Dose splitting and dose skipping

Anhaga,

I recently started splitting my 8 mg dose between 5 mg in the AM and 3 mg in the evening.  I did this primarily because I would wake up at night in discomfort.  The splitting of the dose has helped enough that I'll continue until someone convinces me I'm doing the wrong thing.

I wish you the best.

I have missed a dose by mistake a couple of times. I would definitely not recommend it. I do know that a friend who takes steroids for something else takes his pred every other day, as apparently that can reduce the side effects. I think with PMR it may not work too well though for most people.

I split my dose and have from the beginning. My dr told me the effects of prednisone lasts around 14 hrs, so by splitting the dosage it gets me through the night. I take more in the morning and less at night. 

Yes, I think your interpretation of dose-splitting is about right, If you are able to take your pred all in one go and manage for the full 24 hours that is really best in terms of reducing side effects since it allows the ongest time without any pred being present in the body.

Dose skipping I really wouldn't advise until you are down to 1mg and trying to finally get off pred. I'm sure that it is fine if you are a person for whom the anti-inflammatory effects lasts closer to the maximum which is felt to be about 36 hours and you are still well above the minimum dose you need the antiinflammatory efect lasts from 12 to 36 hours depending on the person).

One way of using pred is double the dose on alternate days - it isn't really recommended for PMR/GCA but I did use it for some time and it worked quite well although reducing was difficult. If you are someone for whom that works OK then you will probably be fine missing doses every so often - but if you are a 12-24 hour person then the second day will probably end in tears!

The "Dead slow and nearly stop" approach is a version of that - but one that doesn't expose the body to such a shock. You can use it with 2.5mg, 1mg or 0.5mg steps - some people will manage the 2.5mg steps, others will still struggle with 0.5mg drops. If you can do 2.5mg drops you will still reduce 2.5mg in a month - which most people would feel is pretty impressive. 

It doesn't matter how you choose to reduce - if you try to reduce too far or have too big variations in the doses from one day to the next you will very likely have problems. And in the end it isn't slower - because you run the risk of having to go back to the previous dose and start again and if you are really unlucky you will need a MUCH higher dose to control the flare you have set off. And you may well miss the dose you need long term -  for example, 10mg could be fine, 7.5mg isn't - but was the right dose 9.5mg or 8mg? There's a considerable difference and believe me, 1/2mg can be the difference!

HI Anhaga,

i found  splitting my dose prior to dropping a mg worked for me eg when feeling active /comfortable at 5 mg I would drop my dose to 4 mg morning 1mg night if I was ok on that for 2days would drop down to 4mg for 2weeks then try split dose again for 2days then drop. It's worked well for me but I have PMR only.I am now down to 2mg and feeling so much better.

I don't know if this information will be useful to anyone else, but I split my 14mg of prednisolone taking 6mg at 0100 and 8 mg at 0330. It seems to be working well. In a week or so I will cut down to 13mg and will do it by taking 12mg and 14mg on alternate days. The next drop will be to 12mg. I will let the group know if I encounter any ill effects.

I was surprised how easy it was to set my double alarm, take my doses, and go right back to sleep. My sleep seems to be very good.

I am primarily interested in the idea of dose skipping, although Eileen's comments certainly reinforce my gut feeling that it would be a bad idea, at least until I am down to a vanishingly small dose anyway, where it might be the best way to taper to zero.  I read someone who speculated that skipping the dose was a way to challenge the adrenal glands and wake them up.  I believe the person in question was male and I also understand that men and women tend to experience PMR and its treatment quite differently.  And in any case I don't know if there is any basis for believing that this technique would be effective.