PMRGCAuk
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Cumulative Prednisone

When taking Prednisone, is it cumulative in the veins. In other words, how long does a daily dose last. As an example - If you start with 19mg on day one and 18mg on day two, does day three start at 18.5mg before you take another 18mg?

Is there research on this subject?

Thanks

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The length of time Prednisolone remains in the blood stream varies from 18-36hrs, depending on the individuals metabolism. Hence why some people wake very stiff and painful in the morning, whilst others don't struggle as much. Hope this helps 😀 Runrig x

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Thanks - It does.

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Pred itself remains in the body for a few hours but as runrig says, its effect lasts for anything up to 12-36 hours depending on the person.

Pred is what is called a moderate acting corticosteroid - some are short acting, such as hydrocortisone, and need to be taken more than once a day while others stay in the body longer and have effects that last for more than one day. Pred is used because for most people a single daily dose is enough and that improves patient compliance. It also leaves the body free from the influence of the steroid for longer between doses and that reduces side effects to some extent. However, for some people the effect doesn't last the full 24 hours and they sometimes split the dose to get better relief from symptoms.

By the way, GCA doesn't affect veins, it is the arteries that are affected, it is an arteritis.

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Thanks for your reply. My wife is struggling with just a drop from 19 to 18, which took us 24 days of gradual reduction based our new plan. She takes her dose about 8:00AM, and mornings are her worst with pain. Some improvement as the day goes and a couple Rum & Cokes at Happy Hour has her feeling better. I just we could move Happy Hour to the morning!

Thanks Again

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Now there's an idea - which the Italians do do! The elderly gentlemen are always to be found in the bar by 9.30am for the papers and their glass of wine...

Mornings are always the worst - the inflammatory substances (cytokines) that lead to the inflammation, stiffness and pain are shed in the body at about 4.30am. A study showed that the optimum time to take ordinary white non-coated pred is at 2am - the peak level in the blood is reached by 4am or so and the inflammation doesn't get a hold. Many people set their alarm early, take their tablets, and then settle down for another couple of hours - by which time the pred is starting to work and falling out of bed is easier ;-) I am on lodotra, a form that you take at 10pm and which then releases at 2am in one lot, achieving the peak in the early morning - I find it outstanding.

Another option is to split the dose, taking part immediately before bed - and that rarely disturbs sleep any more than it is anyway. Some doctors approve and suggest it - others have a fit at the idea. That is based on the fact that another study showed that 5mg taken at midnight is associated with more adrenal suppression than 15mg taken at 8am. However, that really only applies for short-term use of moderate dose pred - we are on pred at high enough doses for long enough for the adrenals to be suppressed anyway, whatever time and whatever pattern we take our dose in, until we get down to well below 10mg/day. So it makes sense to find the pattern of doses that fits us best - as Charlieboy says, everyone is different and a bit of experimentation is worth it.

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Great input! Will check on Lodotra.

Thanks So Much,

Jim

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Not sure where you are.

It is far more expensive than other forms of pred. If you are in the UK it is only available privately and a dose of 15-20 mg/day would cost up to about £100 - it isn't approved for PMR, just RA and even there they have been told to not prescribe it on cost grounds. Each dose costs the same whether 1mg, 2mg or 5mg and you have to combine them to get the right dose - they can't be cut because of the coating.

I do know someone in the US who is on it - it is called Rayos there and it will depend on your insurance.

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We are either in FL or SC during the year. Will check on the cost of Rayos today.

Thanks Again

Jim

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Checked on the cost of Rayos. It is available, but the cost is $2000 for 30 tablets!! Won't go that direction.

Thanks,

Jim

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WHAT?????? Dear god - I'm very glad I don't live in the US is all I can say! 30 tablets would cost me 28 euros if I had to pay for them myself...

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We are considering getting capcels and filling them ourselves. Got that from one of the repliers. Also considering splitting the dosage between late night at about 1/3 and early morning at 2/3. What do you think?

Thanks So Much,

Jim

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I think if it were me I'd start by splitting the dose, as being the simplest. Everyone is a bit different (I know, I keep saying that), some people con't tolerate the capsule materials or the time they take to break down is variable - some are simply designed to take the medication through the stomach without breaking down to irritate the stomach lining and then break down slowly, unlike the Lodotra coating. There are some people who take all their dose at night and it works well so that is also an option.

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Thanks again. We will start with 3 mg tonight and 15 tomorrow morning. We are at 18 and will go to 17 on our slow boat on Thursday.

Thanks So Much,

Jim

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Hi Jim,

I asked the same question when I was diagnosed with pmr just over a year ago, and got the same answer from PMRpro!

For me the pred takes about 4 hours or so to kick in, and then lasts about 12 hours. I have consequently tried various times for taking the pred sometimes splitting the dose, and sometimes not. Currently I am on 7.5mg, and take 5mg at breakfast, then 2.5mg after lunch. I realise this might seem a bit strange, but, from trial and error, it works for me.

As you read these posts, you will note that we are all different in the way we react to the pmr, and to the pred. The best thing about the forum is that it has enabled me to "manage" the pmr by myself, with minimal visits to my GP.

Good luck.

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Thanks for your input and good advise.

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Hi Jim

I am in the UK and both my GP and rheumatologist refused to prescribe enteric coated for me when I asked for them. I now put the plain white tablets into empty enteric coated capsules for each dose. I buy them on line if that helps. I take 5mg before bed and 2.5mg (half a tablet) in the morning which works best for me. Good luck.

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Good idea. We checked on the Rayos drug (US name) and it cost $2000 for 30. Won't go that way.

Thanks, Jim

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