1. Community
  2. Bones, joints and muscles
  3. Polymyalgia Rheumatica and GCA

Dose splitting

Posted , 9 users are following.

Anhaga
Anhaga

I've seen a lot of comments the past few days regarding dose splitting as a way to manage PMR pain or pred reactions.  So far I haven't felt the need, but I do have a question.  Is dose splitting likely to cause any changes in the way the body eventually starts to produce its own cortisol again when reducing pred to low doses?  Have any studies been done to show whether the practise is beneficial, neutral,or possibly likely to keep the adrenals supressed longer?

1 like, 8 replies

8 Replies

  • karen48559
    karen48559 Anhaga

    Posted

    Good question. I await any responses as I just started dose splitting today. 

     

  • FlipDover_Aust
    FlipDover_Aust Anhaga

    Posted

    No idea! But it's a good question.

    I started splitting my dose a while back when I was having trouble getting out of bed in the morning - I'd take a couple of mg in the middle of the night when I got up for a 'wee walk'. I don't feel the need to to it atm, but would if I felt it would be beneficial.

  • EileenH
    EileenH Anhaga

    Posted

    A study was done some time ago that showed that taking 5mg pred at night suppressed production of cortisol next morning whereas taking 15mg at 8 or 9am didn't - hence the reason for telling patients to take their pred then. Which is fine for patients who are taking their pred to deal with general inflammation in chest infections/asthma in the short term but really not very helpful for patients like us who need to take it to avoid morning stiffness.

    However - it all changes when you are taking pred over a longer period. Most patients take a moderate dose for maybe 6 weeks maximum and as a taper - in flares of RA for example, to manage asthma exaccerbations and so on. In those short periods there is less adrenal suppression, especially if you take your dose mid morning as they suggest. When you take it for more than that short time there is an increasing effect on the whole adrenal set-up and you produce less cortisol of your own. Even a few months at a lowish dose is enough to do that - so all of us are affected since we are rarely on pred for that short a time. In that case there is little difference when you take the pred.

    Since you are taking it to avoid morning stiffness as well as achieve a good entire day it makes far more sense to take it when it works best for you. If you wait until 9am then you will need until after midday to get going - half the useful day is gone. You wouldn't believe the number of people who have asked the question on the forums - "the pred seems to take a long time to work" and it is solely because they are waiting to take it until mid to late morning when they first have something to eat. Once they try taking it early morning their day changes dramtically.

    • Anhaga
      Anhaga EileenH

      Posted

      Very interesting information.  I actually find my worst time of day tends to be late afternoon!  So I think I am confounding the experts as I take my pred somewhere between 7 and 8 a.m. and so far not experiencing pain or stiffness when I get up.  But we'll see how things go as I reduce more.
    • EileenH
      EileenH Anhaga

      Posted

      That's the way it should be - get the optimum result for YOU. Some people don't have or have less morning stiffness. For some people the antiinflammatory effect lasts only 12 hours, for others it is up to 36 hours - they are the lucky ones as whatever time they take the pills they will work until tomorrow. It really is a very personal thing - unfortunately too many doctors just don't understand they have to treat us as individuals.
  • maid_mariane
    maid_mariane Anhaga

    Posted

    I was told to split my dose by my Rumi and it made a world of difference in the morning. I split 3 times and have read many articles on prednisone splitting with the higher % in the morning and last dose no later than 6:00. I first head of splitting on this forum and was going to ask my rumi since I was having problems in the afternoon. So pleasantly surprised when she recommended it. I'm told she is one of the best Rumi's in Toronto Canada.

    We in Canada do not have a time released prednisone so by splitting in effect maybe the same.

    in the past 4 days I have read numerous articles on splitting and prednisone shelf life of 4-6hrs in our system. Other medical articals on splitting for people who feel lethargy, brain fog, low sugar in the afternoon to give them a boost.

    I was further interested in a article on reduction of prednisone below 10mg and they recommend splitting to reduce and it's the afternoon dose they drop. Once dropped and stable they split again. You use this theory with the 10% and drop dead could be great. It's something I will be doing.

    • EileenH
      EileenH maid_mariane

      Posted

      No - Lodotra/Rayos, the time released version, isn't a sustained release form which would release the pred in small amounts over a long period, it's a delayed release formulation: you take the tablets at 10pm and the coating breaks down after 4 hours in the gut, releasing the entire dose at 2am so there is a peak in the blood and tissues at about 4-4.30 am just before the cytokines are reduced. 

      I have never seen articles about dose splitting of pred for PMR - there are various ways of using pred for different illnesses but the recommendations I have seen in everything I have read with regard to PMR is for a single dose as early as possible - especially once you are at lower doses as taking a single dose in the early morning has less effect on suppression of the adrenal glands than even small doses taken in the evening. Do give me some of your references - if it is links you will have to use pm as they won't be let through easily.

      What a shame the others in Canada couldn't see your rheumy - because some people don't have any medical guidance at all when they live in a very rural region.

  • maid_mariane
    maid_mariane Anhaga

    Posted

    I know Mavis is on our US/CANADA site and alot of this info is in our materials folder.

    Am I wrong isn't mavis UK?

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.