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Going from split dose to single

Posted , 13 users are following.

nick67069
nick67069

I have split my dose almost from the beginning of the PMR treatment.  Because of the unusual daily schedule ( work late into the night) I take pred before going to sleep at about 1AM and also when I get up 8-9 AM).  When I was at 5mg last fall I attempted to reduce late night dose and had  problems and had to go back to 5mg. I was taking 3mg in the evening and 2mg in the morning.

I stayed there until May, when I tried another reduction. This time I reduced morning dose and I went from 5 to 4.5 and shortly after to 4mg with no problem. So now that I am starting next reduction from 4 to 3.5.  I still have not touched evening dose, so my morning dose will be cut from 1mg to 0.5mg.  I am thinking that I should just take one cumulative dose of 3.5mg in the evening. I know that this goes against usual recommendation that prednisone should be taken in the morning, but I had much better results with current schedule (late evenings).

What are your thoughts and comments? Has anyone done anything similar?

0 likes, 39 replies

39 Replies

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  • Mrs_CJ
    Mrs_CJ nick67069

    Posted

    My comment about someone considering taking their prednisone at night is that in quite a few posts on this forum mainly Eileen has noted s study done that says if you take as little as 5 mg of prednisone in the evening it suppresses your adrenal gland function.

    People who have fatigue issues should note this, and even if a person doesn't have fatigue issues, people should consider the fact that their adrenals are being messed with.  

    This wouldnt apply to people who are at higher doses of prednisone ifrom my reading of this forum info. 

    I had hardly any stiffness when I took my prednisone in the late evening but once I got down to about 4 mgs I switched to the morning and luckily my morning stiffness has been ok. My morning energy has been better tho fatigue has been my constant companion this past almost 6 years of my PMR journey. I am currently almost on 3 mgs of prednisone. 

     

    • nick67069
      nick67069 Mrs_CJ

      Posted

      Thanks for mentioning that.  I think that study that you are talking about was done on short term usage of prednisone. If I recall they have found that 5mg in the evening was interfering with adrenal glands as much as 15mg in the morning.  However, it is my recollection that study is not applicable to long term prednisone patient. If you are taking pred for longer then couple of weeks, then time of the day is irrelevant, was my takeaway from that description.

      One of us may be wrong; hopefully Eileen can enlighten us when she comes back.

    • nick67069
      nick67069 Mrs_CJ

      Posted

      Hi Again. I did some reading and found a study that was done to compare taking steroids in the morning vsa evening. If you search the title

      "The timing of prednisolone dosage and its effect on morning stiffness" you will find it.

      If you go to "discussion" section you will find that the result of the study was that evening dose is much  better in eliminating morning stiffness and that there was not too much of a concern with lower dose of steroids on HPA axis suppression.

      "... Although majority of our patients were taking prednisolone in the morning prior to the study, there was significant preference for the night dose at the end of the study, suggesting that general well-being too may be favorably affected by an evening dose "...

      This has been my experience too.  I remember that when I switched from morning only to split dose I could reduce by additional 2.5mg quickly ( from 12.5 to 10mg).

      "

       

    • Michdonn
      Michdonn nick67069

      Posted

      Hi nick67069, I found several study's, is the one you are referencing for RA?

    • nick67069
      nick67069 Michdonn

      Posted

      yes it is, but the study is about when to take steroids and how it impacts morning stiffness ... so I think it is just as applicable to PMR.
  • EileenH
    EileenH nick67069

    Posted

    I know quite a few people who find late evening dosing of the entire dose works well. It doesn't matter what the docs say - what is important is what works best for you.

    Taking pred at night is said to suppress adrenal function more than taking a bigger dose in the morning - but yours is upset by your working hours anyway so it isn't that important. And for anyone above about 10mg for more than a couple of months whether you split it or not is immaterial - there will be adrenal suppression. Unfortunately doctors read one paper and remember that - without thinking laterally for the differing situations.

    • nick67069
      nick67069 EileenH

      Posted

      Thank you... I know that it is better for me if I take most of the dose at night ( it really is early morning). I have tried it both ways and this works for me.  Today I switched to single dose (3.5mg) at night and so far had no issue. It is already Sunday evening here, so I had my pred 20 hours ago.  I just started taper from 4-->3.5mg, so tonight I will take 4mg all in one dose and nothing in the morning.

