What is the effect of splitting pred dose....

Morning Eileen, Can you remind me again the difference between Prednisone and prednisolone. My 1mgm tabs are prednisolone and the 5 MGM's are Prednisone. I therefore take 2 x 5mgm tabs and 3.5 x 1 MGM tabs. Thanks. Kath

Prednisone is a precursor to prednisolone which is the active form of the drug: you take prednisone and it must be processed by the liver to form prednisolone before it can work. So effectively prednisolone works faster than prednisone. There is maybe an hour or so difference - prednislone takes an hour or so, prednisone over 2 hours. But for someeople both take longer.

No, I'm not thinking "rest" - I'm thinking "try taking it earlier".

Many people take their pred about 6am or even earlier and then settle down for another couple of hours in bed by which time the pred is starting to work and also has less to do as the inflammation is less established. That might well make your morning walk possible more often and also more comfortable as well as allowing it to achieve even more: gentle exercise will help the stiffness on its own. In the 5 years I had PMR with no pred I did an aquafit class every day Monday to Friday. The earlier in the morning it happend, the better day I had. It didn't make much difference to the pain but then, without pred, nothing does.

You do sound as if you might benefit from splitting your dose. That is taking a long time to kick in - where are you? In the UK and on prednisolone or the US and prednisone? 

Hi carlene, I had to be 30 mg for about 6 weeks to get stable and PMR pain free. After tapering to 25 mg I stayed splitting my doses, 75 to 80% in morning after breakfast, 20 to 25% at bedtime. Everyone and every case is different, but has worked for me. Good luck on your PMR journey. Try to be positive and smile. Smiling 🙂

You have answered the question - if you have to work, you will undoubtedly need more pred and won't get as good a result as the person who isn't working. Does your husband also work? I wonder why women are conditioned to feel our husbands have been "good" when they help with household tasks?

Much to my disgust my husband doesn't see why he should help with household tasks - although, to be fair, he does do the finances. But then, I could sit in front of a computer to do something (I do after all) whereas using a vacuum cleaner leaves me in pain for days, both back and hands. His mother was very Victorian, told me once I should be standing at the door with his slippers when he got in "because he'd been working". A point I did dispute since I had also worked full time all week and while he had been in his lab writing up his PhD thesis I had done the week's washing, cooked and cleaned the house as well as doing the shopping. 

I've posted about my xmas present - a Roomba. Magic!!!!!! I can vacuum the floor without pain 

Thanks for the info. It is a comfort to know that I am not alone in this journey. Just so frustrating that there is so much I want to do but can't and I am not used to this.

Luckily we have a 2nd floor appartment with a balcony - the Hausmeister does the small amount of yardwork - and I do the trash (all 20 litres of it per 8 weeks - this is a major recycling household!) and I have a dishwasher thank goodness!

Yes - we often say that if you don't learn anything else with PMR you will learn patience. It will get better - and it would get better quicker if you were able to take some sick leave. I do relaise that in the USA that is often not an option. But do try to cut the non-essentials as much as you can. And with PMR the list of non-essentials does tend to grow over time! You learn that things you thought were important aren't so critical...

Oh no - definitely not alone as you will discover if you stay around us for long! We all had the same experience but you do learn to prioritise things and get the most out of your limited energy and strength. I was lucky, I worked freelance as a translator - from home so no commuting and no heavy stuff. Just had to get from the bed to the computer desk. It still wasn't easy. Now I'm past retirement age and after 14 years of PMR have got it down to a fair art so it doesn't stop me doing much, just differently. Few people have it this long - but it does tend to be longer than the 2 years that many doctors imagine.

Good luck with the rest of your journey with this pernicious condition.

It is amazing isn't it, I been splitting since spring. Mornings used to be terrible for me, but after splitting no more problems. I also have been using a modified DSNS taper method, which I also think a great way to taper. Thinking positive with a smile. 🙂

Yes it is amazing. Had i not been on this forum I would still be suffering! Not going back to the rheumatologist until end of Jan. So guess I don't taper down till then?

Carlene, what sort of instructions were you given when you got your prescription?  You need to be as pain free as you are going to get for several weeks before tapering, and that would bring you to about the end of January. 🙂 Just remember when you get to that stage the recommendation is to taper by no more than 10% at a time.

You are so right no more than a 10% taper. I have had a difficult time my Rheumy, wants a bigger quicker taper.

They just do not understand it is not a RACE! Thinking positive with a smile.🙂

What size are your tablets? Are they 10 mg?  You'll need smaller tablets for tapering purposes.  If your doctor tries to get you to drop by 5 or 10 mg, remember that 10% of 30 is only 3 mg. 

Here is a link to one of the slow tapering plans.  This one can be used with a four day start and finish rather than six days.  I found that good at the beginning of my taper, but as the dose got very small and closer to the lowest I found I had to go much slower.  You probably won't need to use a method like this until you are at a much lower level but it's good to know about it.  It helps get one over the spots where you might have pred withdrawal pain which is almost identical to PMR itself!

https://patient.info/forums/discuss/dead-slow-nearly-stop-plan-to-decrease-pred-dose-295902

Hi Twopies.  I started the dsns taper when I had trouble getting from 10 to 9, probably around August 2015.  That was, in fact, when I discovered this forum in the middle of a sleepless night wondering whether I could raise my dose, my doctor having told me to stop lowering if I felt pain returning, but not what to do to deal with that returning pain.  Anyway I've used dsns, with my own tweaks, ever since.  At first I used the 4 day start stop.  When I got down to about 7 I started tapering by only .5 at a time, but was able to drop the second .5 halfway through each taper.  Eventually I started using the six day start stop.  I started pred in June 2015, was at 7 early 2016, down to 3 in July.  It then took me until June 2017 to get to 1.5, using dsns with an emphasis on the nearly stop, whereupon my doctor told me to use up the tablets I had and see what happened. 

I tried to taper to 1 (had only just got to 1.5 so this was a big mistake).  Since then there have been some ups and downs and I had to go as high as 7 to get a handle on the situation of increasing pain, but seem to be back at a point about halfway through a slow taper from 4 to 3.5, so fingers crossed I can at least get back to 2 where I was last secure.  This muddle of a flare has been going on since June probably because I was so reluctant to try a significantly higher dose much earlier than I did (7 mg for six days mid November, along with restarting the low level light therapy I had used earlier to help lower the production of pain causing cytokines).