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How, when and why in taking steroids: about Alternate Day Dosing and Dose Splitting

Mark has suggested I put a reply I wrote to a post as a thread. So here it is:

This was the question someone asked:

"... what an interesting article. It suggests that taking your pred every other day will help stimulate the adrenal glands . Has anybody tried doing this and if so with what effects?"

My reply was:

It very much depends why you are taking pred in the first place. Alternate Day Dosing is not recommended in GCA because it is felt there is inadequate management of the inflammation. If the dose is significantly above 15mg/day or for more than a couple of months then there will be adrenal suppression whatever pattern of dosing you try. It is mentioned somewhere that trials of using it in PMR didn't result in good symptom control.

It depends a lot on how long the anti-inflammatory effect lasts for YOU. It varies from 12 to about 36 hours in various people. If you are a 36 hour person then you will find symptoms creeping back in in the second part of the second day and overnight, Morning stiffness will be a problem until the next dose kicks in. People for whom the effect lasts nearer to the 12 hour end will have returning symptoms far sooner although with double the dose maybe later than just 12 hours but it is difficult to say exactly how long. These patients often find 2x daily works better to manage their symptoms - they are definitely not candidates for ADD!

I used ADD quite early on in my PMR journey and for me it seemed to work well except I struggled to get below 17.5mg/2 days without a flare. Was that the effect of the ADD? Difficult to say, but I had no side effects I was aware of. Then I had some blurred vision which COULD have been due to GCA so I was told to go back to 15mg and daily dosing. It dealt with the double vision, I reduced again but I've never tried ADD again.

The majority of PMR patients will get to well below 10mg and adrenal function will start to return once they are below their physiological dose. It is actually recommended that ADD not be considered until the patient is at 10mg/day or lower.

2 Replies

Brilliantly explained PMRpro - as usual :-)

It's a pity that gems of wisdom like this often get buried in the mass of long threads and aren't more accessible as Headline Topics. As has been said before, maybe something for the site architects to consider..?

Keep up the great work

MB :-)


I had a section of my own on the NE forum where posts of this sort that people felt were useful were collected together and sometimes amplified under a heading. Not just my posts - I would take other posts (with permission) and create a mini-thread of posts that were linked. It was very popular then. No way of doing it in the same way here - unless you go to my profile page and read my posts. Since I rarely start a thread unless it is like this they are easy enough to look through the couple of pages and most of the posts are quite significant info.

In fact, if anyone were to request a particular subject I could compile something suitable.


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