Splitting dosage advice~~please~!: I've been taking... - PMRGCAuk

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Splitting dosage advice~~please~!

Grammy80 profile image
27 Replies

I've been taking 8 mg per day and my rheumy wanted me to drop to 6. Well, last time that did not work very well and after reviewing the 'UK-Way', he agrees.

My question...is has worked best for me to split my doses with 1/2 about 7 am and the other 1/2 about 5 pm. Is it better to take the larger dose in the am or pm if they can't be split equally? I only have 8mg and 4mg tabs to work with, the pharmacy said they don't have any 1mg.

Thanks you all...hope all is well💗💗

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Grammy80 profile image
Grammy80
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27 Replies
scats profile image
scats

Hi Grammy, I can only says what works for me. I take the larger amount in the evening about 7, they are enteric coated so take about 6 hours to become active. I find uncoated pred taken then will give me gastric problems and I don't want to add to my meds. The smaller amount I take with breakfast and this includes any uncoated I need, if necessary I will split a tablet to get the right dose, but this can't be done with the coated pred. Hope this helps.

Grammy80 profile image
Grammy80 in reply to scats

Thanks, Scats...have a good weekend~! xo

scats profile image
scats in reply to Grammy80

Thanks, Same to you. The weather's nice, hoping to get some gentle gardening done

Hildalew profile image
Hildalew in reply to scats

Did you mean to say you can't split uncoated tablets? I thought the opposite was the case.

scats profile image
scats in reply to Hildalew

Yes you are right, thanks for pointing that out, I will change it.

Grammy80 profile image
Grammy80 in reply to Hildalew

For me....I want to go from 8 to 7mg in a very slow taper. All I have is uncoated 8mg and 4 mg tablets. I cannot cut those cleanly to know I'm getting 1mg.....but thanks to the forum I have a list of companies that the pharmacy can contact to get some of those little fellas.

Have a great day~! xo

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer

Hi

Couple of points -

Drop from 8mg to 6 mg is too big - thats why it didn't work last time - why does he think it will this time?

There’s no reason why the pharmacy cannot order 1mg - they might not hold them normally- but that doesn’t mean they cannot get them. Ask the question.

Usual recommendation is approx. 2/3rds am:1/3rd on split, but not usually recommended for GCA. But if it suits you, then carry on.

If there is no possible way to get 1mg tablets maybe try the ultra slow taper shown in this link - I did devise for someone in States who had same issue with 1mg tabs - healthunlocked.com/pmrgcauk...

PMRpro profile image
PMRproAmbassador in reply to DorsetLady

Medrol/methylprednisolone doesn't usually come in 1mg tablets - it does come in 2mg tablets though

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply to PMRpro

Ok, thks. But ultra long taper might be useful in that case.

PMRpro profile image
PMRproAmbassador in reply to DorsetLady

Yup ...

Grammy80 profile image
Grammy80 in reply to DorsetLady

This information is so helpful, actually, it is what I shall do. For some reason...beyond me...it has been like pulling teeth to get the script for two mg.

I'm determined not to cut by 2mg...and use your prescribed method. I'm going to do it really slow and alternating days as the program lays out. I feel good on the 8 but I do think my body would appreciate it if I gave tapering another go, but I'll do it s-l-o-w-l-y and not by 2mg!

You are a God sent.....xo, Marilyn

Grammy80 profile image
Grammy80 in reply to DorsetLady

I had to share...I chuckle each time I read this from you....."It didn't work before........"

Love it~!!💖

PMRpro profile image
PMRproAmbassador

You are on methyl prednisolone/Medrol aren't you? Medrol DOES come in 2mg tablets. That would be one step better!

The usual suggestion for splitting is 2/3-ish in the morning and the rest later. But really it is a case of experimenting a bit to find what works best for you.

Grammy80 profile image
Grammy80 in reply to PMRpro

Thanks for all your help!! I just wrote the rheumy another message through my electronic chart for the 2 mg. He isn't in on Fridays but I'll follow up on Monday!!

Have a good weekend...and I just can't express how grateful I am to all of you!!💖

Luciejc profile image
Luciejc

Hi Marilyn, I'm right behind you with tapering prednisone and on Actemra also. I was on 9 and my Dr. wanted me to drop by 1 mg. I was uncomfortable with that so I cut my 1 mg. in half for 8.5. Doing well so I will now go down to 8. Will continue taking full dose each morning. Good luck and I hope you can get 1 mg pills.. I will be taking a 5mg and 3 ,1 mgs.

Grammy80 profile image
Grammy80 in reply to Luciejc

Jean, I am so happy you are doing well~! That is fantastic...we were walking a wiggly path until we landed in England with this terrific group.

I'd love to know what pharmaceutical company manufactures the 1 mg. I deal with two pharmacies all the time and I'll bet I could get 1mg if I could send them in the right direction...in other words, I could tell them who does make it~! Could you find that info out for me?

