Splitting pred dose

[Hollieby]

After reading a lot of you seem to be doing a lot better by splitting your dose to breakfast and bedtime, I’m going to give this a try. I’m in a lot of pain, neck, shoulders, arms, hands in the morning, I have to start with painkillers and my 4mg of pred, having had to go back up to after being on 3mg since December. I have already taken my 4mg this morning so should I begin by taking 2mg tonight or start fresh by splitting the dose from tomorrow? This disease is a constant battle, all advice greatly received.

[DorsetLady PMRGCAuk volunteer]

Might just as well start from tonight - but have you considered that 4mg is just not enough for you at the moment?

Could try 5mg for a week or so - if the split dose doesn’t help - 3mg am/2mg pm

Do the painkillers help?

[Hollieby in reply to DorsetLady]

Yes take co-codamol 30mg/500mg as required, they don’t take away all the pain but it reduces it in less than an hour to make it comfortable enough to move.

[DorsetLady PMRGCAuk volunteer in reply to Hollieby]

If that’s the case, then I would questionn if all the pain is down to PMR - normal painkillers usually don’t touch it.

Do you have Arthritis as well? Or what are Cocodamol prescribed for? - that’s a pretty high dose - just one of them knocked me out before I had my various arthritis joints replaced.

[Hollieby in reply to DorsetLady]

Yes it’s definitely PMR, usually the pred have it totally under control, it’s only because I have had a flare up that I have also needed to use pain killers. They were prescribed by my doctor, and no, I don’t have any other medical problems.

[DorsetLady PMRGCAuk volunteer in reply to Hollieby]

Ok. It’s just that it’s unusual to use a painkiller for a flare. Normal practice is to increase Pred for about a week or maybe two by 5mg above the dose you last felt okay - get the inflammation back under control and then drop back down.

[Hollieby in reply to DorsetLady]

Thanks for the advice, splitting the dose had no effect and after talking to PMRGCAuk volunteer today she has suggested the same as you said by going up by 5mg until the pain is back under control. Obviously I came down from 4 to 3mg too quickly! You never quite know where you stand with this condition, but hopefully this will get me back on track, thank you once again.

[DorsetLady PMRGCAuk volunteer in reply to Hollieby]

Come back down to 4mg or even 4.5mg not 3 as that wasn’t enough - and then decrease in 0.5mg steps. Much easier on illness and body and less likely to overshoot what you need.

The lower you go, the less “spare” capacity you have to play with, so it’s a very fine line between what is enough - and what isn’t!

[PMRpro Ambassador in reply to Hollieby]

It's also unusual for ordinary painkillers to touch PMR pain - might take the worst edge off but rarely more.

[madhouse1 in reply to Hollieby]

Up your prednisolone then as that’s will work far better than cocodamol for your pain for a while and then try reducing again once your pain is under control.

[PMRpro Ambassador]

I agree with DL