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splitting your dose of Prednisone

Posted , 9 users are following.

bonnielee
bonnielee

Hi, everybody!

I haven't been on this discussion forum for quite awhile. I was diagnosed with PMR a year ago, Aug 2016, and put on increasing doses of Prednisone until I reached 40mg. Exactly the wrong way to handle it, but it took awhile to get diagnosed. Shoulder pain stayed away until down to 20 mg. Rheumy extremely anxious to get me off prednisone, so now am down to 8mg on the slow method. In April I fell in a deep hole and blew disc L3.  I've been in such pain trying to get out of bed in the morning and just get to the toilet, my shoulders are nothing on comparison, but still hurt. I have been put on Gabapentin (Lyrica) 300 mg 3x day and hydrocodone (norco) when needed, usually 1/2 pill in morning. I remembered someone on this list or the prednisone list mentioning splitting her dosage to help with morning stiffness, so I tried it, 5mg in morning 2mg at  bedtime. I was afraid it would keep me up, but I also take Trazodone for sleep and it didn't seem to bother me. I got up at least 60% better. I could move out of the bed and walk to toilet and sit down without excruciating pain. I thought I could tell the difference on my back pain (and butt and leg) and PMR pain. It seems I can not. I am waiting to have surgery on my back..not until latter half of November, but, am wondering, now, how much pain is PMR and how much back pain. Has anyone split their dosage and found relief the next morning? How much relief? Has anyone needed back surgery while trying to get off Prednisone? Help?!!

0 likes, 16 replies

16 Replies

  • EileenH
    EileenH bonnielee

    Posted

    Even splitting the dose isn't going to help if you are simply not taking quite enough. The way to find out what is the PMR and what is due to the injury is to take enough pred to wipe out the PMR pain - and the stress of the injury and the pain will probably mean you need a bit more. 

    Why on earth do doctors put patients on pred - the only option to manage PMR pain - and then insist on rushing us off it? It is sheer stupidity! 

    Have you seen the new work from the Mayo showing that actually we DON'T develop more "side effects" when on PMR-level pred?

    https://patient.info/forums/discuss/polymyalgia-rheumatica-and-steroid-side-effects-new-findings-608738

  • maid_mariane
    maid_mariane bonnielee

    Posted

    Hi there

    I've split my dose since the beginning and i now get out of bed stiff not necessarily pain. What i was getting was afternoon pain that's why i split and it helps with that.

    As for the rest i can't help you but I'm sure someone will.

    Good luck

  • Bethune
    Bethune bonnielee

    Posted

    So sorry to hear about your fall and the complications it has caused.  Will they give you extra infection protection when you have surgery while on prednisone?   I tried splitting my Prednisone dose for PMR, because I take it in the morning but feel worse in the evening.  The splitting did not work well for me. I had trouble sleeping, and did not feel the difference... But each person is so unique with these illnesses and treatments, do what works for you. 
  • Blockhead
    Blockhead bonnielee

    Posted

    Yes 10 MG in the morning and 10 at night an hour or so prior bed. doses to be at least 12 hours apart. 
  • Michdonn
    Michdonn bonnielee

    Posted

    bonnielee, you need enough to control PMR pain, I need 30 mg, I then started splitting my dose 20 in AM and 10 in PM. Using a mod DSNS at 17.5 tapering to 15, still splitting my doses. I will not reduce my dosage if I am not PMR pain free. But I think positive, keep smiling and move forward! 🙂

  • snapperblue
    snapperblue bonnielee

    Posted

    I empathize completely.  I recently developed inflammation at L4-L5 that squeezed the nerve and, boy, that causes pain that does not kid around. I will have a steroid shot this Friday. 

    The great stress of your back pain may well have made your PMR more active and you may need more prednisone to control it.  

    I don't know much about disc pain.  However, I suspect that some of it is related to inflammation which might be helped by more prednisone during the months while you wait for surgery. (Knowing that a steroid shot was the treatment for my back pain, I went rogue and increased the prednisone to 40 mg for 3 days, then decreased quickly to 15 mg.  It certainly worked, changing me from a crippled, yelping, pain obsessed creature to a normal person with hip pain when she walked.)

    Short rant:  I am convinced that the longer we have some conditions- back pain is among them- the less likely we are to truly overcome them.  But doctors will happily leave you in such severe pain that you develop secondary problems (from inactivity,  weird posture, and use of painkillers) for MONTHS.  Not to mention your suffering.

