Splitting dose

[marigolds]

I am wondering if anyone hsd tried splitting their dose of Predisalone?

[Slowdown]

Hello marigolds, yes I am a 'splitter' : there are some things to consider first, though. I have had PMR for 3 years so plenty of time to experiment with what works for me. It depends whether you're taking plain or gastro-resistant pred (coated). At present I'm on 9.5mg coated which I take 7.5mg around 8a.m. and 2mg before bed which means they release in time to deal with the inflammatory cytokine 'dump' about 4a.m. You do have to experiment a bit to get the split right, generally two-thirds a.m. one-third p.m. seems to be optimal.

I think if you have GCA it's recommended the whole dose is taken in the morning.

[DorsetLady PMRGCAuk volunteer]

Hi marigolds,

as slowdown says, some do split their dose, but there is usually a good reason to do so as it recommended to take in morning, definitely a no, no if you have GCA though.

You can look at related posts - on right of screen.

It would help us to advise if you gave a bit more info -

what you have, PMR or GCA,

dose you started, date you started, dose you’re on now,

why you asked - are you having problems.

[PMRpro Ambassador in reply to DorsetLady]

You just reminded me - I found a research paper the other week that said they found no difference in GCA patients taking their pred in a single dose or in split ones!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Thanks, that’s interesting.

[PMRpro Ambassador in reply to DorsetLady]

I thought so too. Makes sense though - if you get a return of symptoms during the day surely that suggests there is some inflammation going on?

[Hidden]

Hi marigolds

I split my dose last year as we were going on a Cruise to the Far East & needed to be up, in the Theatre most mornings by 7am to join our tour for the day.

I knew l couldn’t manage that so about a month before l went split my dose 2.5mg coated Pred around 11pm then 5mg uncoated in the morning. It worked for the Cruise & l stayed on it when l got home for a couple of weeks but then returned to all in the morning as l wanted to start reducing again.

I got back to 5mg but currently back at 7.5mg the old, old story!

Good Luck with whatever you decide to do! 🍀

I didn’t mention it to my Rheumatologist l ‘forgot’ 😉

Mrs N 💅🏼

[PMRpro Ambassador]

My impression on the forums is that even rheumatologists now seem to be suggesting splitting the dose - possibly after a patient tells them how much better it works for their pain control.

The antiinflammatory effect of pred lasts for between 12 and 36 hours - if you are someone who is to the higher end of the time span you will manage fine with a single dose but if you are nearer to 12 hours you will have a return of symptoms before the next dose. That is when splitting makes sense - or if you find you have problems after taking it as a single dose but not with 2 lower doses.

[Berylholley in reply to PMRpro]

Sorry I have not replied before but I had an appointment for blood test. It will be interesting to see if there are any markers as I didn't get any last time. I was diagnosed with PMR and also had jaw stiffness so my doctor put me on 40mg. When I reduced the dose to 35mg on the 12th day (that was on advice of doctor) I was great for 3 days then developed a lower back problem, couldn't get sitting up to get out of bed, muscle spasms, trouble with waist and spinal pain. Went back to 40mg. Have my first appointment with Rheumatologist on 21st June.

[Mgt1234]

Hi, I have PMR and GCA, I struggled to reduce my Prednisolone, every time I got down below 12mg I had a flare, however, about 2 years ago I decided to split my dose and am now on 6mg in the morning and 5mg in the evening. My Rheumatologist agreed the change and it works for me. Good luck.

Margaret x

[Berylholley in reply to Mgt1234]

Hello Mgt1234

I was only diagnosed in May but the doctor thought I may have GCA with my PMR so she put me on 40mg,12 days later I was told to reduce to 35mg and 6 days later developed very bad lower back muscles problem because when I woke up I couldn't move from the hips up with bad spine pain. Managed to get out of bed with the help of a heavy large wardrobe I could hold on to. Still trying to get over it and am tempted to try the splitting as it might help in the mornings when I wake up. The only thing is whether it would be suitable for my high dose.

[PMRpro Ambassador in reply to Berylholley]

Shouldn't make any difference - I assume your doctor no longer thinks it is GCA?

[Berylholley in reply to PMRpro]

Prior to diagnosis had bad arm muscle, waking me in night,top & back of neck and shoulders hurting, I was worried about carotid artery as I had pulsatile tinnitis and thought it was perhaps connected. When I told doctor I was getting stiff jaw she wanted to send me for a biopsy but as my blood test did not have markers I thought it might not show so she gave me the 40mg dose and the next morning I woke with all pain gone. Felt wonderfull.

[Berylholley in reply to PMRpro]

On Thursday I had an appointment with the tinnitis clinic and all the stress (waiting about etc) made my problems in my lower back worse next morning when I got out of bed so I tried the split dose, third last thing at night and two thirds at 6 am. Next morning It was quite a bit better.

[PMRpro Ambassador in reply to Berylholley]

Promising!

[strathearn]

I take 5mg at 2am and 9mg at 8am and this seems to take me through the day in a reasonable shape - however, I have to have my afternoon nap!!

[Berylholley in reply to strathearn]

You are lucky on such a low dose. I hope I can get down to that.