Splitting the pred dose 10 mg - 5mg in the morning and 5mg in the afternoon

[Littlejan22]

Hi has anyone split there dose of pred so half in the morning at 9am and the other half at tea time I an told it will stop the waking up at 3am every night is this true?

[SheffieldJane]

What time do you take your full dose now?

[PMRpro Ambassador]

It won't necessarily stop waking at night - unless you happen to be waking to take your whole dose at 2-3am as some people do. The optimum time to take pred to avoid morning stiffness is 2-3am so it is at its peak in the blood before the new batch of inflammatory substances is shed in the body ar 4-4.30am and then the inflammation never gets started.

Sometimes splitting the dose, not necessarily half and half and not necessarily morning and evening, will extend the antiinflammatory effect to 24+ hours - it varies betwen 12 and 36 hours depending on the person. If you take it too late in the day it is more likely to keep you awake at night and the usual split suggested is 2/3 or so in the morning with breakfast and the rest later enough in the day so you still have the effect next morning. People vary so you may need to experiment a bit to find what suits you best.

[Littlejan22 in reply to PMRpro]

Thank you does it have to be 12 hours between each split dose?

[PMRpro Ambassador in reply to Littlejan22]

That's what I said in the second paragraph - you take one dose as convenient in the morning and then the rest sometime later in the day. Often taking it with your lunch may be late enough so it works right up until next morning but early enough so it doesn't affect your sleep.

No it doesn't have to be 12 hours apart, the best is felt to be taking it all as one dose so it doesn't have to be evenly split up. And taking it in a large and a smaller dose may work better.

[Lejazzhot]

Yes I’ve always split my dose which gave me flexibility and worked with my schedule. I take half before bed 1 -3am and the other half 2-3pm. Sometimes it’s not a 50 50 split / taking more than half before I go to bed has helped me in the morning. My rheumy allowed me this flexibility when he saw it worked for me - and I insisted. When dividing the pill became impossible i went to a compound pharmacist to make pills of 1 and .5 mg.

[Littlejan22 in reply to Lejazzhot]

Thanks does it have to be 12 hours between doses? I am trying it today for the first time, taking 5mg at the normal time of 9am and I go to bed at 10pm so was going to take other half then?

[Lejazzhot in reply to Littlejan22]

There’s a lot of trial and error. No right or wrong or any set rule. It’s all very overwhelming in the beginning. My only advice is to pay attention to your body noting how it reacts to the dose at different times. Try to make it work for your own daily routine. I couldn’t sleep so taking a dose 2-3 am was not a hardship. I never set an alarm to wake up. I got into the habit of taking the other dose 1-3pm. This worked for me. Experiment. Listen to your body and this forum

[HeronNS in reply to Littlejan22]

As PMRpro says, they don't have to be 12 hours apart. I know some people even take a 2 am dose and the remainder at breakfast as normal. I've been experimenting myself lately as my pred stopped working for the full 24 hours and have ended up with a 12 hour schedule, but that was to reflect how my body appears to be currently metabolizing the drug. I took an early morning dose, then observed when the pain started to return in the evening, and discovered that 2 pm for the second dose appears to be optimum at least for now. At some point I want to get back to breakfast time only.

I did find it took a while to get to sleep when I started the afternoon dose, but as I've reduced it and also as I've adapted to the timing, that problem has sorted.

What does concern me is for later - does keeping a more constant level of pred in the system eventually lead to even more trouble getting the adrenals back up to speed as one gets closer to zero? But a moot point at present.

[PMRpro Ambassador in reply to HeronNS]

Depends on how much and how late that second dose is. What's your 2pm dose? 3mg or so? It takes up to 5 half lives to get to effectively zero - bit over 10 hours for most people.

[HeronNS in reply to PMRpro]

Just got it to 2.5 (cutting 5 mg tablet), most I've taken in the afternoon is 4. Currently taking 4 mg at 2 a.m. Planning to pause at this dose and split for a few days before proceeding as since this flare began I've not really been able to go below 7 without regretting it a few days later.

[PMRpro Ambassador in reply to HeronNS]

Know that feeling - except at nearly double the dose!!!!

[HeronNS in reply to PMRpro]

🤗

[Deyazlex]

Not really understanding the condition when confirmed approx 4 yrs ago, I took my then prescribed 15mg as 5mg three times with meals!! Felt good with a burst of energy. Now fluctuate between 2 to 3mg a day. Do wake up during the night but not regularly but will consider splitting my 2mg to see if it has a positive affect

[dmart7]

I split my dose - currently 9mg - after breakfast (9am) and after dinner (6pm). Works fine, and generally I use the second dose to apply tapering, so it is smaller most of the time (currently 5:4mg). Never had any problem with sleep. Am aware that most experts recommend one single dose in the morning, and suspect that I adopted the split strategy early on due to inexperience rather than necessity. Doesn't matter - unless someone tells me that I could take a smaller overall dose if I changed my timings.....

[Gellybabie]

Hi, Yes i split my dose , but 7 am , when i get up and 7pm keeping within the 24 hours 😊to see me through the night so not so stiff in the morning, omg it really worked for me , its been about 8 months . Im still doing the same as i reduce, im down to 6mg now started last march @ 15mg. Fingers crossed it will still work for me ! Good luck 🍀

[Pr0jection]

When I first started on prednisolone I split my doses, took 2/3rds in the morning and 1/3rd in the late afternoon. This went on for 5 months. Then having been told by my rheumatologist that it's better to take it all in the morning I started to take the full dose around 8.30 a.m. I didn't notice any difference at all. I'm still pain free day and night, and I still wake up at 4.00 a.m. every day. It may work for you though. Fingers crossed.

[PMRpro Ambassador in reply to Pr0jection]

I'd always suggest to someone to start with single daily dosing and see if it works for them. If the pain/symptoms return before the next day's dose is due, that is a sign you might be better with splitting the dose. It only really makes a difference when you get towards the realm of adrenal function needing to start up again and if the second part of the dose is small enough and taken early enough in the day, it shouldn't matter even then

[Cycles4fun]

Have had PMR 5 years. Have never gotten below 8.5. Have split dose many times and always reduced pm dose to 0 then started am dose. Now I am experimenting and take 5.5 (7am) and 5 (7pm). When I get to 5 am , next step 4.5 pm then 4.5 am. Willing to try anything.

[Littlejan22 in reply to Cycles4fun]

Thanks for this advice, Janet

[Littlejan22 in reply to Cycles4fun]

Thanks I felt the pain came back when I splitting the dose, gone back to single dose in the morning which seems to be suiting me better, hope you are well?