Splitting Pred dose

[Dinahmite]

On pred for PMR since end of October 2023. I have noticed some folk split their Pred dose. Can anyone tell me the pros and cons of doing this? I don't have early morning Pmr symptoms but I find the steroid v hard to tolerate during the daytime. I am at least sleeping again at 10mg after 4 months of total insomnia. Would splitting the dose help reduce steroid side effects during the day - say 3 quarters? But would taking a quarter dose at night be likely to bring back the insomnia? A dilemma.

[piglette]

It really is a matter of try it. It seems some people like taking pred just once a day some, like me, take it in the middle of the night even. Others find twice a day works better for them.

[PMRpro Ambassador]

The concept of splitting the dose is to extend the antiinflammatory effect of pred to the full 24 hours up to the next dose being due since for some people it can be a short as 12 hours and anything in between and the symptoms return before the next morning.

My usual suggestion is to take about 2/3 of the total dose in the early morning with breakfast at a convenient time. Then take the rest later enough so you have no return of symptoms before the next dose is due or while you are waiting for it to act. It may be as soon as morning coffee or lunchtime and that still allows enough time for the smaller amount of pred to be out of your system before bed, minimising the effect on sleep.

But as piglette says - it is a trial and error timing, The nearer to bedtime you take the pred, the more effect it will have on your sleep pattern,

What daytime problems do you have? That isn't usually a reason to split the dose but 2 or 3 much lower doses might improve things.

[Dinahmite in reply to PMRpro]

Thank you. I have had constant side effects from Pred - shaky, jelly legs, exhaustion, weakness, brain fog, rapid pulse, and so on -all a bit less than at the beginning thank goodness but hugely impacting daily life. But will just stick with single dose I think.

[howtotaperdown]

I have tried splitting the dose, I got down to 7 (again having done it a year ago) and found that dose just brings on such unpleasant effects after I take it, so I tried taking 1.5 or 2 in the night about 2am or when I woke up around then, which I inevitably do, and it seemed to lessen the unpleasant effects of the morning dose,

but stopped doing that as it was also confusing , having to take the stomach protector first, and eat a banana! & to feel I had to take it in the night and on insomnia nights was not sure if it was the night dose or something else.. now I'm down to 6 but still have per pains, but desperate to take as little as possible of the pred. But I feel it helped me not have 7 in one go.. tho did not have that much impact on the pain

as the advice here said before I tried it, it depends on the individual so worth re-checking what they said about it in the archives

I presume that inflammation being shed around 2/3 am corresponds to the liver energy intensifying at that time (Chinese time clock meridians etc.)... not sure if anyone does such correlation here

good luck, it is perhaps worth a try

[PMRpro Ambassador in reply to howtotaperdown]

The effect of the PPI lasts the full day once you have been taking it regularly - and you probably don't need as much as a banana for just a couple of mg, a spoonful of yoghurt is enough for many. Waking to take it is a bit of a disturbance though.