Split dose prednisone

[Snerd]

Hi all! What is the reasoning, the logic, the asset in splitting your dose of prednisone morning and night?

[PMRpro Ambassador]

There isn't much for splitting it evenly morning and evening - the recommended dosing in PMR is all your dose at once in the morning. If you take an evening dose you may find it keeps you awake so if you don't need it, why take it then?

There is a rationale for splitting if the symptoms are clearing with pred but return before the next daily dose is due, The antiinflammatory effect of pred lasts between 12 and 36 hours depending on the person. If you are at the longer end of the scale you will get away well with a single dose at a time that suits you, preferably early in the day as that may help the adrenal function problem. However, if the symptoms are coming back before the next dose then splitting the dose unevenly may achieve a better result. Most recommendations are for about 2/3 in the morning and the rest late enough in the day for the antiinflammatory effect to be extended to the next morning. It is different for everyone and a bit of experimentation may be needed to find the split and the times that work best for you.

The ideal time to take steroids is 2am for prednisone and 3am for prednisolone (prednisone takes longer to work because it must be processed by the liver before it is effective). This means the blood level is at its peak just before the new batch of inflammatory substances is shed in the body about 4-4.30am and so the pred stops the inflammation ever getting a hold. The result is no morning symptoms - and sometimes the effect lasts longer or you manage as well with a lower daily dose. That is always a good thing though it may not happen but you can always hope! OTOH - if you don't find waking in the night works for you, you can wake a bit early and take your dose before settling down for another couple of hours before getting up by which time it should be working. Or even take it before bed - which should stop morning problems but might keep you awake.

[Snerd in reply to PMRpro]

Thank you Pro lady! I appreciate your comprehensive reply.

[Rugger]

I split my dose because I noticed that pred was lasting only 18 hours for me.