High dose Pred advice

[clachaig]

I am on 50mg a a day, taking three times daily after meals and spreading relatively evenly 30,20,20 to minimise stomach problems.

I have since read that it might be better to take more in morning after breakfast and fewer later which might benefit sleep and perhaps reducing other side effects.

Would appreciate advice from anyone’s experience or second hand knowledge? Thanks

[SnazzyD]

Hello. Is your doc happy with you breaking up the dose? For GCA it is normally advised to do one dose a day. The other way to look at it, is one dose allows a break from the stomach irritation whereas giving it still fairly reasonable doses three times is not. What sort of stomach protection measures are you doing?

[clachaig in reply to SnazzyD]

Thanks. As far as I can remember I have never been advised to take all at beginning of day. I assumed that spreading the dose would be best. I am now thinking of 50,30,20, but your response suggests 100mg after breakfast might be better.

I am on esomeprazole and up to now I have had no problems with indigestion

[Theziggy in reply to clachaig]

You say that you are on 50mg a day but all your calculations seem to add up to 100mg per day "I am now thinking of 50,30,20"

[clachaig in reply to Theziggy]

Sorry meant 5 mg tablets, of which perhaps spreading 5,3 and 2, 50 mg in total. At the moment taking 4,3,3 mg. sorry about confusion.

But would one dose be better and advised?

[Hidden]

You may have meant 30-10-10? I split my dose to a.m. & p.m. at docs recommendation when I was having night symptoms after taking it all in the morning. It helped as far as symptoms, but it messed up my sleep even more. Once the symptoms were under control for a few weeks(?) I did a.m. and afternoon, then eventually back to all in the a.m.. It worked for me.

[clachaig in reply to Hidden]

Thanks Dreamer43,

Your experience suggests that perhaps earlier doses might be helpful- either am or am/pm.

Seems to be more trial and error and listening to the body’s response to changes in dose as long as the Pred dose in 24 hours remains unchanged.

Thanks again

[Hidden in reply to clachaig]

Yes, that's it! Good luck!

[DorsetLady PMRGCAuk volunteer]

Hi

For GCA not really recommended to split dose - although there are various view - but from a personal point of view I think one dose deals with it better. In the morning with or after breakfast.

At 50mg you are likely to get sleep disturbances whenever you take it.

As you are on a PPI then you shouldn’t get problems unless you are specifically susceptible to digestive issues.

[clachaig in reply to DorsetLady]

Hi DorsetLady,

Thanks for your help. Do the sleep disturbances you refer to, if dose taken early, mean feeling sleepy early or later?

Regards

[DorsetLady PMRGCAuk volunteer in reply to clachaig]

Personally I found on high doses (60mg) that I went to bed at normal time (between 10-11pm) and slept fine until around 3-4am) - and then once awake then there was no further sleep that night!

But as I took it in the morning I can’t say whether it would have been different if I’d taken it at night - but I would imagine if the Pred is at its peak it would be more problematic- just a thought!

Others seem to have different patterns - so there’s no one simple answer.

Fortunately mine only lasted about 6 weeks - but I did occasionally take an ‘over the counter’ sleeping aid about every 4th or 5th night. Enough to give me a good sleep every so often, but not enough to be addictive- recommendation of GP.

[clachaig in reply to DorsetLady]

Hi,

Thanks. Your sleeping pill suggestion seems to be an practical , more helpful and less unhealthy option which I think I may follow.

Thanks and regards

[DorsetLady PMRGCAuk volunteer in reply to clachaig]

Hi,

Not sure where you live - but if in UK -I purchased Nytol from local pharmacy. But sure if you ask pharmacist they will steer you in the right direction.

[PMRpro Ambassador]

In GCA, in particular, the hit of one single dose, achieving a much higher blood level is felt to be important.

Always look at the pack and see what the dose per tablet is when writing about dose. Now it is obvious you are on 50mg, I think you need to try a single dose and see how you get on. I do appreciate the positive of splitting the dose may have for your stomach but the GCA is what matters at present and it need a sledgehammer not 3 tackhammers!

[clachaig in reply to PMRpro]

Thanks PMRpro,

Your advice helps to focus on the importance of GCA with your hammer analogy.

Unfortunately my current side effects are more PMR related with fatigue, dizziness and disorientation even with the very high overall daily dose.

Nevertheless, my inclination is to move towards front loading of the dose and see what see how my body responds.

Is there any evidence that this approach could also help with my more PMR related symptoms?

[PMRpro Ambassador in reply to clachaig]

"Unfortunately my current side effects are more PMR related with fatigue, dizziness and disorientation even with the very high overall daily dose."

Unlikely to be PMR- related at that dose and all of them can be adverse effects of high dose pred. Fatigue is a given I fear, apart from pred-induced euphoria and the Duracell Engergiser Bunny effect in some people the pred has little effect on the fatigue of autoimmune disease and it is something that has to be "managed":

healthunlocked.com/pmrgcauk......