Wondering about splitting daily dose

[Ebiker]

Following from previous post I upped to 12.5mg as it seemed that the bivalent booster for covid had reactivated my pmr....conjecture agreed on here. I have very little stiffness and it can go later in day. Seems more likely to be DOMS. Doing household chores and walking 1.5mls as part of using muscles again, is not a problem.Increased pred meant awful gerd as I have a duodenal ulcer. I am on omeprazole so upped that from 20mg to 2x20mg and it has helped.

However, I am still feeling symptoms of slow to function and a bit light headed until about 3pm. Then it gets better fairly quickly. By 8pm I am fine, lively and my sparky self. It is hard to differentiate I know, as gerd can make one feel dreadful. Plus long term omeprazole can also have side effects

I am on coated prednisolone. Does this mean that it is taking a long time to kick in? I take it at 9am and am wondering about splitting dose?

Any thoughts?

[PMRpro Ambassador]

If you are on enteric coated pred - try taking it before bed. It takes at least 4 hours to get into the system and often longer.

However - if you have a duodenal ulcer I wonder if e/c pred is the ideal for you since it is broken down and absorbed in the duodenum and further down the GI tract! But you would have to discuss that with a GI expert. Have you been treated for H.pylori with the triple approach (2 different antibiotics and a PPI at the same time for at least a week)

What you absolutely must NOT do is take any NSAIDs at all.

[Ebiker in reply to PMRpro]

Thanks pmrpro. I was treated for h pylori last March/April as I had awful reflux problems after pulmonary embolism. Doc changed me from apixaban to wafarin. We communicated some time ago on that one.Re GI tract I will follow that one up with doc next week. I am also going to ask him about famotidine which you mentioned recently.

So where is non coated absorbed? It presumably enters system faster.

[PMRpro Ambassador in reply to Ebiker]

It is absorbed from the stomach within an hour or so - so has been blamed for the development of gastric ulcers though others say it is the presence of steroids in the system that leads to that! They can't agree on that. The study that claims e/c isn't any less likely to cause problems is old and flawed (I believe) because working on the belief that the proof of the pudding is in the eating - patients on here report it helps and a few need both e/c pred AND a PPI/H2 antagonist.

[Ebiker in reply to PMRpro]

Thanks Pro. Very useful information as usual and a speedy reply. You probably have visitors too.So I have options I can try. Too many variables in this "equation"🤔. I can't decide whether to take 7.5mg tonight and 3.5mg in the morning or go all out with 11mg tonight. I will mull it over.

I am in middle of DL slow drop from 12 to 11mg.

Also I have uncoated 5's and 1's dispensed in error once....fun for another time??

[PMRpro Ambassador in reply to Ebiker]

They were skiing today ...

[Ebiker in reply to PMRpro]

Brilliant. Blue skies I hope.Have decided to take 11mg before bed. Give it a go I say - what the heck!

[PMRpro Ambassador in reply to Ebiker]

Oh they were! Not a cloud in sight - tad frisky though

[Alebeau]

Splitting the dose worked for me, it was like I was reborn.

Pain free all night and all day.

Wish I had learned that 2 years earlier.

Good luck.

[Ebiker in reply to Alebeau]

Thanks A. Good to know.