Split doses and tapering

First, don't worry too much about hitting the target dose... You can always say that you tried the suggested reduction and it did not work, because the symptoms returned. Because everyone is different, genetically and lifestyle as well, you have to find out what works for you. I have split the dose about 50/50 between morning and evening and kept it split all the way down to 4mg.  That is what I found the best for me.  In your case, the best is to go back to the last dose that worked for you and see if it clears the symptoms. Also, next time you reduce, try to use gradual DSNS method, which takes several weeks for EACH reduction ( in which case dropping 1mg every 2 weeks is out of the question).

Pred does not cure PMR and underlying activity of the illness dictates how much pred you need to manage inflammation. It is silly, borderline stupid, from doctors to insist forced reduction and disregard symptoms IMO.

Move your tapering back to the last time you had no pain.  Start again and go s l o w for weeks.  I got down to 3 last fall and had a big flair when I tried to lower.  My rheumy said "Maybe 3 is where you should be so when you get back to it stay there a long time; maybe forever."  It is now a year later and I have been on mostly 5 and a 6. This week I am having 1 day of 4.  I will go on like this two weeks and then try 2 4's.  for a few weeks. It has taken all year to get back to this point.  I wish you luck.

Hi Raven, I'm having those 3-minds thoughts.. briefly, I've had PMR since July 2015 and steadily reduced to 7mg until 2 weeks ago when I had a big stress-related flare with bad headaches which I don't normally suffer from, thoughts of GCA loomed and I went up to 25mg to get it under control. Scared me to bits but all is well, hit it hard and have decreased steadily and now on 15.5mg   

 I use a mixture of plain pred (1mg and they can be cut to get  0.5mg) and slow-release coated pred at 5mg/2.5mg/1mg. Packets of pred everywhere, (very supportive GP  but great to combine to get just what you need. Like you, I split my dose:

Evening dose at 9pm of 4.5mg coated  with a small bowl of porridge (sleep aid!) 

Morning dose at 8a.m. 10mg coated, plus 1mg plain for quick-release.  I'm finding this works very well but not quite sure how to proceed with reduction after 2 weeks on higher doses than normal.  Think I'll sit at this level for a few days more.

In your case I'd go for option 1 - the last dose you felt good at, don't think you can lay the blame for increased pain at steroid withdrawal's door.  It sounds very fast to be reducing to that plan.  

Now I'm going to watch a film and stop juggling pills and timings around in my head .. good luck !

I too split my dose and find it works really well to keep pain at bay.  But I think your reduction is far too fast for anyone.  I can only reduce half mg every 4-6 weeks as my body complains for at least 5 days although no pain. Just feel ill and then recover. My rheumy wanted me off pred in 2 years which is this Christmas -no way.  I am on 9.5mg and it will be at least another year to get to 5mg I reckon.  So I don't see him any more as I told him I was going to do the drops myself and use this forum, to which he agreed. Good luck and Slowly Slowly.....

I think he is trying to reduce you too fast - 1mg per month is easier on the body. It isn't slow when it works and you don't have to return to a higher dose. 

I think I would try reducing from the afternoon dose one time and the morning dose the next - if the morning dose doesn't cover you for 24 hours there is no point relentlessly reducing that to zero.

The Dead Slow reduction has been mentioned:

https://patient.info/forums/discuss/reducing-pred-dead-slow-and-nearly-stop-method-531439

Thank you everyone for the excellent discussion and thoughts!  I knew my new rheumy was pushing it too fast (I've learned since that he specializes in Rheumatoid Arthritis - big surprise) but was second guessing my own instincts and thought maybe I could sneak a couple quick reductions through before slowing things way down.  Wrong move.  Oh well, onward and upward.  

I've only been at 10 mg/ 3 mg for 5 days so tonight I'm going back to 4 mg and see if I level out in the next couple days.  If not, up to 10 mg/ 5 mg.  Then go with the DSNS reduction.  Eileen, I like the idea of alternating the reduction between morning and evening doses - makes sense.  I guess that's what it's about, what makes sense for each person.  Viktoria, I wasn't even aware there was a time release version of Pred.  That's something I'll keep in mind for the future as well.  

As important as the discussion is, I think the support we give each other here is equally important.  I know it sure helps me keep my head on straight and focused on the long term goal.  Just imagine how it'd be if our only source of info and guidance was from our Rheumys and GP's!  Scary thought.

I've only just begun Pred.  My understanding is that if you drop the dose and PMR symptoms begin, return at once to the symptom-free dose and be more patient before you drop again.