    Please get the article Eileen notes, print it, and give it to your doctor.  View this as part of a worldwide campaign to re-educate doctors who are so wary of prednisone that they under-prescribe it and leave their patients in unnecessary misery.  

     

    • bonnielee
      bonnielee snapperblue

      Posted

      you are soooo right. I've given up complaining, but maybe we need to become squeaky wheels in order to receive the care we need. I am very thrilled that splitting the prednisone dose has helped me get out of bed in the

      morning with tolerable pain instead of excruciating pain. We need to be our own advocates when we are already so tired of it all and sparring with the Dr. is just too hard to do. For me it's only been one year. I don't know how you all manage. I believe the USA Drs are terribly afraid of prednisone, certainly my rheumy is. She goes by the numbers. If the numbers say I have no inflamation then reducing prednisone is the course of action regardless of whether my shoulders ache all the time. What to do??

       

    • Michdonn
      Michdonn bonnielee

      Posted

      You may be right bonnielee, but I think American doctors were taught something in Medical school and they are affraid to deviate from that because they could end up in court. So when I had a bad flare I had to fight to get Prednisone, ended up in a wheelchair unable to walk. Then the Rheumy up the Pred, and gave the Pharmacy a prescription for 30 days, but would only have covered 10 days. Once again another battle, to get a prescription for the full 30 days. I am staying positive, keeping a smile on my face, traveling on this PMR journey. 🙂

  • Bethune
    Bethune bonnielee

    Posted

    Luckily my doc is very flexible and treats me by symptoms as my "numbers" are often not bad.  However, I think she does not know about very slow dead stop method of tapering.  Can someone send me that protocol? I'd like to try it! thanks for any advice with that. 

  • TheRaven
    TheRaven bonnielee

    Posted

    When I started on Prednisone it was just a dose in the morning initially and everything was fine.  Without giving a long story, I had a flare up a couple months later and had to increase the Pred dose.  At that point the morning 6 am dose no longer worked for 24 hours.  I would wake up about 4 am with pain that would last until 9 or 10 am when the 6 am dose would kick in.  I think it's been at least 6 months since I split the dose and it has worked well to eliminate the morning pain.  Currently I'm at 10 mg at 6 am and 5 mg at 6 pm.  

    Yes, the evening dose does mess up my sleep at times but I'm glad to trade that to eliminate the morning pain.  I was given a prescription for Trazodone too but I get extremely dry mouth from it and would rather deal with the sleep issues without a drug.  Just me I guess.  Like you I have a prescription for Hydrocodone (10 mg) to use as needed for when my worn out knees give me a bad day.  It seems like the Hydro has minimal effect on PMR-related pain but is still effective for my knee or other joint pain.  I have had some times when I took Hydro to "help" the prednisone during a minor flare up and that did make a difference without increasing the Pred dose.

    • Michdonn
      Michdonn TheRaven

      Posted

      TheRaven, I split morning dose 12 a10 and 2-1s. And bedtime dose 3-1s, with out that bedtime dose I am stiff and in pain in morning.
    • bonnielee
      bonnielee TheRaven

      Posted

      yes, that is me. 8mg at 8am does not last 24 hours, thus early morning pain lasting until pain meds work. I usually take 300 mg of Gabapentin (hence a 16 lb weight gain in 3 months!) and 1/2 hydrocodone then stumble back to bed until they work. I am useless for the first 2 hrs of each day, sometimes more. I have also noticed nothing seems to work on the shoulder pain. I just have learned to live with it. Compared to the back pain, my shoulders are nothing in comparison. My mom used to tell me, "the body can get used to anything but hanging". She had Lupus and lived to be 87 in lots of pain. She was not biologically related, BTW, if you're thinking genetic autoimmune disease. Now, I feel prednisone wearing off in late afternoon, but, it is tolerable, not like the morning pain I was experiencing before I split the Prednisone.  2 mg doesn't seem to bother my sleep. Actually I think my sleep is better if I'm not experiencing pain and waking up every time I move. I've only done this for 3 nights, so we shall see how it works in the long run. It's a heck of a lot better than trying to pee standing up because it hurts too much to sit 😂

    • Michdonn
      Michdonn bonnielee

      Posted

      bonnielee, I think what it proves is each individual case is different. It is strange how different bodies react to Prednisone. But thank God we have it. Smiling 🙂

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