Split low dose prednisone?

[Karenjaninaz]

I have tapered slowly down to 4.25 after “parking” at 4.5 mgm for many weeks. I feel rather miserable when waking up:my IBS more crampy than usual and a general feeling of unwell until around lunchtime after which I can do normal stuff and exercise. I have had absolutely no symptoms of PMR for maybe a year. I suspect low cortisol based on recent history of extreme low blood sugar-evaluated. I thought I would try ,say, one mgm at supper and the 3.25 at breakfast. Has anyone tried this? I know everyone is different. I don’t have excessive fatigue but an occasional nap depends on activity-

[PMRpro Ambassador]

Only way you can find out is to try - but that will possibly blunt the trigger of low midnight cortisol for the morning shedding in the body. Have you had a synacthen test done to see if your adrenals are functioning? Or at least, a 9am basal cortisol test which your GP can arrange very easily.

[Karenjaninaz in reply to PMRpro]

I’m going to ask him for that since the cortisol test was drawn one hour after the 5 mgm pred. This time I’ll hold pred for 24 hrs.Instead of 48.

When you talk about morning “shedding”I do not have any PMR symptoms at any time waking up not even excessive stiffness.

[PMRpro Ambassador in reply to Karenjaninaz]

In this case I meant the shedding of cortisol - it is meant to reach its peak at 8-9am to prepare you for the day ahead.

[Karenjaninaz in reply to PMRpro]

Apparently it’s not shedding enough before my morning pred dose. The timing is confusing; I notice if I have an adequate dose the day before it carries over till morning. I only take the dose with breakfast. So that previous dose can inhibit cortisone release the next day???

[PMRpro Ambassador in reply to Karenjaninaz]

Only if it is high enough at midnight - a very low cortisol level then is what flicks the switch for the HPA axis (hypothalamus, pituitary, adrenal set-up) to grind into action. So the earlier in the day you take the pred, the more likely it is to be low. The half-life for pred is about 3-4 hours, it takes 5 half-lives to get to a negligible amount of pred being left in circulation. And that is why doctors get iffy about evening/night time dosing of pred. It does matter for some people but doesn't appear to affect others.

[Karenjaninaz in reply to PMRpro]

I’m suspecting that I had low cortisol before pred due to a near fatal bowel obstruction 3 years before PMR. I probably need a good specialist to sort this out. I need a good referral to an expert.

[SnazzyD in reply to Karenjaninaz]

Hello. When you say an “adequate dose” lasts you until morning, do you mean back to 4.5mg or more? Until I got down to these low doses I had no idea that I’d be mucking about with crumbs of Pred, thinking that 0.5mg was so low that it’s presence or absence would make little difference. How wrong I was, though docs, including Endocrinologists, seemed to think a faster taper was fine. Well it wasn’t for me. I was a bedtime taker at higher doses but was advised by and Endo to take it in the morning to allow that low in cortisol at night be allowed to happen because it triggers the adrenal axis for morning. I have been an early bird all my life but as soon as I hit that too little but not quite enough Pred level around 7.5mg taken at night I suddenly couldn’t get up in the mornings without a lot of misery (not pain). I’ll get to the point in a minute. Changing to morning dose further down the road at 4mg and after a Synacthen test that said ok (cortisol there but not exciting) and feeling somewhat better than 7mg, my mornings were still rubbish. Even when my second Synacthen test said good at 1mg, I still wasn’t great before 11am. Even with no Pred for 7 months other than an occasional 1-3mg per month (long story) I still won’t wake naturally before 9am. Something has shifted and it made no difference taking Pred am, though it may well have made difference to whether my adrenal comeback occurred quickly or not. So, try split dose by all means but it might subtly slow the return and still not give you your morning glory. Therefore, if it doesn’t work soon it might be worth not labouring it especially as you are not needing a split dose for PMR control.

[Karenjaninaz]

I’m wondering if my adrenals were damaged by the sepsis. I never had much energy for those 3 years then got PMR after a flu shot same day as pneumonia shot... The sepsis was from small bowel obstruction due to an internal hernia. The bowel was necrotic and leaked. I had a partial jejunectomy. Was near death.

[Karenjaninaz]

I agree. I’d rather have them work automatically the way they were meant to. Stuff happens as we age without our consent.

[Karenjaninaz]

What’s the solution if the adrenals don’t put out? Years ago steroid doses were much higher long term and we learned from that. They save lives in certain circumstances.

What hospital work did you do? I was a nurse anesthetist for 37 years now “over the hill”.

[Karenjaninaz]

Anesthesia IS stressful; I retired at 68.

I still wonder how I ever did it.

The physical part is not hard but the mental - is plus the multitasking.

[ignatz]

All very interesting. I may try splitting my dose.