Split Prednisone or one dose daily?

[Macadoo]

Many with PMR seem to have extreme fatigue when tapering prednisone.

I’m curious if anyone who was splitting their daily dose went to once per day in an attempt to help with fatigue caused by adrenals struggling.

Thank you in advance to anyone who replies.

[SheffieldJane]

Unfortunately, I think that because Prednisalone works in the acute, ie on the inflammation as it occurs, you tend to feel symptoms on the drug free day. The fatigue we feel is often associated with the autoimmune diseases themselves rather than Adrenal deficiency. I have seen, occasionally, people’s doctors suggesting the same thing on here. I haven’t seen reports of success though.

[PMRpro Ambassador]

Once you are down to the realms of returning adrenal function it is important to take the smaller share of a split dose early enough in the day so that the blood level at midnight is as low as possible to trigger production of cortisol in the morning.

[Macadoo in reply to PMRpro]

I am just dropping to 5mg daily…so maybe 3mg in the a.m. and 2mg around 5pm? I have been using that proportionate tapering schedule over the past year.

I have terrible fatigue every day from noon on and looking for any way possible to treat it.

[PMRpro Ambassador in reply to Macadoo]

That is probably the lack of your adrenal function producing a boost of cortisol in the afternoon - part of the circadian rhythm. That late afternoon dose isn't into your system for 2 hours (prednisone must be absorbed and then processed by the liver to be active as prednisolone) so there is still some present at midnight. The optimum time to take pred is 2am - if you can face waking then, a lot do. It is possible taking that second dose about midday might perk up your afternoons?

[SnazzyD]

My Endocrinologist said that all the Pred should be taken in the morning. At that time I was an evening taker. As PMRPro says, your Pred levels need to be at rock bottom in the night to trigger the body to produce cortisol. I’m afraid feeling dog tired is part of the recovery process for many and if your adrenal glands are struggling, you can’t short circuit this bit. If you take a bit to feel better you are potentially stopping that low from happening so your adrenal axis will stay asleep and you’ll still feel tired if the Pred level is below what you would make yourself naturally.

[Zebedee44 in reply to SnazzyD]

Thankyou for that comprehensive explanation which I will now incorporate into my taper. I have always split the dose so that I can be pain free in the morning, taking 1/3 rd at bedtime and the rest at 7.30/8am. It has worked well for me, but I understand what you are saying here and realise that to get below 6.5 mg I need to take it in one hit, probably at 2am!

I’m on day 5 of a short increase to 10mg after what I thought of as a mini flare but now I feel armed with the necessary knowledge to negotiate the next hurdle, so Thankyou. Chrissie