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PMR, Prednisone, Timing of Dosage

Posted , 12 users are following.

kathy67492
kathy67492

Since the onset of PMR 2-1/2 years ago I have always (with a week or so exception) taken my dose of prednisone @8:00 a.m. Even tho I do not wake up stiff or in pain...that starts later in the day and peaks at bedtime.

This morning I almost forgot!!...but took my 9m at 11:30 a.m.

I felt so much better today and even now at bedtime have less niggles. I plan on trying this again tomorrow. Isn't this a bit strange?

 

0 likes, 19 replies

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  • nick67069
    nick67069 kathy67492

    Posted

    It all depends how your body processes prednisone and how long it stays in the system. It is good to experiment and find out what is the best "fit".  As long as you keep total at the same dose, it is OK to try different time for medication and even splitting the dose in 2 parts. Almost from the begining I split my dose in half; I take it very late at night (12-1AM) and ~8AM.. In general you are trying to have enough prednisone in the system to match cytokines that body releases sometimes in early morning hours ( ~4:30AM).  In your case it seems that you need boost later in a day.  Why not try to split dose into morning 2/3rd and evening or late night 1/3rd. Just make sure that your overal daily dose is the same - 9mg

    • kathy67492
      kathy67492 nick67069

      Posted

      Thank you...slitting the dose sounds like it might work better.

  • koen1
    koen1 kathy67492

    Posted

    Hi Kathy, a single dose at an other time seems OK, but splitting is only recommended when you reach a lower daily dose. The following is a copy of a recommendation from European and American rheumatologists, one of the reports available on the page with useful links at the first page of this forum:

    Recommendation 6: (PICO 8) The panel conditionally recommends using a single rather than divided daily doses of oral GCs for the treatment of PMR, except for special situations such as prominent night pain while tapering GCs below the low-dose range (prednisone or equivalent ,5 mg daily). There are no studies available addressing this issue specifically in PMR. Based on clinical experience and because of the concern that adverse events (including disturbance of the hypothalamic–pituitary–adrenal axis) may be higher with divided doses, the group agreed against the general use of divided GC doses in PMR (40–43). The effectiveness and acceptability of a single daily GC dose has been standard clinical practice in PMR and other inflammatory conditions (44,45) and evening doses can cause circadian rhythm and sleep disturbances (46). In special situations such as in case of night pain while tapering below the low-dose range (prednisone or equivalent ,5 mg daily), split doses may be considered. However, persistent breakthrough symptoms should prompt re-consideration of the diagnosis.

    Good luck!

    • kathy67492
      kathy67492 koen1

      Posted

      Certainly anything that could disrupt my already sketchy sleeping pattern is a problem. I will have to see how I feel if I split the dose and take 6m in the am, 3 at night. I have to say, taking only 6m in the am scares me in terms of starting a flare before sundown!!...although I could always just take the other 3m at the first sign of added pain. Thank you!
    • nick67069
      nick67069 koen1

      Posted

      nothing is black and white in PMR. Everyone is different. I worked with my rheumatologist and we came to agreement that split dose might be better for me to accomodate my daily schedule. I have done it at either 12.5 or 15mg dose ( almost at the begining of the treatment) and used it now for almost a year.
    • koen1
      koen1 nick67069

      Posted

      Nick, you are right this disease is very different for each of us. But please keep in mind that you may be the exception, when you recommend things to others.
    • nick67069
      nick67069 kathy67492

      Posted

      Kathy, the way to do it is to take 6mg at usual time and then take 3 mg at noon or so. If you dont have any negative reaction, then next day take second dose an hour later, etc. , until you find perfect time for you and hpopefully take care of niggles late at night .  As long as you dont take more then 9mg during the same day, you will be fine. Just do it "gently".  I am pretty sure that some of the "old timers" will come along soon and give you their point of view.

    • nick67069
      nick67069 koen1

      Posted

      understood, except if you were reading posts on this site, many people split the dose, so it is not so unusual.
    • maid_mariane
      maid_mariane koen1

      Posted

      i have one of the best rheumatologist as far as controlling pain and i was splitting prednisone morning and late afternoon after 2 weeks at 20mg.

      1 year later at 16mg and still splitting majority in morning and 5mg at 3pm.

      if splitting works for her and i please dont discouraged. for many of us it controls the pain.

    • diana21296
      diana21296 koen1

      Posted

      Splitting the dose was the best thing I ever did to control the pain I suffered from 2am.  I then became virtually pain free for 24 hours.  I got the idea from the forum and then told my  rheumy and GP so they could pass on to other sufferers.  Pred acts as like a sleeping pill for me though, not a stimulant.
    • koen1
      koen1 diana21296

      Posted

      I am no expert, so I am trying not to give anyone advice. I started end of July with 10mg, after 2 weeks 15mg. I split the 15mg: 10 before breakfast, 5 at night. 2 weeks later 20mg split: 15 morning, 5 night. After 4 weeks on 20mg I went to 60mg after some trouble with my eyesight. I wanted to split this 3 way, but was pointed at the single dose recommendation from the Eur/American rheumatologists. I tried this and have no problem with it. I take 60mg with a large glass of water before breakfast and then take a heaping table spoon organic active culture yogurt. This is also makes it easier to take the famotidine (pepcid ac) for my stomach at night. After one day on 60mg I finally was free of low fever and constant nighsweats that I had for 8 weeks. Still have occasional light headache and fatigue, seemingly more when under stress...
    • Anhaga
      Anhaga koen1

      Posted

      I believe that for GCA the single dose is recommended.  
    • koen1
      koen1 Anhaga

      Posted

      Could it be that there is a difference between how to best take Prednisone versus Prednisolone? I understand that in Europe many people get prednisolone in stead of prednisone in the US. Prednisolone could potentially be absorbed much more quickly since the liver does not need to process it?

      Perhaps that impacts how best to take it, or how quickly the body needs another shot?

      Just wondering...

    • Anhaga
      Anhaga koen1

      Posted

      I don't know.  But I have read in more than one place that the medication for GCA should be taken in a single dose, at least until the GCA is under control, because a high dose is needed to deal with it.  I've simply assumed everything is the same for both medications.  I take prednisone for PMR and a single morning dose at breakfast has always worked for me so I read about others' adventures with dose timing or splitting with interest but not out of necessity.

    • maid_mariane
      maid_mariane Anhaga

      Posted

      hi Anhaga

      splitting dose for those of us who do it is out of necessity of controlling the pain. we just don't split because of no reason. my rumi actually fine tuned the time of day to control the afternoon pain.

    • Anhaga
      Anhaga maid_mariane

      Posted

      I'm only talking about the need to control GCA to prevent blindness, which I thought I was making clear in my post.  I have nothing to say on the matter of splitting dose to control PMR pain. As I plainly said I follow other people's experiences out of interest, but I myself do not need to split my dose.  I know why some people do.

      The post also referred to Koen's suggestion that prednisone and prednisolone work differently but I don't know anything about that and have simply assumed they work the same way to relieve inflammation, the only difference being that in one case the liver has to do some processing, not in the other.  I'm sure I have read the experts here and on the other forum I follow state that in cases of GCA the dose should not be split, certainly not until the inflammation is well under control which in the case of GCA could take a while.

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