Dr. said take it twice a day [new rheumatologist] but previously to this flare up i was taking 20 mg. in the a.m. Is there any difference at all? I keep thinking I will try the 2 a.m. dose but haven't awakened yet for that. I don't have a lot of trouble sleeping.
Right now, I am still taking the 20 mg. in the morning all at once. Pain if finally gone from the flareup but stiff?? whoa, until I hit some stairs or loosen up..........
Hi,
Did Rheumy give any reason for splitting dose?
Usually we recommend it, if the patient doesn’t seem to get relief all day, or is having particular problems first thing in the morning. 2/3rd of dose in the morning, 1/3rd evening - so in your case 13mg/7mg if you have the appropriate tablets. If not you could try 15mg/5mg split - if you do 10mg/10mg it may disrupt your sleep.
You can only try and see - very often it’s a case of trial and error. Good news the increase is helping, but you must still be aware PMR is very active! So rest as much as you can.
The received wisdom for dosing in both PMR and GCA is as a single dose in the morning. This is felt to affect adrenal function less and sleep disturbances are lessened - the work originally will have been done for more usual uses of pred which is short term, maybe up to a month to 6 weeks on a taper. In our case, we are going to be on high enough doses for long enough (above 10mg for many months, even years) for adrenal suppression to be inevitable. This means it makes more sense to take the pred in a way that manages our symptoms best.
The antiinflammatory effect of pred lasts 12-36 hours depending on the patient. So, if you are towards the 12 hour end, you may experience breakthrough pain and stiffness before the next daily dose is due. Then splitting the dose to extend the effect makes sense - but the usual advice is not to split it 50/50 but take maybe 2/3 of the dose in the morning and the rest later, about an hour before symptoms reappear if that is during the latter part of the day. This also is felt to help reduce sleep disturbance. But it is also OK to experiment a bit - some people do well taking all the dose immediately before bed, good mornings and no sleep problems.
As in everything with PMR - we are all different.
You’ve probably got to try and see what works for you.
For me, taking my coated pred at bedtime makes all the difference. I’d need a higher dose if I took it in the morning.
I have been following "doctor's orders" for 5 weeks now, taking all my Pred around 8.00am in the morning - I only have the uncoated tablets, currently 12.5mg. Morning stiffness up to mid-day has been a problem. Last night, as an experiment, I took the tablets at 2.00 am as I was awake then anyway. Result? Felt like a new Spring chicken when I got up, but I'm not sure how I'll feel by this evening. Keep experimenting, but give each change of timing at least 3-4 days to see how you go. Good luck.
Prednisone
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TIMING OF 55 MG OF PRED...OR SOMETHING ELSE?
