Hi. I was wondering if it is considered to take the 15 mg of prednisone as 3 separate doses throughout the day/night instead of taking them all as one complete 15 mg dose? A doctor friend said he wondered if that would be a way to manage any pain or discomfort at times just before the medication is taken. Any ideas on that?
Sue
Hi,
It's usually recommended to take as one dose in the morning then you get the full effect of the whole dose, particularly if you have GCA.
The most discomfort is usually early morning because the cytokines (which when not controlled cause your pain and inflammation) are produced every morning around 4am.
Some people do split their dose 2/3rd am, 1/3rd evening to get them through the 4am onslaught. Others put either the alarm on, or if they get up for a loo break take their dose before 4am so that the Pred is in the system reading for the release at 4am. They then go back to sleep whilst the tablets start to work, it can take an hour or so.
If you are getting symptoms throughout the day, then maybe you are not on enough Pred, or your body is not getting the full benefit of the dose (that does happen with some people), or maybe you are doing too much and not resting enough.
Just because you've started Pred that doesn't mean the PMR is cured it's not, there is no cure. The Pred is only helping the inflammation/pain caused by the underlying disease. So to that end, you have to adjust your lifestyle to take things easier, and that includes plenty of rest.
Sometimes you have to try different things to find what suits you, but in the case of PMR it is best to take as one dose - although I can see where your friend is goming from.
Hi, thank you for that. PMRpro recommends taking at 2am as this would ease the 4 am pain. What do you think DorsetLady?
I'm also now scared to split the dose in case gca could become a problem as I see that it is recommended to take full dose for that. I am still early days, 15mg, and managing okay, but I will take on board the rest time I should be taking as perhaps I'm trying to still do too much. Thank you, I appreciate all this feedback.
Sue
Hi again
Try the 2am route and see if that helps.
You have been diagnosed with PMR not GCA , so there is no reason to assume you will get GCA. Most don't. I only mentioned it because others who do have may be thinking about splitting their dose.
I think you'll find most that split their dose do so under the advice of the Rheumy and have PMR and aren't getting the best out of the Pred.
As you admit you may still be doing too much, try slowing down a bit. That and a change of timings may sort things out. Do hope so, and please let us know how you get on.
Thank you very much. I will try the 2am route and let you know.
Sue
No, the accepted way for PMR and even more so for GCA is as a single dose in the early morning. In fact, it is warned against splitting the dose in GCA.
The inflammation is caused by inflammatory substances being released in the body at about 4.30am. The sooner you take your pred after this the less the pred has to do. A study showed that the optimal time to take pred to avoid morning stiffness is 2am so the peak level of pred in the blood is achieved about 4am. Taking it as a single dose achieve a higher level at that time so deals with the problem better.
In some patients the antiinflammatory effect doesn't last the full 24 hours, it varies from 12 to 36 hours depending on the person. Then in PMR it often works well to split the dose as about 2/3 in the morning and the rest later to make sure the rest of the 24 hours is covered. But they are the minority.
Thank you, I appreciate all the feedback I have been getting. I just feel a bit frustrated. Sue
Hi, I have had PMR and GCA for several years. After struggling to lower my Prednisolone over many years, resulting in several flare ups, and in agreement with my Rheumatologist, I now have a split dose. I take 6mg with Breakfast and 5mg with Dinner. I have managed to maintain this dose for about the past 7 months. My trigger dose appears to be 10mg, despite every effort to reduce. My consultant is just pleased I have managed to get down and maintain with the dose of 11mg. I am very thankful we have such experienced and knowledgeable members on this forum as without their information I don’t think I would be able to manage this challenging situation. Splitting the dose works for me but please be guided by your body and your Rheumatologist as getting it wrong can start another flare up.
Best wishes. God bless.
Margaret x
Hi, thanks for you reply. I read that gca had to be taken in one single dose, so does it not worry you that you split it? Does it not make too big a difference to the gca symptoms? I'm still finding my feet with this condition, thanks for your patience.
Sue
Hi Sue, it was approved by my Rheumatologist and to date works for me. I think GCA itself is a challenging condition but time will tell.
Margaret x
Hi again,
From my understanding because GCA can have more serious affects -not that I'm saying PMR isn't serious - a full dose of Pred is considered more effective.
PMR usually affects the blood vessels feeding the main muscles in and around joints whereas GCA, along with shoulders may also affect the arteries in the head and torso. That means that if untreated or under medicated it can affect sight, coronary system and the possibility of strokes. A single dose is usually the recommended option, but of course if your Rheumy is happy for you to split the dose then fair enough, but it's not a decision the patient should make.
I suspect that at this low dose it probably makes little difference - but in the early stages the dose is supposed to be a single one. However - if someone is on a single dose and the symptoms return after, say, 15 hours it does suggest there is unmanaged inflammation present and either the dose needs to be increased or split so there is NO resurgent inflammation.
Hi, I've had PMR for 18 months now and have been splitting my dose for about a year now. I had such discomfort through the night I was being kept awake. I felt as if my Pred had run out. Splitting has worked for me and I now take 5 mg at night and 6 mg in morning. Not sure how I'm going to manage as I drop below 10 but it might be trial and error. I have my rheumy appointment on 2nd Oct, last saw him back in march so will see what his thoughts are. Mind you having said that back in march he'd never heard of splitting the dose!
I think you listen to how your body feels and ask questions especially on here. I usually then take that info to my GP! I still think I know more than him now about PMR.
Thanks. Sue
When first diagnosed in June and prescribed 20mg of pred. On box said to take with food so as they were 5mg tabs took 4 X day and had no problems . Did this for about a month and when next seen GP said they should be taken in one dose.
Prednisone levels
Prednisone and Antidepressants
Prednisone dosage /split
Shingles and Prednisone 
Prednisone reduction 
