Tapering from split dose for PMR

[oscarandchloe]

My GP encouraged me to find the 'lowest dose' of pred. that stopped my symptoms of PMR that had slowly appeared as I'd tapered down successfully to 2mg. from 45mg when diagnosed with GCA. This took about 6months. I thought 7mg was doing it but remaining stiffness made me try 10mg. Having read about split doses here I tried 5mg after breakfast and another 5 before going to bed - bingo! A whole month with no stiffness and feeling well. Now I need to start tapering. How should I do this? I think I should drop to 9mg, for how long and should I split it again? I have just read in a post that when I get to the 7mg mark (adrenals) I shouldn't take pred at 12 am? Would be so grateful for advice.

In these days without face to face doctors and cancelled rheumy checks, this website has been invaluable - thank you .

[DorsetLady PMRGCAuk volunteer]

Personally I would try tapers of 0.5mg - on a monthly basis , provided you have issues.

If you want to keep the 50/50 split ( although we do sometimes recommend 2/3rds:1/3rd - but whatever suits you) - I would reduce morning dose one month, then evening dose next month etc...

As you’re only 18 months through GCA , you have a way to go - so ease off a bit. It much more difficult to reduce below 10mg than the earlier high doses....not so much ‘spare” Pred to juggle with.

I shouldn’t worry about your adrenals as yet - and if you continue taking split doses morning and evening (no later than 10pm) - there shouldn’t be an issue.

Getting your GCA back under control is the most important thing at the moment .

[SnazzyD]

Adrenally speaking the Endo I saw said from 5mg below is when they like to see Pred taken in the morning. That’s when I changed from pm dosing, though I didn’t have PMR pain to worry about.

[PMRpro Ambassador]

What time do you take your pred in the evening? Ideal at the lower doses would be midnight - it is the level then that tells the body that it needs to produce some cortisol in the morning and the lower it is the better for that. Pred takes over an hour to get into the system so if you take it about midnight it won't have an effect until 1am or later but still be effective in the morning. As DL says, the usual split suggested is 2/3 and 1/3 but it doesn't really matter - what works for you is the point.

Some people take 1/2mg off each part of a split dose, others take 1mg from one one time and the other the next. Really it needs a bit of experimentation to identify what works for you and you have also to bear in mind this is PMR symptoms that you are looking to manage and they have their own rules!

[oscarandchloe in reply to PMRpro]

Thanks for this. I usually take the evening pred at about 10.30pm but could do it later as I don't get to sleep very easily. The 1/3 and 2/3 split hadn't occurred to me but might well suit very well. I'm not sure how I actually manage a 1/2 mg reduction as I have 5mg and 1mg pills (the 1mg ones would be a challenge to cut in half!)

[PMRpro Ambassador in reply to oscarandchloe]

Cut a 5mg to give 2.5 and add 1mg tablets - though with a pill cutter from the pharmacy you would be surprised how well even the 1mg pills cut!

[Lochy]

I’ve been spoiling my dose for several years and it works for me. Currently at 7.5 and take 2 before bed around 11 and rest in the morning. Try and get 2.5 tablets, it really helps the 0.5 drops.

I tried to drop to 1mg at night, the other week, and balance in the morning but it really did not work and I felt rubbish. I’ve decided not to worry about that yet as have still got a long way to go! Feel good at the moment, almost feel as if I’m in control 🤞🤞

[Lochy]

*splitting, but you probably worked that out 😂