This afternoon I wasted some fours trying to cut them down to one. I also find it interesting that you take it in one dose...I may give that a try also.

What a great post to hear you feeling so chipper and doing what is best for you. How long are you staying on each dose? I think I'm going with Dorset Lady's 'alternate days' plan.

I thank heaven every morning and night that I landed here and I bet you do too.

Be well..mask up!! xo💗🎉

PMRpro profile image
PMRproAmbassador in reply to Grammy80

Does this help?

drugs.com/price-guide/predn...

You do NOT want Rayos - that is a 1mg prednsione formulation but a delayed release type and VERY expensive in the USA.

Grammy80 profile image
Grammy80 in reply to PMRpro

You never cease to amaze me!! You have the info on just about anything and everything...I am going to call one of the pharmacies I deal with which is connected to the hospital (vs. CVS chain) on Monday and see what they can do~!

I get pill packs from the one pharmacy and then use CVS for those meds with dosage changes. I'm doing another change...I've been on 1 mg clonazepam since age 15 originally prescribed for seizures which I haven't had since 1975...I am decreasing and deleting that by .25 over an 8 week period then there is one other that I'll be getting rid of if all goes well. I'm thrilled.

Just one thing on cost???? Here is the states..sometimes I just scratch my head. My present insurance there is usually either a $10 or $30 copay per script. Now this year about the month of February most of my scripts were costing me $.00~! I think it is because of the high cost of the Actemra injections, I'm guessing about $5,000 per month that Medicare is paying for since I'm so close to 80....puts me in a different category. It is a first for me and it is fairly complex formula the insurance companies and government use....I'm just grateful~!

Thanks so much💖 You are a PRO~!

PMRpro profile image
PMRproAmbassador in reply to Grammy80

It is years of experience and knowing where to look. Nothing more ;)

Grammy80 profile image
Grammy80 in reply to PMRpro

It is way more than nothing to folks like me...who don't know where to dig !!xo

Luciejc profile image
Luciejc in reply to Grammy80

The pharmaceutical company is Cadista. I paid very little for 240 tablets. I have been able to cut them in half for .5mg. Feeling pretty well. Took Access-a-Ride into Manhattan for the first time to see my new rheumatologist. She called me the next day with blood work results..all good. I was concerned about yellow eyes. She added Covid antibody test which was negative. We have sheltered in place since March and are enjoying a little sunshine. Be Well and Be Safe💖

Grammy80 profile image
Grammy80 in reply to Luciejc

Such good news for you, Jean....I know what a relief it is for you to be near normal. It takes us a while to get there...so kick back and enjoy~!💗

I'll be talking to the pharmacy ....they have been saying "they don't make a 1mg" and that is obviously not true...look at the info from PMRPro~! I'm armed and I'll get it.

PMRpro profile image
PMRproAmbassador in reply to Grammy80

Their supplier may not have 1mg - and they may not be able or bothered to seek further ...

Grammy80 profile image
Grammy80 in reply to PMRpro

I hear you....Monday I will find out if it is a case of ability or bothering.😅😊xo

Grammy80 profile image
Grammy80 in reply to PMRpro

Well, it was all a pain in the padupah!!

After multiple calls with the doctor and two pharmacies, I still came up empty-handed in regard to securing 1 mg tabs. To add insult to injury the reason I had not received the 2 mg tabs was that the pharmacy was waiting for the doctor to secure prior authorization. In the states, prior auth is what the doctor has to secure from the insurance company when the insurance company refuses to pay for the prescription when it is processed through the pharmacy. My insurance was refusing payment because the pharmacy didn't have the generic only Medrol brand prednisolone. Whew!

Confused? Frustrated? Here in the states..all that, politics and burning streets too~!

WELL! 360 Medrol 2 mg tabs were over $600~! I did decide to pay $52 for 25 so I could get started with the taper while my Dr. secures the prior auth from the insurance company for the balance which will probably cost me $1.65US.

This is exhausting. xo

Whitner profile image
Whitner

Thank you all for such great information! I had what must be a flare when I moved from 7.5 mg pred to 7. Shoulder pain and thigh stiffness reappeared along with new pain in my jaw which scared me. I went back to 8 mg but am still having shoulder pain especially at night so these posts reminded me to split my dose which should help that. Sounds like you’re getting everything worked out Grammy80!

Grammy80 profile image
Grammy80 in reply to Whitner

I'm working at it, thanks to the folk here. For me...and it seems others....tapering from 8 to 6mg (what my American rheumy wanted initially) has been a real problem. So I'm following the slower models outlined on this site. Thankfully, he agreed with me because I could only get my methylpred from him, my GP would not have prescribed it so I could go slower.

I'll try it again and we'll see. We are all engaged in 'hopeful' tapering~! xo

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