How does the body use prednisone and should the dose be split?
Posted , 8 users are following.
My Ruhamatoligist has me splitting my dosage between morning and evening. He recommended this procedure because i was ok during the early periods of the day but I started cramping up and having vision problems in the evening (GCA). Since splitting the dose I have seldom had any problems except for 3 or 4 days after I reduce my dose by the standard 10% or having too many carbs.
I assume that during periods of normal activity the adrenal gland substitute provided by prednisone is used by the body at a fairly standard rate; however, during periods of stress I also assume that more of the chemical is used which left me short in the evening. Can any one on this forum explain how this really works?
Eileen, I will discuss your reduction method with my rheumatologist but I would like to know if you split you doses.
0 likes, 32 replies
shawn99
Posted
I have been splitting my dose of prednisone (50/50) now since the start of 2014. I am at 30mg now, with 15mg in the morning and the other 15 late afternoon.
So far so good, but you have to remember to take the late day dose. I sometimes have forgotten and woken up in the morning not feeling so well.
My physician supported me in this and I'll continue this pattern the whole time I am lowering my dose.
Good luck,
Shawn
Kassie_beetle
Posted
Do you have GCA or PMR?
Thanks
Kassie B.
mary68968
Posted
I have just recently been diagnosed with Polymylagia & have had quite a time adjusting to the prednisone & the pain & this whole new body which is unlike my own. Been taking it now for about 11 days (12 1/2 mg). I am writing from across the pond. Funny, every time I ask my search engine a question it directs me to
this site. Another blood test this Friday for CRP etc. If the inflammation is down does that mean the dose can be lowered?
Mary
EileenH
Posted
https://patient.info/forums/discuss/pmr-gca-and-other-website-addresses-35316
Splitting the dose works for some people - and good doctors will suggest trying it for a few patients. The best way to take pred for inflammation of most sorts is in one dose, as early in the day as possible - the best time to take the ordinary white tablets is at 2am to achieve best morning effects (there is a German study showing this and a delayed release form of pred was developed as a result, the peak blood level needs to be before 4.30am). The pred acts as an anti-inflammatory and is then excreted via the kidneys within a few hours. However, its action persists for between approximately 12 and 36 hours, depending on the person.
For me it lasts a good 36 hours, I could actually manage to take doses on alternate days and not be too stiff on the second day (I have PMR, you never even think of trying that in GCA). Others find they start to have symptoms again in the evening/overnight. Then splitting the dose works better for them.
In some people, splitting the dose means the smaller dose in the morning isn't as effective - it's the difference between using a small hammer to hit a big nail and a larger one. Others find taking a dose later in the day stops them sleeping. It is something that differs from patient to patient so a bit of experimentation is OK, the usual split is 2/3 in the morning, 1/3 in the late afternoon. It seems to be more commonly done in the US as far as I can tell from the hundreds of contacts I've had through the forums.
Mary - I would say you need to spend at least 6 weeks at the first dose. A study in Italy showed 12.5mg was adequate within a month for most patients - but 15mg is the usual starter and achieves results a bit quicker. But don't rush reducing - it will just come back. The pred hasn't cured anything - it is allowing you to manage the symptoms and that's how it stays until the underlying autoimmune disease dies away. You are now looking for the lowest dose that controls the symptoms at the moment - but truly: don't hurry it! PMR comes back to bite if you do.
Fixmecc EileenH
Posted
Hi Eileen! I have a similar question for you. I am currently on 20 milligrams of prednisone. I have been taking 5 mg approximately every 5 to 6 hours and it seems to keep me reasonably pain-free so that I can function. Without it I cannot function at all. I usually take at midnight, 5am , 10am, and then around 5 PM. If necessary I take a Tylenol to get me through the difference of time. I have tried to split that does some in the morning and in the evening but my nervous system cannot handle it and I become so fidgety and with headache. My question is, if I continue to take it like this, is it having the impact it needs to have in lowering my inflammation. Also, with my adrenals, is it impacting those worse. It seems like there would be less in my body spreading it out like this, thus giving my adrenals more of a chance, but I could be looking at this completely wrong. Your advice would be very helpful. Is it necessary that I take it all at once, or split the whole dose 50/50 morning and then at night. Like I said, if I don't take every 5 to 6 hours, I will wake up in excruciating pain. Please advise and thank you so much. Currently on my lab work is negative except for white blood cell count and inflammation markers. They cannot really diagnose me with anything specific. Thank you. I will forward to your reply.
EileenH Fixmecc
Posted
None of us here are doctors - we can't provide advice on a particular dosage and even a doctor couldn't do that without seeing you.
However - that is a very unusual way of using pred in PMR and it isn't surprising that if you need the best part of 20mg you are soon in pain after taking only 5mg. Imagine your body as a bucket of inflammation that is full and spilling over because of a dripping tap of mroe inflammation arriving every morning. If you just take a small amount of pred it will just scoop out a little bit of the inflammation so the bucket isn't overflowing - until it fills up again. You need to get all that inflammation cleared out with - possibly - a slightly higher dose for a short time - and then you take your pred once or twice a day not in small dribs and drabs through the day and reduce the dose to find the lowest dose that achieves that freedom from symptoms.
Most people have some side effect problems at higher doses - and lots say they feel like the Duracell Bunny or very hyper. At higher doses your adrenal glands won't be producing cortisol anyway so at the moment it probably doesn't make a lot of difference that you are taking it all through the day. I think the real problem is going to arise when you try to reduce that dose - and you cannot stay on 20mg for ever.
