Question about splitting prednisone dose

[Navion]

I have been on prednisone since May (15 mg.) and have never been able to reduce below 12.5 without my symptoms returning and my CRP and ESR climbing back up. Until now, that is. A month ago my doctor said to try splitting my dose. I am now taking 7 mg first thing in the morning and 3 with dinner. I feel much better and my ESR is normal and my CRP, though still above normal, is down from 23 to 9.

My questions are, what should I do when trying to reduce? Should I drop just the morning or evening dose, or drop both?

Also, is there a dosage where you should stop splitting the dose? I thought I read that under 5 mg you should not split?

Thanks

[123mossie]

Watching for replies with interest.

[PMRpro Ambassador]

I personally don't think there is a lower dose where you should stop splitting if you need it. Provided you take the later dose in the early evening the blood level will be down low enough by midnight for the feedback system to still work.

As for which to reduce - probably alternate at first. Drop the larger dose one time, the smaller the next. But you will have to experiment a bit to find what works for you because everyone will be that bit different.

[Lochy in reply to PMRpro]

As one who ‘splits’ can you please explain the feedback system ? I tend to take my doses morning c.8 am and bedtime c.10.30ish. Thanks

[PMRpro Ambassador in reply to Lochy]

The lowest level of cortisol in the blood is at midnight or so - that triggers the pituitary gland to signal that the adrenal glands should produce cortisol in the early morning. If the blood level is too high then that trigger doesn't happen. If you could shift yours forward so earlier in the morning and also earlier in the evening it should trigger the adrenal function better. It is also the reason for taking the larger dose in the morning.

[Lochy in reply to PMRpro]

Thanks for the explanation I wasn’t aware of that. I’ll try what you suggest.

Happy Hogmanay to you all. X

[bunnymom in reply to PMRpro]

So I've been talking 3.5 at 7 am and 3 at 3 ish am when I wake up for a bathroom break. Should I move it to 930 or 10 pm instead? ( My night dose that is)

[PMRpro Ambassador in reply to bunnymom]

You mean 3am I take it?

No - that is ideal if that is what you are doing at present. By taking it all early in the day the level at midnight will be low

[bunnymom in reply to PMRpro]

Got it thanks. Happy New Year 🎉

[Linny3 in reply to PMRpro]

how early in the evening?

[PMRpro Ambassador in reply to Linny3]

Depends on how much it is - and how well it carries over to the next morning. There is no point taking it so early the pain is back before the next dose is due.

[Lochy in reply to PMRpro]

Just thinking as I wake up on New Year’s Day what are the optimum times for the split? 7pm and 7am? Or can you recommend please. It can be my New Years resolution to try a new regime.

[PMRpro Ambassador in reply to Lochy]

What works for you. A usual split is 2/3 in the morning, as early as you can manage and then the rest at least 1-2 hours before you would expect symptoms to reappear. Or as early in the day as allows the effect to carry over to the next morning - the earlier it is the less likely it is to interfere with sleep.

[Blearyeyed]

Personally I think a bit of alternation is key in tapering on split doses . And that it's altering is very individual to what continues to work for you.

So , if I was on your dose at the moment , I may go with reducing by 1 mg in the morning for the first taper , creating a perfect two third , one third split dose.

I would probably try to reduce the evening dose next from 3 to 2.5 .

If that worked I may try another 0.5 from the evening but if it felt that this was creating more symptoms , return to 3 mg in the evening but continue the reduction from the morning dose again instead .

As I say it will involve more Personal Management , and perhaps keeping a proper log in a little note book of your daily Pain level on a 1-10 scale and writing specifically where the pain comes up so that you can look back over a few weeks if new pain emerges and so altering your dose to cover the hardest time that you feel yourself while still managing to maintain the reduction over a month that is part of your Tapering Plan.

As Pro says , if your body is used to a split dose you would not necessarily be better off if you suddenly started taking your dose just in the morning or evening . At a month on 5 mg you could of course choose to experiment trying to take it in a single dose for a few weeks

trying at first in the morning , or if that didn't suit moving to the evening with a few days split dose again in between to stop you having a long period without Pred on one day . If neither time felt right for you as a single dose then I'd continue to split , probably at least until I had reached 3 mg and was coping on that dose comfortably without additional non PMR issues or Fatigue from the Adrenal Changes to the body resuming it's full role.