    • Michdonn
      Michdonn nick67069

      Posted

      Everyone is different, after my flare on 30 mg I found stiffness and PMR pain in morning. I split my dosage, 20 am, 10 PM before bed, morning stiffness and PMR pain was almost gone. I have continued splitting dosage with good results. Now at 15 tapering to 12.5, and have been very active, PMR pain free. Smiling 🙂

    • Michdonn
      Michdonn EileenH

      Posted

      EileenH, I am aware that at some point I am going to be in trouble. Just like now trying to answer you. I just keep dropping into the adds at the bottom of the page. I stated in another comment that I didn't know what I was going to do at some point, probably discontinue my PM dose.

  • Whisper2003
    Whisper2003 nick67069

    Posted

    I did the same as you and split my dose. If I reduced the evening dose I suffered more so when I got to 3 mg I took all in the evening and none in the morning. Everyone is different but it suited me. 4 weeks now on zero pred. I finished on half every other evening. Good luck with your reductions
    • Michdonn
      Michdonn Whisper2003

      Posted

      Whisper2003, I am looking forward to being under 10 and figuring out how much to take and when. SMILING just hoping no FLARE! Thinking positive.🙂

    • nick67069
      nick67069 Whisper2003

      Posted

      Thank you. There are so many other factors in out life that it is hard to be sure with our conclusions about the effect of pred. Thank you for confirming that indeed you had the same experience with evening dose vsa morning.  I am under the impression that if I switched to morning dose only, I would have to increase at least 1mg if not more to have the same benefit.  There was another concern about the impact on adrenal function as few have mentioned on this site, so thank you for confirming that while staying on evening dose it is possible to get to reduce completely.

      I am not in a rush to reduce to zero, although I hope it happens within a year or so.

       

    • BillyP
      BillyP nick67069

      Posted

      nick....you are right about so many other factors that effect us..........

      After being on pred for over 15 years you would think I would have a bit 

      of a clue about what is happening...........how ever...... just recently I have 

      ​developed a senovial cyst in a lower spine facet joint giving me some bad 

      sciatic pain.

      The Doc put me on Lyrica and this has really thrown the cat among the 

      pigeons.........up setting my PMR to no end..........(apparently)....

      ​With what appears to be Lyrica side effects and my re emerging PMR pain

      plus my doc and my rheumy at loggerheads , I feel as though I am starting 

      on a pain journey all over again...........never a dull moment is there.................

       

    • Whisper2003
      Whisper2003 Michdonn

      Posted

      I spent a long time between 10 and 12 mg and wondered if I was ever going to be able to reduce any more without a flare. Probably about a year  eek. just be patient and keep smiling and your time will come. 

      Its a bit trial and error and is different for everyone so you have to find whatever is best for you. Good luck

    • Whisper2003
      Whisper2003 BillyP

      Posted

      Never forget that you are in charge of your  own body despite any disagreements between doctore and rheumis. If Lyrica is causing you pain then insist on a change. You are supposed to have relief from pain, not more pain! Have you tried Bowen therapy? It can be very helpful for sciatic pain, whatever the cause.

      Sorry that its been so many years for you which certainly will get you down but there is light at the end of the tunnel. Best of luck

    • Michdonn
      Michdonn Whisper2003

      Posted

      Whisper2003, I am being patient which is not normal for me. I think the flare put the fear of God in me. No hurry using a modified DSNS method. Any sign of PMR pain, will just extended the old dose. Walking up to 15K steps a day and feeling good, with a smile on my face. I

      will get there. Thanks 🙂

    • EileenH
      EileenH Whisper2003

      Posted

      I think it took nearly 4 years for me to get significantly lower than 10mg without a flare.
    • Whisper2003
      Whisper2003 EileenH

      Posted

      That must have been so hard for you. I think the worst part is being nagged constantly to reduce more. Especially as you don't have raised inflammatory markers as proof! I was luckier on that one which did help. i think we put enough pressure on ourselves to reduce at those times so we don't need others joining the band wagon.

      Thank you for the many times you have helped me.

    • Michdonn
      Michdonn EileenH

      Posted

      EileenH, I do hope I have better luck than you have had reducing my dosage. Tapering from 17.5 to 15 and can just start to feel less side effects, but still having night sweats. I hoping for less side effects under 10 mg. Still smiling heading out for a walk. Good luck getting off the Devil's Tic Tacs. 🙂

    • EileenH
      EileenH Whisper2003

      Posted

      I've always been lucky enough to be left to manage my own reduction and trusted. It is a great gift!

    • Michdonn
      Michdonn EileenH

      Posted

      EileenH, you truly are lucky I wish my Rheumy would let me manage mine, although I almost do. Each visit is a battle, ridiculous! But I am smiling. 🙂

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