My plan was to reduced from 20mg to 17.5 two days ago, but I decided to delay it. A bit of history for those who have not read my previous post. Diagnosed with PMR 22 days ago, put on 50mg for 7 days and been on 20mg since. I've been drinking night time tea and sleeping better, but my problem is in the morning. It takes me 4 to 5 hours before I can start moving. I have pain in my shoulders, upper arms, and really bad in my thighs. Just a month ago I used to look forward getting up in the morning to go fishing, now I just hate it cause I know what I have to deal with. Is it possible I need to be on a higher dose to settle this down? Not seeing my doctor till September 22, but I will ask him then.
Thanks for reading,
Gil
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Ligtocicar
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How early in the morning do you take your pred? The best time is to take it as early as possible - it takes about 40 mins to 2 hours to be absorbed and start to work, depending on the person. Your body sheds a new dose of inflammatory substances (cytokines) at about 4.30am and the optimum time to take ordinary white uncoated pred is 2am - it is present in the body when the cytokines are shed and they never get to cause inflammation at all. Some people do actually get up and take their pred in the middle of the night but the next best thing is to take it a couple of hours before you would normally get up, say 6am, and then settle down for another rest so that by the time you want to get up it is working and the morning stiffness won't last so long.
Alternatively, some people find that the antiinflammatory effect of pred doesn't last the full 24 hours for them (it is 12-36 hours depending on the person) so they take most of their dose in the morning but reserve about 1/3 to take in the evening. Once you get the balance and the timing right this reduces the morning stiffness.
I had 5 years with no pred (not diagnosed) and found that if I fell out of bed in the morning and got into a swimsuit before I cooled down and crawled to a warm swimming pool, after an hour of aqua aerobics in a warm pool I could move almost normally - the pain was still there, the stiffness less so. Others found using an electric blanket in bed BEFORE getting up helped, especially if they then had a warm shower and did gentle stretching exercises in the warmth.
Think some of us replied to earlier post saying that your reduction to 20mg was very quick. As things seemed to have got worse since your last post, then certainly a reduction is a no-no. In fact as you suggest - an increase might be a better idea, you could try going up to 22 .5mg , and maybe split your dose, some people find that helps with the early morning.
Why don't you try 5mg or 7.5mg at night with the remainder in the morning? As you are seeing Rheumy in 3 weeks, your new dose will have had time to work - or not, by then.
I will probably try splitting the dose, but I can't increase because I will run out of before my next doctors appointment. Thank God for this support group.
You can always get emergency supplies from a pharmacy as it is dangerous to just stop taking pred. Usually showing them the packet is enough to prove the need. I'm slightly appalled that you don't have enough to give you a reserve - what happens if you can't get to that appointment?
My regular doctor was off when I went last time. (his father passed) I went last time. The other young doctor just gave me enough, because he figured I could drop 5mg every two weeks. They really don't know much about this disorder. In Canada you can get it from the pharmacy, if you have repeats on your prescription. (which I don't) I'll try to call him on Tuesday when he's back.
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