Splitting the dose

[Pippah45]

Rheumy told me to split the 50 pred into 2. Any tips? With food? Bedtime? (doubt that's a great idea?). Just done second half with carrot and cream cheese.

[DorsetLady PMRGCAuk volunteer]

Hi,

I see you’ve had a chequered time so far, but a month ago you said you were on 15mg. What has happened in the interim to rise to 50mg?

If GCA is suspected then splitting the dose is not usually recommended early days - so do you know why Rheumy has told you to do this?

If he has a good reason, and one assumes he does - the usual, recommendation is normally 2/3rd am, 1/3rd evening. So 30mg with or after breakfast - 20mg with or after early evening meal. If you leave too close to bedtime then sleep may be affected, but on 50mg per day it is likely to be anyway!

Good luck

[Pippah45 in reply to DorsetLady]

As you say this journey has been on and off! The 15 wasn't touching the jaw pain that got worse although pelvic pain was much better. Then raised blood vessels at temple and jaw area so dose crept up. I was happier creeping up than being hit by the ,60 they chucked me on in March that hit me like a sledge hammer! Well that plus the Doxazosin deemed necessary. She wants me to do 2 weeks at 50 split then reduce to 40 split 2 weeks then 30 in one dose.

[DorsetLady PMRGCAuk volunteer in reply to Pippah45]

Ok, good luck with that.

Pains usually are worse early morning until the Pred kicks in - so she may have a point. Hope it works for you.

[PMRpro Ambassador]

Although there is some evidence that it makes no difference for most patients, it is not recommended to split the pred dose in GCA. As DL asks - has he a good reason?

[Pippah45 in reply to PMRpro]

The only reason that springs to my mind is to keep some pred in the system through the 24 hours. My painful temple area seems worse early morning so I kind of rush to take the meds at breakfast?

[PMRpro Ambassador in reply to Pippah45]

Some doctors agree with my feeling - if you are experiencing a return of symptoms during the 24 hours until the next dose is due it suggests that the anti-inflammatory effect is not lasting the full time. It can vary between 12 and 36 hours depending on the person. If the inflammation is resurfacing it seems to me you need pred more often.

[Pippah45 in reply to PMRpro]

Thank you very much. Splitting the dose makes sense to me. Apart from sleep deprivation that is! But I had that badly at the beginning on one dose. 6.5 hours sleep last night so not grumbling! Time release preds would make sense. Hey ho.

[Pippah45 in reply to Pippah45]

I seem to be ok on split dose but now I see Rheumy has said to drop from 50 to 40 for two weeks. Then down again. I still have discomfort and a bit of swelling in the temple/jaw area and my left eye isn't quite perfect till late afternoon (maybe cataracts not GCA?). I would prefer 45 this week and 40 next. Any reason why not? I did 45 today, should have been yesterday but it was a very stressful day. Thank you.

[PMRpro Ambassador in reply to Pippah45]

But if you still have symptoms you should be wary about reducing at all - have you been better than you are now?

[Pippah45 in reply to PMRpro]

Well I think the discomfort/slight swellings in the jaw area are symptoms? Not something I have had before anyway. I can live with them happily as long as my eyesight is safe! Inflammatory markers at last blood test were lower than in years. So I will see how 45 goes for a few days. I should perhaps have stayed at home for monitoring blood tests etc. But getting away seemed important too! Thank you so much for being there!