Thanks to all here - split dose over 24 hrs evenly?

[Digory]

Anyone tried splitting dose of Pred over 24hrs to help taper - is it worth a try ?

Thanks to everyone here such a supportive, knowledgeable group.I was recently diagnosed with pmr - (details on my profile)

Starting tapering now at 12.5 Pred . I was thinking - would splitting the dose through 24 hrs make tapering easier as I don’t seem to have too much problem doing that in terms of sleep. I know this is complicated in term of circadian rhythms and adrenal gc production but I would have thought taking all at once will produce an uneven level of steroids over 24 hrs whilst an overall level could be lower if spread out. Is that faulty reasoning ?Has anyone tried this ? If so how did it go?

[DorsetLady PMRGCAuk volunteer]

As ever, you won’t know until you try -but don’t start both at same time.

Try the splitting dose regime for at least a week initially to see if body likes it before you try and taper.

If you action both together and it doesn’t work -you won’t know which is the culprit.

[Digory in reply to DorsetLady]

Thanks for this good advice much appreciated

[DorsetLady PMRGCAuk volunteer in reply to Digory]

Personal opinion - think one dose is better option [unless it's not lasting full 24 hours] - but then, I did have GCA...

[PMRpro Ambassador]

The standard approach of single daily dose in the morning is because the entire shedding of the inflammatory substances that cause the inflammation and symptoms happens in the early morning, about 4-4.30am. By taking the entire dose soon after, all the inflammation should be dealt with and then the antiinflammatory effect lasts through the day. If you split it into multiple small doses the level may not be enough to combat all of the inflammation and some be left to cause symptoms. Once that morning dose falls below the amount you need, the symptoms will reappear - you risk that happening if a third of the dose in the morning isn't enough for the clear out.

Occasionally the antiinflammatory effect doesn't last the full 24 hours to the next daily dose and then splitting the dose may help by taking the bulk of the dose in the morning and the rest later enough in the day to extend the duration of effect.

Think of it like a dirty floor - a good scrub in the morning will leave it looking nice all day. If you just clean a third of it, the rest will look rubbish until you do another bit and it won't all be clean until just before bed.

I doubt it would make the tapering process easier - you have to decide which dose you will reduce first and you may be down to a level that isn't enough to clear out the inflammation. We usually advise sticking at the once daily dosing, which is much more convenient anyway, until you are familiar with YOUR PMR and YOUR reaction to pred. Once you know a bit more about that, then you can tinker with the dose to find an ideal for you.

But whatever you try, never change two things at once because then you don't know which did what ... Always make a change and wait until you are settled on it before trying something else.

[Digory in reply to PMRpro]

Thanks so much Pmr pro - will do as you suggest & see how it goes