Prednisolone dosage problem

[gannie]

I have been taking Prednisolone for 8 months now and for the past 2 months have been taking 8 mgs with no problems. I have always split my dose of prednisolone, taking part of the dose in the morning and the remainder at night but I recently read that it is best taken in just one dose. For two days I have taken the entire 8 mgs in the morning but now I am experiencing shoulder pain I, therefore, think it would be better to go back to my old method so the question I need to ask is, although I've taken 8 mgs this morning, would it do any harm to take another 3 mgs tonight and then 5 mgs tomorrow morning just to get back on track?

[SheffieldJane]

I think that is what I would do gannie. It won’t do harm or interfere with a taper. I am glad you have found a method that suits you. I think the advice is to definitely take all your dose at once if it is GCA because of the damage the inflammation can do, quite rapidly. We have more flexibility with PMR.

[gannie in reply to SheffieldJane]

Thank you very much, Sheffieldjane - That is most helpful and, perhaps a lesson learned for me, 'If it ain't broke, don't mend it'

[DorsetLady PMRGCAuk volunteer]

Hi Gannie

No problem.

As you say, if it’s works, don’t change it!

It’s more important for GCA patients to take their dose in one hit.

You are coming to what could be a slightly difficult time dose-wise, so stick with what’s tried and tested.

[gannie in reply to DorsetLady]

Yes, I will, DorsetLady, and thank you

[PMRpro Ambassador]

Shouldn't pose a problem - you'll just get a bit of a boost

At the start in GCA the single dose is advisable because of suppressing the inflammation. When giving pred otherwise, including for PMR, they say "all in a single dose in the morning" because a study showed there was more adrenal suppression with 5mg taken at night than 15mg taken in the morning. Doctors extrapolated that to mean that when patients were on pred they should always take it in the morning and all at once to reduce side effects (the half-life is only a couple of hours, effectively all pred is out of the body in 12 hours or so, leaving the body free of pred for 12 hours if you take it in one dose). That works well for patients on short courses, up to 6 weeks or so, less with higher doses. However - in the case of PMR, we are on pred at above 10mg for so long there is going to be adrenal suppression anyway. And if taking it as a split dose means you can manage the symptoms better, and possibly at a lower dose, that is good.

The only way you can find out if it works for you is to try - but to be honest, if you need to split at higher doses, then you are likely to need to do so at lower doses if the disease is still active. Once it isn't active you will be able to reduce the dose and once you are below 5mg, adrenal function will slowly return anyway.

[gannie in reply to PMRpro]

Thank you very much, PMRpro I understand now the complex way in which these things work. As always, you have been very helpful