Tapering - taking lower dose morning or evening and why?

[Megams]

Hi wonderful folk 12,000 miles away.

When I eventually start my slow, dead slow tapering plan as per PMRpro's information, would the lower dose best be taken in the morning or late afternoon?

Which ever it is please explain why, so I have better understanding.

Presently still 15mg x 2 hydrocortisone acid resistant slow release which has thus far worked well as it has broken down in bowel and left my fragile gut in reasonable condition without the need for PPI's that had their own dreadful side effects.

My kind regards to you all

[Jora]

I'm currently tapering off Prednisilone, in preparation for surgery. I always take my Pred ( currently at 15 mg) in the morning, with breakfast. They are stimulants, so it makes sense to take them then rather than at night. When I was on 25mg +, I would then take 15 mg at breakfast and 10 mg at lunchtime,

The tapering is giving me a bumpy old ride, so I have to keep reminding myself that this will pass, especially the mood swings.

I hope that helps.

Jora

[Megams in reply to Jora]

Thank you Jora - most helpful indeed.

Good luck with the surgery plus tapering further with Pred.

Kind regards

[Celtic PMRGCAuk volunteer]

Megams, it is generally recommended to take the whole dose as early in the morning as possible. However a few people have found that splitting their dose can help to prevent much of the early morning stiffness, especially those people for whom the Pred takes longer to kick in each day and for whom the effects wear off more quickly. Those people splitting their dose generally take two-thirds of their dose in the morning and the remaining third in the evening. Better to have the bulk of the dose in the early morning to help boost your body to help with the activities of the day ahead. I'm sure some people who are splitting their doses will reply with their experiences.

[Megams in reply to Celtic]

Hi Celtic

Thank you for this insight.

Initially my Rheumi suggested to split dose and can not remember his reasoning behind this.

Maybe because it is a slow release capsule over 7 hours. Unsure and only a supposition on my behalf.

Since day three of taking my hydocort. just about most of pain under control with the exception of my neck and lower spine. Once I had had strengthening injections in neck and lower spine I seemed to gradually improve pain wise, so I count myself really blessed that I can get through the day without pain.

I still certainly need to be very careful with my neck for what ever reason. Prior to PMR never knew neck issues - I digress.

I am due to see Rheumi in just under 2 weeks and usually take a list of questions written down as I don't trust my short term memory one ounce - I have just added the split dose query.

Kind regards once more.

[PMRpro Ambassador in reply to Megams]

I agree with Celtic - I'd take the most in the morning when the new inflammation has started up - it is a daily renewal, hence the reason for long term use of steroids. But really it depends on what suits you best - some people can take their pred in the evening and it doesn't stop them sleeping and gives them a good result.

[Megams in reply to PMRpro]

Hi there PMRpro - good to hear from you.

My sleep has certainly been disrupted since my hyrdocort intake.

I take morning dose (15mg) about 9am and afternoon dose (15mg) about 4pm to 5pm - I notice the later the better as I have been waking around 4am (mostly) since being on the meds.

Maybe I could try taking afternoon dose with my evening meal and see if I can get through to 7am with my sleep?

Waking up in very early hours and trying to get through my day just not bodes well for marital bliss nor any form of saneness on my behalf.

I digress as I always do.

[PMRpro Ambassador in reply to Megams]

Try an afternoon nap - even a short one if that is at all possible. Counter-intuitive but often that helps avoid over-tiredness.

[Megams in reply to PMRpro]

Yes sometimes I just have to lie down and feel so much better for a short nap - I've given myself permission despite feeling a little guilty initially. I've got over myself now & moved on as to what others might think.

Of course there are times I can't fit in a nap - swings and round abouts.

Cheers again.

[Reneej]

I was told the pred wears off in 16 hours. I first started taking 15 mg in the morning and by 2am and the next morning, I couldn't move! I went back to 20 mg split throughout the day. I just decreased to 15mg (after being on 17.5 for a week) and I spread it out over the day (8am, 3:30pm, 11pm). It absolutely works! I plan on being on 15 mg for 3-4 weeks before lowering to 12.5, and will also spread it out during the day. The pred doesn't affect my sleep so I don't mind taking it at night. I would probably take the lesser dose mid day.

[Megams in reply to Reneej]

Hi Reneej

Thank you for your insights.

It is always interesting to read of others like your good self and how your body deals with your split dose.

Unfortunately for me I can not split my dose successfully unless I have a capsule made up in a lower dose.

I can't cut this in half probably like Preds?

The reason being is that I am taking hydrocortisone which is made up in an acid resistant capsule to protect my stomach due to history of GI issues and problems I had when 1st put on uncoated Preds plus PPI's. All no good and ulcerated gut lining as a result.

I am paying dearly for this meds to be made up but small price to pay to enable me to tackle other PMR issues and meds side effects.

I am planning to taper once we are well past our winter and into warmer weather as struggling with on-going respiratory virus's which is a daily challenge for me.

Love to hear from you and thank you once more.

[PMRpro Ambassador in reply to Reneej]

Actually anything from 12 to 36 hours depending on the person - I'm a 36+ hours person and could manage taking double pred on alternate days! I don't now though.

[Megams in reply to PMRpro]

Goodness me, I am surprised by that - I learn something every time on this site and did not know that could be done.

Thanks again

[PMRpro Ambassador in reply to Megams]

It's a recognised way of taking pred for some illnesses as it reduces the side-effects because your body has long periods without any pred in your body while the anti-inflammatory effect continues.

[Megams in reply to PMRpro]

Interesting and that makes sense to me.

For those extra sensitive, by taking double wouldn't that magnify the side effects?

[PMRpro Ambassador in reply to Megams]

Not really since it is excreted from the body quickly - it is the time it is present in the body that causes the problems.

[Megams in reply to PMRpro]

Thank you PMR pro, that answers that with clarity, I have a greater understanding every time with these questions I ask - appreciated your feedback as always

[Reneej]

That good to know! I hope when I get down to under 10 mg I'll be able to tell itonce a day! Thanks! I love this site because of all the info, but sometimes it scares me not knowing what to expect!

[Megams in reply to Reneej]

Absolutely Reneej and I feel most privileged to have found this site as we have absolutely nothing like this or any PMR support in NZ other than requesting via Arthritis NZ to speak by phone to a lady with PMR in the Sth Island which is a very long way from Auckland.

It amazes and concerns me at the same time!!

[Whittlesey]

Have had pred upped to 4 MG's. Have been breaking it in half. 1/2 in the a.m. and the other at night. Hopefully the taper won't be so difficult.

Best to all

[Megams in reply to Whittlesey]

Thank u Whittlesey for your response - interesting to know this works OK for you too.

Kind regards

[Whittlesey in reply to Megams]

Thanks, Megan. So far, it does. Luck and health with your taper, too. All my best to you, Wbittlesey

[Megams]

Oh Elizcarroll this is no good - doesn't help our cause much does it?

So pleased sleep is improving with reduction of Pred as well as being able to go back to sleep after 3 to 4 hours.

When this happens to me I reach for an half of the Melatonin tablet my Dr prx'd, washed down with a cup of milky hot chocolate drink - does help some of the time.

Kind regards