Does anyone split their dose of PRED? I can't sleep due to pain unless I take some at night but also has stimulant effect. 10 day /2.5 nite

[Sunnyday365]

I was recently diagnosed with PMR a few months ago and am grateful for this site. I have learned so much from everyone that posts. I have noticed this disease seems to be about managing the prednisone more than the actual disease. Thanks for your comments.

[Shesfromboston]

I did have to split my dose in the beginning. It didn't seem to work for a full 24 hours. I did 20mgs in the morning and 10mgs at night.

[PMRpro Ambassador]

The usual suggestion is about 2/3 of the total dose in the morning and the rest later enough to extend the anti-inflammatory effect to 24 hours. It doesn't have to be in the evening, often lunch time is lat enough to achieve the required result. That usually then means the level of pred in the body in the evening is low enough not to disturb your sleep.

Yes, I think that is true - and between us over the years we have found several ways of sorting the pred better in all ways. Unfortunately a lot of doctors won't listen. I tell them the study they need to do is the best way to manage the pred - not messing about with so-called steroid sparers.

[Chris_1236]

I'm presently at 30mg. I split it three times. 10mg @ 1:15am, 10mg @ 7:15am, and 10mg @1:15pm. I get good symptom control over 24 hrs right now. Of course your mileage may vary as they say. The body is a unique thing.

[PMRpro Ambassador in reply to Chris_1236]

You would hope to get good control for 24 hours in PMR and at 30mg. It is better to take it all at once and at most 1 larger early in the day and 1 smaller dose later if the effect doesn't last for the full 24 hours.

[Chris_1236 in reply to PMRpro]

I initially took a 20/10 split, but I have a proclivity towards SVTs which require an injection of Andenosine to resolve and the 20mg dose elevated my heartrate enough for concern.

[HeronNS]

For a month or two I had to split my dose. After a little experimentation I ended up taking the larger amount at 2 am (to take advantage of it then already acting at the time the cytokines are released at 4 am) and the rest at about 2 in the afternoon. Eventually I gradually shifted the whole dose (although I was also tapering) to the 2 am time and have stayed with that.

I was at 10 mg at the end of March when I started splitting, and about 5 (with unsuccessful effort to be at 4) when I began to manage with the single dose, end of May. I did have to go up to 7 for a couple of days, but then back down quickly to 5. I'm now tapering again, so far successfully to 4, and plan to try 3.5 tomorrow morning.

I'm constantly surprised by how easy it is to get back to sleep after the 2 am dose, despite getting out of bed to take it. And for now the effects are lasting all day. However it's probably relevant to note that until this recent adventure I had always found my pred dose lasted all day. I think by splitting I was able to avoid having to take an even larger dose to deal with the flare I was experiencing.

[Sunnyday365]

The 2am dose doesn't keep you awake? I find taking it in the evening keeps me awake but not taking it I'm in more pain so awake anyway.

[HeronNS in reply to Sunnyday365]

No not at all. It wouldn't get into your system soon enough to even make you wake up early! Mind you my dose is now so low it wouldn't have an effect anyway, but even when I was taking 7 at 2 am it had no effect on my sleep pattern. Then again, I never had a pred problem with sleep. I felt so much better in early days after months of interrupted sleep from pain that I slept like a log! Also a calcium supplement, about 300 mg, usually taken around 11 pm with plain kefir or yoghurt, although I really should take it a bit earlier to guarantee avoiding interference with the pred, seems to act as a sleep aid. 😴

[Bcol]

Morning Sunnyday365, I've taken my Pred at around 02:00 for many months now and it has happily got me through the day. I also suffer from OA and realised many years ago that staying in any one position, whether lying or sitting down, for a long time made the pain worse and so I'm used to being up and about during the night, no point tossing and turning in bed, unable to sleep and getting stressed about it.

[Zebedee44]

After seeing a comment on this site some years ago I took to splitting my dose and take 3mg when I go to bed and 5mg in the morning, thereby managing morning stiffness and energy levels throughout the day. But it does get more complicated as you taper the dose and I have read on here that it’s better to take it as one dose when you drop to 7mg. I sleep well and have never tried the 2am method, although I found the slow release coated 2.5mg pred tablets more pleasant to take with water at bedtime, the 1mg tablets taste vile and even worse when cut in half!

[Sunnyday365 in reply to Zebedee44]

Agree on taste! Thanks for the reply.