or 80 mg. or even 5 or 10 mg... she should take what the doc prescribed as when she gets better or improves symptomatically, her dosage will be tapered down slowly to the next level till she is either off of it or maintained on it at a very low dosage level; ie: 5 mg daily.

Is 6 weeks a realistic time frame to start tapering?
Very realistic as I have tapered as early as 10 days or 1 week even and as long as 3 months... again it is individual and based on lab work and symptoms.

Should she have a bone density scan to get a reference since
Prednisone will affect her bone density?
Depends on the individual again.... her age and her general health over her years of life... if she is osteoporotic I am sure the doc will find the calcium in her blood or if he suspects that the pred may cause it he will likely to a bone density scan after enough time determines the necessity.

She also has Anemia and the doctor wants her to take 375mg ferrous
sulfate 3 times a day. My understanding is the Anemia could be caused
by Lupus through the Kidneys or Bone Marrow and in such cases Iron
will not help. Shouldn't she have a Ferritin test to determine if Iron
is low?
I do question her taking the ferrous sulfate compound and wonder how the doctor came to the conclusion of her anemia dx... do you know how his conclusions were derived?

If she has trouble sleeping from the Prednisone what is the best
approach? The doctor suggested Ambien, Xanax, etc. We ended up with a
prescription for Valium.
She will likely have a hyper active state and need some sedating for a while.... but she will be able to go off it once off the pred.... I am taking Diazepam as needed at night as I take pred daily and find it hypes me up even at a low maintenance level, some days more than others and it is nice to have a med. on hand for those times.

I would appreciate any feedback.
Plaquenil, an antimalarial med like chloroquin I was put on, is an excellent medication for lupus and I think many of our group members are taking it and agree.... I had to go off of it and I miss it terribly for my joint involvement in particular, as well as my skin and fevers;  it kept lupus at bay and since being off it I have been flaring often and badly....needing to take more steroids than I like to take and resting more often as well.. the fatigue is also helped greatly by the antimalarial... it takes a while for it to work but once it has built up to a good level in your blood, it really works well!... just be patient with it as it is not immediate relief as is prednisone and sometimes up to 6 months of time is necessary for the right level to be reached in the blood for symptomatic relief...

I hope this helped you out somewhat;  
just out of curriousity, how old is your daughter?
I have a site with info based on my life with lupus and all the relative problems
at  http://members.shaw.ca/tiderington  
and there is also a page of links to other relevant and helpful sites as well.
GOOD LUCK to you all!
~Shelagh

I took 80mg of prednisone for awhile.  When she gets tapered off of
it, depends on how well she responds to it.  I am being put on B12 for
anemia and it helps a lot.  Look up anemia on WebMD and it will
probably tell you that there are different causes for anemia  If you
think that her anemia has something to do with her kidneys, they
should do blood tests to determine if she has decreased kidney
function.

For sleeping, I take elavil.  It helps depression, sleeping problems
and muscle pain all three.
It will also help headaches some.  I am curious as to why she has to
wait until she comes off steroids before going on plaquenil. I started
both at the same time. When the Dr started tapering off my prednisone
he upped my plaquenil.