Hi all, I’m so thankful for this forum and all the knowledgeable people, hoping for more good advice…Started on split dose of 10mgs Prednisolone morning and evening in January this year. After 4 weeks I started tapering my evening dose by 1 mg every 2-3 weeks with no problems or recurrence of pain, am now down to 2 mgs, still on 10 in the am. Over the last couple of weeks I’ve started to get hip and back pain in the morning, it doesn’t feel like PMR pain but I’m hesitant about reducing at the moment (have been on 2 mgs for 3 weeks so would be going to 1 mg this evening). I was going to continue reducing the evening dose to zero if I had no symptoms, then start on the am dose, but is this the best plan given that 20mg as one am dose did not initially cover me for the full 24 hours? And am I being sensible not reducing tonight - obviously I want to be off Pred asap but am happy to go as slow as necessary to avoid a flare.
Tapering on split dose: Hi all, I’m so thankful for... - PMRGCAuk
Tapering on split dose
I would continue to take the evening dose I needed to keep me happy in the morning abd start on the morning dose - it obviously doesn't last the full 24 hours and you will need the extension for longer.
However - you have no control over the time it takes you get off pred. That depends on the underlying autoimmune cause of the PMR itself - PMR is the name given to the symptoms, that isn't the actual disorder. As long as it is active you will need some pred to manage the inflammation it creates. Pred isn't a cure, it is a management strategy and you have to identify the best way of using it for YOU. We are all different so what anyone else manages doesn't necessarily apply to you.
Thanks for this, it seems sensible to do that - the Pred has affected my sleep quite a bit so I wanted to reduce the pm dose if possible, but I guess I’m about as low as I can go for the time being and will start on the am dose in a week or two, all being well 🤞🏻
Have you tried other times? Sometimes taking the top-up at as early as lunchtime is enough to extend the effect to the next daily dose. The basic approach is 2/3 in the morning and the rest later - not necessarily half and half or at 12 hour intervals. It does pay to experiment a bit to get better sleep and good mornings.
I’m currently taking the pm dose between 4 and 5pm, my only concern re moving it earlier is remembering to take it! I will try moving it to 2-3 pm, no tapering, and see how it goes. If ok will reduce am dose to 9mgs in a week or two, depending on how it feels 🙂 many thanks xx
When I was on prednisone (remission) from week one I needed to split my doses. I split my doses from morning to 2nd dose at 3pm.
As for tappering, I tappered both morning and night. At high doses I could only drop 1 mg at a time so I split it. I did this right to the end.
You may not be getting enough in your afternoon dose.
I would start to get pains around 5-6 pm thus taking prednisone at 3pm.
When does your pain start in the afternoon?
At the moment I don’t have any PMR pain, I have aches and soreness due to mild osteoarthritis in my hip from time to time, and residual pain in my right shoulder from a fall 3 months ago. When tapering was discussed briefly with my rheumatologist months ago, when I had just started on prednisolone, he suggested that it would be best to reduce the pm dose first due to sleep disturbance, so that’s what I did. I think I’ll stay on 2 mgs in the afternoon and start reducing the am dose now though.
When people split their dose -we usually suggest tapering the doses in turn -so morning first time, evening on second one etc…
The main reason to split the dose is to help the morning pain - so if you’d followed suggestion you may have mitigated the issue you have now having.
As PMRpro has said… you may want to be off Pred asap, but that’s really down to your illness.. as many have discovered it has its own agenda time wise.
I hadn’t realised it’s best to alternate between am and pm dose for tapering, however too late now so I’ll start on the am dose when I’m ready to go down again. Thank you so much for advice, it’s so helpful 🙂
Unfortunately it’s one of those things you don’t know unless someone mentions it in passing -or you ask for advice
Medical bods probably wouldn’t even think about it! 😊
My thoughts and experience are that you should split your dose equally and reduce both morning and night equally by 1 mg so 1\2 mg morning and night.. I don't understand why you think the morning dose should be higher than the night one. Sadly PMR tends to attack during the night so at your dose splitting equally will help.Good luck on your journey.
Thanks for your reply. I think generally the advice re splitting the dose is 2/3 in the morning and the rest later because of the effect on sleep - most people seem to be ok with taking the whole dose in the morning but I still had pain from about 2-3 am until mid-morning which is why I was advised to split my dose. But it does affect sleep quite badly which is why I wanted to get rid of the later dose before starting on the am dose. So far while tapering I haven’t had any pain so I hope I can continue this by taking it very slowly.
"I don't understand why you think the morning dose should be higher than the night one."
Because that is the usual advice from experts on dose splitting. The inflammatory substances are only shed in the body once a day, at between 4 and 4,30am. The ideal time to take a single dose is 2am for prednisone, 3am for prednisolone so it is at its peak in the blood as the inflammatory substances appear and then they don't get hold at all. Then the effect lasts all day - but varies from 12 to 36 hours. So for some it holds well until the next daily dose is due, not for others, By splitting 2/3 and 1/3 the level at night is lower which benefits sleep and, at later stages, the return of adrenal function.
Great question, in the same situation here. I started by reducing the night dose by 1 mg a month ago.. I guess I need to do that again next week when I attempt going down to 13 mg, but with my morning dose. Let's hope we both are successful!
I have done what DL has described as I started splitting my dose when I was at 10mg (having initially started on 20mg pred), because I was having morning stiffness. As I’ve tapered down I go back and forth each drop taking from either my evening dose or morning dose. While doing so I’ve tried to maintain 2/3 of my dose in evening and 1/3 in the morning.
My split dose is likely different than others because we do not have acid resistant pred tablets here in Canada. So my evening dose is taken at 11pm (pred tablets stuffed into clear, acid-resistant capsules), this means it’s absorbed around 2-3am before the cytokines emerge at 4am. My morning dose is taken at 11am (plain pred with food).
I’m currently at 5mg total dose….3mg in evening/early morning and 2mg in late morning. My next taper by .5mg means I’ll take it off my late morning dose reducing it to 1.5mg. So my split dose will be 3mg in evening/early morning and 1.5mg in late morning, total dose being 4.5mg. Hope this makes sense.
I have had to slow down my taper when I got to 6mg as my adrenals are sputtering back to being functional and the related symptoms are pretty awful. Not sure how low I’ll get to pred wise but I’m also on Methotrexate so all I can do is keep trying, SLOWLY. I’ve been on pred 6+ years.
Goodness it’s such a long road isn’t it? And I’m only 8 months in so far! Your explanation makes perfect sense but I’m going to concentrate on reducing the morning dose for a bit, since it’s just been the later dose I’ve reduced (on my rheumy’s advice initially) and it seems I should try and balance it up a bit till I get to a 2/3 1/3 split, then I’ll try to alternate am/pm. I’m dreading the adrenal problem when I get lower, it sounds awful!
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