Pmr, prednisone and split dose

He didn’t mention gca; to be real honest, I doubt my gp has any gca patients; I’m guessing he would have referred them to a rheumy.  My gp mentioned the rheumies at the conference reporting having better outcomes splitting the dose for patients with for example, pmr and I believe he said gout?  

Interesting.  Shall we say, then, that for patients who are not getting adequate symptom control from a single dose that splitting the dose is worth a try?  Because in my case the single dose was and remains fine.  I believe there can be a wide difference in the amount of pred actually absorbed by different people, and how fast an individual may metabolize the dosage, so other things to keep in mind when decided on optimum dosage, both amount and frequency.  It's a good thing that splitting the dose is now considered a perfectly good option, not one that a patient may have to fight for, or might not even know is a possibility.

I’m starting tonight...thinking about 1 1/2 tonight and 5 in the morning.  If that doesn’t make a difference after a few days trial, I will try say 3  at night and 3 1/2 in am?  Worth a try, huh?

Good Luck.  i was going to post a little four leaf clover for you, but my computer updated this evening and now I see the icon for the touch keyboard is missing.  Darn.  Time to turn this device off.  Hope your splitting works - give it a day or so, I think.

🍀

The advantage of a single dose is that it has the biggest clout against the inflammation which happens once a day in the early morning. For patients on longterm pred the adrenal function bit is of no real interest until you get to below 10mg - there will have been adrenal suppression anyway. A study showed there was more adrenal suppression taking 5mg at night than 15mg at 8.30am - of significance to the patient on pred for 6 weeks and tapering rapidly, not for the patient on it for 6 months and more as we all are. But GPs are programmed for patients on short-term pred and extrapolate everything for us too.

Thanks Eileen!

I think like so much about PMR it's so idiosyncratic and, like you, people simply have to experiment until they find the split and timing which works best for them.  I believe a standard way to start is two thirds in the morning at the usual morning time, and the remaining one third later in the day, preferably at a time which won't interfere with sleep.

 

Ok, it’s the interfere with sleep part...I’m at 6 1/2.  Took 1 1/2 at 7:30 p.m.  went to bed at 10:00 p.m.   wide awake at 11:00 p.m. for couple of hours.  I have sleep problems with pred but usually wake at 1:00 am or so.

However this morning when I got up, wow!  My groin and upper thigh stiffness was sooo much better, I was shocked.  Will try the split dose again tonight in same ratio, if sleeping problems again, I will have to play around some more.  Wish it all were easier...don’t we all?

There may be some other things you can do to encourage sleep.  A soak in a warm bath, maybe with epsom salts?  A bedtime snack high in tryptophan?  Lots of fresh air earlier in the day?  Or just give in to it and enjoy the extra hours of wakefulness with a slightly boring book which will send you back to sleep.

Thanks for the tips...maybe they will help me settle down to the new regime.

It can be tiresome not being able to sleep when you know you "should" be!  I used to list all fifty United States in alphabetical order and usually forget one and have to go back and try again, and fall asleep out of sheer boredom, but now I know them too well for that to be effective.  Maybe I'll try counting backwards from one hundred by threes or sevens or some similarly awkward number....   

I list a town in my state that begins with each letter of the alphabet. Then a city in each state. Then in a country in the world, yep, I know all the capitols...

I must be lucky that 7 mg pred around 8 pm has no effect on my sleep.  You might try taking the 1.5 mg earlier, say, mid afternoon.

It doesn't have to be 12 hours apart?  Thanks!

Some people take a part of the dose as soon as they wake and the rest later in the morning - it's a question of being able to extend the effect to fill the 24 hours . Theoretically you'd say to take the second part a couple of hours before you would expect the symptoms to start to reappear. So for some it may be the other way round - take the small amount in the morning and the larger amount some time later. You have to experiment a bit to find out what works for you. I know a couple of people who take 1 or 2mg at night immediately before bed which doesn't affect their sleep but is enough to give them a good start in the morning, the rest in the morning which has then worn off by bedtime.