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Splitting the dose

Posted , 6 users are following.

lbh
lbh

Hi everyone, my clinical pharmacist has suggested that splitting my dose - I've managed to get to 7mg so take half am and half pm - is going to suppress adrenal function more than taking it all in the morning, which is what he is asking me to do. I'm wondering if there is any scientific basis for what he says. I doubt I will do as he recommends because as I tapered I initially reduced the evening dose and was taking 5mg am and 2mg pm. I noticed a big difference when I split it equally and wasn't as stiff in the mornings. Thank you

0 likes, 11 replies

11 Replies

  • EileenH
    EileenH lbh

    Edited

    It depends a bit when you take the second part of the dose, how big it is and at what time. And the patient. Some people split the dose and still are able to reduce down to zero with adrenal function returning. Others take it once daily in the morning - and struggle to regain normal adrenal function. It isn't a black and white question.

    The trigger for the body to produce cortisol in the morning is a low level at midnight or thereabouts. If you take a dose at 11pm, immediately before bed, it will possibly be higher than will work optimally. On the other hand, of you are a night owl and take it at midnight - the level will be low.

    It is all very well telling a patient for whom the anti-inflammatory effect doesn't last 24 hours they can't take a later dose - their mornings may become far too difficult. If you take a single dose, the optimum time to take the plain pred is 2am The level was at its lowest possible at midnight and the pred is at its highest level just before the inflammatory substances are shed in the body at 4am-ish so morning stiffness is reduced. Usually PMR symptoms do improve during the day and so the evenings are acceptable.

  • BillyP
    BillyP lbh

    Edited

    .

    Gday lbh.............

    Nothing like asking how every one else controls their problems, then deciding what really

    works for you. Eileen really is a guiding light...........What ever change you decide to make to your

    medication, make a note of it for future reference, Change does not generally happen over night,

    so if the change is for better or worse, with a reference you can go back to a dose that may be

    better than the current one..........FOR ME...... it took about 4 or 5 years (give or take a few) to get

    into a regime that was acceptable. .............one thing i settled on was my full dose in the morning

    half way through brekky. My reasoning (right or wrong) was a big dose of pred generally does

    wonders , so the full dose in the morning got me through the day. Being able to get out of bed ok was all controlled by the daily dose that i had settled on . This seemed to suit me.

    Sadly it may not work for you !!!!!!!!!! But by having some reference notes you can check back to

    see how your doses were effecting you. Any body that gets things settled in a hurry is

    indeed a very lucky person. ................................

  • TheRaven
    TheRaven lbh

    Edited

    A few years ago I resorted to a split dose because a single dose just wouldn't last the full 24 hours, plus I was having a real problem getting lower than 10 mg, flaring up each time. Splitting the dose and slowing the reduction way down (years slower than what the rheumy said) helped in both ways I believe. Once I got down to 5 mg I could see that splitting the dose as I reduced further was going to be tougher just because of the 1 mg pill size. Over 6 months I successfully converted slowly until I was back to taking my dose only in the evening.

    I'm currently at 3 mg but do move the dose up and down as I feel the need. At this level I'm just happy if I can keep any flares from showing up. Am in no rush to get to zero.

    • lbh
      lbh TheRaven

      Posted

      Oh, that sounds just like my story, thank you. I also struggled to get below 10 but after I did, I slowed down the tapering and split the dose. I've been back on a single dose of 7mg for 2 days now and so far it's ok. There is so much pressure from the medics (GP & rheumy) to go faster but I'm not giving in to it, it just backfires. Thanks again.

    • TheRaven
      TheRaven lbh

      Edited

      I agree with your comment about the medics. I think their intentions are good, wanting us to avoid potential side effects from long term use of prednisone, but they are so focused on reduction that they lose sight of the far worse potential of flaring up! I got to the point where I'd nod my head and agree with my rheumy - whatever it took to be certain I'd keep getting the prednisone prescription. Then I'd continue my own reduction schedule.

      It was rather interesting the last time I saw my rheumy about 2 weeks ago. In the past he's always pushed, pushed, pushed for me to reduce fast to zero. After I told him that I was now at 3 mg and doing reasonably well, he said "That's really fine. You could sit back, put your feet up and take 3 mg for the rest of your life and I'd be good with it". I was struck speechless. This coming from the guy who had pushed for a faster reduction. Makes me wonder if he caught up on his reading of PMR , such as the Mayo Clinic report from a couple years ago!

      Good luck to you. I hope your move to 1 dose at the 7 mg level continues to work. Everyone has to find what works for them. There's certainly nothing written in stone for reducing with PMR.

    • lbh
      lbh TheRaven

      Posted

      Single dose is certainly working, I'm really pleased.

      I had to smile when I read your reply because that's almost exactly what happened to me. I'm always expecting to be somewhat reprimanded when I visit the medical profession but no, as with yours, my rheumy , on the last visit did not seem too disappointed that I'd only reduced by 2mg in 7months. I was very surprised, and he doesn't want to see me again for 9 months so no rush there either. All good. I can't wait to also be at 3mg like you but I'll be taking my time.

  • Joydeck
    Joydeck lbh

    Posted

    I found a 50:50 split after breakfast and dinner worked well, avoiding PMR pain both morning and afternoon. After a year or more above 10 mg anyone's adrenal function will likely be suppressed.

    Tapering below 7 mg, I was able to single dose. I'm currently at 2.5 mg pred.

    • lbh
      lbh Joydeck

      Posted

      I've been on single dose 7mg a.m. for 5 days now and I would say that it actually suits me better, I'm very pleased. I long to be at 2.5mg but I'm on my way there and feeling hopeful & positive. Thank you

  • Joydeck
    Joydeck lbh

    Posted

    Listening to a BBC podcast, today, I was surprised to learn that a good night's sleep, approaching 9 hours, gives protection against colds!

    • lbh
      lbh Joydeck

      Posted

      Thank you. Interesting! I have definitely noticed that my stiffness is worse when I have a bad night's sleep but I'm so much better with a good night. In fact, I thought about (but didn't) posting to ask if others experience the same thing.

    • EileenH
      EileenH lbh

      Posted

      I used to find that. But I wonder f the bad night is due to increased stiffness rather than the other way round!

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