Lots of people take about 2/3 of their dose early in the morning - and you say you wake with pain at about 5am so the sooner after that you take a good dose to counter the inflammation that has just arrived the best and the better effect it will have - less work to do. Then, they take the rest later, not necessarily at night, some people find they can last the entire rest of the 24 hours if they take the balance of the dose at lunchtime even.
I think you need to discuss this in detail with your doctor - as I say, I'm not convinced the existing inflammation is properly cleared out and you may need a short time of a higher pred dose and try to cope with the unpleasant side effects. Some experts would use medication to help that. I also don't see how they "can't diagnose you with anything specific" - characteristic symptoms plus raised inflammatory markers is enough for most good doctors! On that basis, they would never make a diagnosis of PMR. PMR doesn't really show any other blood markers, you MAY have a positive rheumatoid factor, but that doesn't mean it is rheumatoid arthritis in the absence of other signs and symptoms. PMR is a diagnosis of exclusion - you exclude everything else it might be - then say PMR.
Fixmecc EileenH
Posted
Thank you so much for the analogy, it definitely makes better sense explain that way. As of yesterday my current diagnosis is in Inflammatory arthritis with a positive Panca factor for vasculitis. However none of my other tests are remarkable. And I have no symptoms of us vasculitis. I did revisit with my doctor regarding my usage throughout the day, and he said to split my dosage happen the morning with Breakfast and a half with supper. I am tapering from 20 mg to 15 today and I will do 10 in the morning and five at night. Surprisingly, I survived all night on 10 mg that I took was supper last night without any pain this morning. But I didn't sleep but about three hours. So I'll have to work on this. Thank you so much for your input I greatly appreciate it.
EileenH Fixmecc
Posted
As I say - you might find taking more than half in the morning affects your sleep a bit less.
joey2
Posted
anapp joey2
Posted
I agree, it's good to exercise and I feel better when I do...but I also agree with Eileen. It's not in the mind. My mindset is I want to do it. I play pickleball regularly...it's great exercise and I also love it. I hate it when I can't play. But, when my body say "no", it says "no." There are just times I can't. I also used to walk 4 fast miles 3x a week but either the disease or Prednisone (plus a 2 yr old back fracture as a result of Prednisone) has worn me down and now can only manage two slow miles. Yes, by all means, people on Prednisone should exercise...to the best of their ability...if they can. We are not all alike and don't all respond alike and if others are like me, they have good and bad days. I congratulate you though on the weight loss. That is no easy feat on Prednisone.
EileenH
Posted
And one thing I will object to is your assertion that "It is all in the mind" - many of us met that from our doctors at the outset and certainly don't need to be told THAT again. There is provable inflammation in blood vessels in PMR - and it certainly didn't happen because it was thought there. Nor will thinking make it go away.
Many of us were fit, active and healthy persons until one morning (in a lot of cases) we couldn't get out of bed. I was at the gym 5 days a week and was pretty fit. I have always eaten a fairly healthy diet. I know a fireman who ran marathons, an university lecturer who ran half marathons and both trained regularly - both developed PMR and have not had easy journeys. And not one of us wanted to be anything but healthy again.
Please don't tell people they aren't well because they don't "think right" - it is far more complex than that.
mary68968
Posted
Thank you so much for the information. I am a bit in the dark here. Went from my family doctor, an internist, a neurologist & finally a rheumatologist before finally being diagnosed. It's been a strange & frustrating journey. All & all about seven months before diagnoses.
I too am/was a very active person. (68). Cycled about 40 miles a week prior to this & right now there is no way I could undertake that. The lack of activity seems to pack a big dose of depression with it. Just some random thoughts...do people take pain pills along with pred ever? If the blood test shows the inflammation is down does that indicate the pain will be down as well. Strange, although I live in a fairly big city in N CA I think we only have about 5 rheumatologist in the city & I don't think a whole lot of research is going on here.
Thanks again for all your amazing info. Very helpful.
Mary
shawn99
Posted
I have PMR.
Shawn
EileenH
Posted
Some people use painkillers, many of us find they do nothing for PMR pain. You shouldn't mix NSAIDs (ibuprofen, and aspirin or the COX inhibitor drugs - sorry, can't remember the US names) with corticosteroids. Paracetamol (acetaminophen) is OK but take care you don't overdose.
Hmmm - pain/blood tests: chicken and egg situation this! Usually the blood tests will lag behind a bit. You may be in more pain than the doctor thinks is right for the blood tests - but they are only a guide. Basically it is the pain and stiffness that should be taken as the real sign. In some people the blood tests never show anything, even at the start. In some people they are raised at first, go down with pred but don't go back up in a flare.
It's funny - I get the impression the UK has a better handle on PMR than the USA. Maybe it is perceived as an "older" person's illness, less significant in a work environment. But I have friends in the US with RA and they seem to struggle with rheumys! It is more common in communities with Scandinavian genes - maybe they didn't get to N Carolina ;-) Plenty of Brits in Virginia though you'd have thought! I have friends in Toano near Williamsberg - we didn't get to NC when we visited though. Years ago we had friends in Germany from Knoxville.
Ask anything you like - we'll try to answer.
Lee-Colorado
Posted
I have been looking for a site that discusses PMR-GCA using laymen's terms and found this one located by
googling "Management of Giant Cell Arteritis and Polymyalgia Rheumatica - American Family Physician".
It describes both diseases and I finally understand why I was initially put on a 60mg coarse (GCA) of pred.
verses the 20mg starting dose (PMR).