Am I taking enough Predisolone?

[Archiethedog]

SusanLynne. Hi I'm new to this site. I've been taking Predisolone for four years this March. My dosage has gone up and down like a rollercoaster. One question I have ...if I wake up in the morning and I have pain and stiffness, am I taking enough Predisolone? My doctor is a always encouraging me to decrease my dose, 1mg at a time. I got down to 4mg. I had so much pain and stiffness in the morning that I've slowly increased my dosage to 7mg. Still some slight pain and stiffness first thing. Do I got to 8mg?? I do lots of walking. It's very hilly where I live but I don't walk miles every day.

[PMRpro Ambassador]

The morning stiffness and pain happens because the disease process means that the inflammatory substances are released about 4-4.30am and start to produce the inflammation which causes the symptoms. Added to that, the antiinflammatory effect of pred lasts 12-36 hours - so if you are towards the 12 hour end, it doesn't cover you for the full 24 hours until the next dose is due. You have symptoms in the morning until the new dose kicks in.

There are a few ways of dealing with that:

The ideal time to take pred is 2am - it is present by 4am and the inflammation never gets hold. Mornings are far better - although you might be a bit stiff overnight but not necessarily. And it has the downside of having to wake in the night.

Or you can try splitting the dose: the majority in the morning when convenient (usually about 2/3) and the rest a bit later in the day, late enough to carry the effect over to the morning dose. Even lunchtime may be plenty late enough to achieve that.

Another option is to take the whole dose as early as possible - and then settle down for another hour or two before you need to get up by which time it is working. The sooner it is after 4.30am, the less inflammation will have been created and the less work the pred must do so the effect is felt quickly.

The idea is to keep at as low a dose as possible - so if 7mg is good apart from that morning stiffness that goes, that is better. But with a split or changing the time a bit you might even get a bit lower - you have to try to find out.

[Blearyeyed]

You've got PMR Pros brilliant summary of the options you can try in taking your dose to reduce that morning feeling.

You could try out which one of those options work for you first before increasing your dose , or if you feel the pain level is high enough , or you feel like it is a flare , increase to 8 mg if it makes you feel more comfortable and then assess which of Pros options give you the least morning pain , after which, follow one of the slow taper methods available on this forum.

Make sure you get yourself " taper fit" and reduce your activities on the first few days of each new taper to help prevent a flare of pain because you have both reduced your dose and put your body through more stress at the same time.

The final advice that will help you as you go is to take a look at your day to day activity and see if you can adapt your activity routine or exercise choices to help you reduce the additional inflammation certain activities can cause . Sometimes the daily growth in pain for a certain amount if hours isn't always PMR but PMR pain in combination with inflammation caused by activity added into the symptoms you already have.

Walking is a great way for people with PMR to get exercise and keep fit , but choose your routes and times of day you do it carefully on days when your symptoms are higher and take plenty of little rests as you go with some gentle stretching at the end of your exercise routine and a good relaxing cool down. That will help prevent any rebound pain adding to your PMR pain level too.

[alangg]

Hi. I would suggest staying at a dose that works for at least 4 weeks before thinking about reducing it. Then use a taper plan (rather than a sudden drop in dose) and your target dose should be no more than 10% less than your previous dose. As Pro says, you can also split the dose to give maximum effect when it's needed.

Stay on your new dose for another 4 weeks and only start the next taper if you are certain that your current dose is working. PMR seems to thrive on 'rollercoaster' doses.

[Rugger]

When you do start to taper your dose, try 0.5mg at a time. My Rheumatologist advised me to drop by 0.5mg per month. I use the Dead Slow Nearly Stop taper plan, even for that small change. You'll find the DSNS taper in FAQs.

[PUMC]

You might try taking your dose at 2:00 or 3:00 in the morning. I switched a month ago, it it made a world of difference on how I felt upon waking. (I keep a large bite of banana or a small piece of cheese on my nightstand to take with the prednisone). I have had no trouble falling back asleep.