Dose increase

[Lasagne777]

I have always been on a split dose of methylprednisolone and my latest was 4mcg at breakfast and 4mcg tea time. I had some achy hips and shoulders and neck last week so Dr increased my dose to 10mcg at breakfast .

I'm on the second day of this dose and my pain feels more than when I was taking 4mcg breakfast and 4mcg teatime .

Is it too early days or is the increase from 4mcg at breakfast to 10mcg at breakfast only too much in one dose .

Should I try 6mg morning and 4 mcg tea time .

I hope you can understand my jumbled explanation . Any other advice ? Should I stay on 10mcg per day for 2 weeks or one month ?

Thankyou for any support .

[PMRpro Ambassador]

Sorry - don't quite understand - or do you mean he has switched from 4+4 to only 10mg at breakfast? The removal of the 4mg in the evening will probably make a big difference to your morning symptoms and so it takes longer for the 10mg to improve the inflammation.

It also bothers me when you say "the pain is more" - you shouldn't have an appreciable PMR pain and if you do it is a sign you are already at too low a dose. Were you mainly pain-free at your starting doses?

Personally I don't like splitting the dose equally and approximately 12 hour doses - the inflammation is only created in the morning so you usually get a better result with say 2/3 in the morning and the rest late enough to extend the antiinflammatory effect to 24 hours until the next morning dose without affecting sleep.

[Lasagne777 in reply to PMRpro]

Yes 4mg + 4mg changed to 1x 10mgNo pain from March 2024 when started till last week . Maybe I need to persevere on the 10mg morning dose for longer as only second day .

When would be best time to take morning dose as 2am to 3am would give disturbed sleep. I tried it once and felt very tired in the morning because I read you musnt lie down after taking the dose .Is that right ?

[PMRpro Ambassador in reply to Lasagne777]

As soon after 4-4,30 am as reasonably possible. That is when the inflammatory substances are shed in the body. If you can take the pred at 2am, they never get a hold, the sooner after 4am you take it, the less new inflammation has been created. On the other hand, one advantage of the split dose is that the effect is still ongoing in the early morning and you can take the main dose at a convenient time, with breakfast. And that does appear to be the case for you - at first glance at least.

We used to suggest taking your pred early morning if you woke and then going back to sleep for a couple of hours until it worked. I can't think of a reason not to lie down - unless you find it bothers you. There are other medications where you shouldn't lie down, such as the alendronic acid, but most things don't demand that.

The other question has to be, have you done anything different?

[Lasagne777 in reply to PMRpro]

Thankyou so much for your reply . I will take all of your advice in and try to see if taking at 2am helps . That's good to hear I can take it with food and sleep again . I don't know where I read it was better not to lie flat after. Obviously had trouble with it but I'm ok.

Only thing I've done different was maybe too much daily swimming and pilates and pain started after a short bout of stress.

Thanks for your valuable support . Would 6mcg at 2am and 4 mg at 9am be acceptable to try. ?

[PMRpro Ambassador in reply to Lasagne777]

You just need to experiment a bit and while the 2am version is the ideal, if it disturbs your sleep too much it isn't right for you. Everyone is different and what works for me might not work for you.

However - you seem to have done more and whatever the stress was, it may have woken up the sleeping PMR, it often does more than people think it does. You may need to try a few days of the flare protocol to clear things out: to do that you would add 4mg of methyl pred to our current dose for up to a week and then drop back to your chosen current dose. That would be 14mg methyl pred for a few days and back to 10mg and see how you feel after that.

Going from 2x4mg one day to 1x10mg the next day shouldn't be too much of problem but it sounds as if it was.

[Lasagne777 in reply to PMRpro]

Ok will try your advice and see what works for me . Thanks 👍

[DorsetLady PMRGCAuk volunteer]

Agree with PMRpro not really clear exactly what daily overall increase is-

Is it from 2 x4 to 1x10 (am only)

Or increased to 1x10, 1x4

but as PMRpro says sounds as if evening dose has been stopped that may be part of the issue

[Lasagne777]

Yes 2x4 has been changed to 1x10 am only . Sorry I thought I explained it rather confusing .

[AyJayBass]

Small point, but mcg is the abbreviation for micro grams and mg for milligrams. You mean milligrams.

[Lasagne777 in reply to AyJayBass]

Sorry you are right , my thyroid meds are mcg and my steroids are mg . Got them mixed up together . I am very new to taking any other medication than thyroid so learning all the time. Thanks for pointing this out to me Ay Jay . Much appreciated. X