New case of PMR Started pred 15 mg with breakfast 3 days back. First dose gave me some relief during the day- less fatigue, better appetite, less pain. However, night time pain and morning stiffness was still severe. Now, even day time relief has gone and back to pre-predinsone level despite on 15mg Pred. What is your experience? Do I add 5 mg in the night? or 12.5 in morning and 5 in the night?
Hi<
I think you definitely need to go to 20 MGS pred which is what I started on. I have always split my dose so I would suggest 10 mgs in the morning and 10 mgs in the early afternoon. As you improve you can slowly start to reduce your dose but don’t be in a hurry!
Pred can keep you awake so most people try and keep it away from bedtime.
PMR is always at its worst in the early morning; the cytokines that cause the inflammation are at their most active around 4.30 a.m.
Some people take their pred at 2 a.m to prepare for this but I prefer to be asleep!
With the higher dose you should get some relief.
The best of luck on this journey that none of us chose to go on but, we are all here for you.
You might try 7.5/7.5 for a few days. If bilateral pain persists, no harm done, try 10/10.
On a single dose, I also had PMR pain all day. After a month, I began a 17/7 split dose and, on tapering, kept the evening dose high. Evening pred after the meal never affected my sleep. I stopped splitting at 7 mg pred.
Did you immediately go back to normal activity levels once you felt better? It can take up to a couple of weeks for good relief - but it does also depend on you being on an adequate dose and management on your part with appropriate lifestyle changes.
Another possibility is that you were diagnosed and managed quickly - and the underlying autoimmune disorder that causes the symptoms is still building up and getting worse. This is particularly the case when PMR is a symptom of large vessel vasculitis or GCA.
When you stopped splitting, when did you take the 7mg pred? I’m taking 4 in the evening and 3 in the morning, but this doesn’t work consistently. Sleep is not an issue with me either.
PMR is a life changer and you need to slow down and take life easier. Rest, rest, rest.
I tapered to 7.5 mg pred in nine months and was stuck thereabouts for a whole year, with several unsuccessful tapers. Your current daily 7 mg may well be a little low, just as I experienced.
At 7.5 mg, I experimented with different split doses and tapers, starting with 4 after breakfast and 3.5 after tea and, six months later, settling on the reverse.
After another five months, I transitioned to a single dose of 7.5 mg after breakfast and, soon, after began the successful taper towards 4.5 mg pred, PMR pain free.
I began taking pred two years ago today.
thanks, evening pred leads to adrenal gland suppression. Isn’t that true?
what lifestyle changes actually help?
Thank you. Rest actually increases stiffness/pain for me and in most PMR. no?
I thought pred led to adrenal gland suppression!
When I say rest, I mean don’t rush around the place, I did not mean rest by lying around in bed all day! Just take it easier. I think a lot of people do need to rest in bed occassionally on the other hand.
Hi Vijay, I started on 20 mg but after a bad flare end up on 30 mg for 6 weeks to get PMR pain free. I then started splitting my dosage about 70 % after breakfast and 30 % at bedtime. Currently on 3 mg, but not splitting. We all have different ideas, but I believe an anti-inflammatory diet, staying positive, active and smiling helps a lot. Good luck on the rest of your PMR journey. 
All pred above about 8mg/day leads to suppression of natural cortisone production - whatever time you take it. Yes, it was found that 5mg at night suppresses more than 15mg in the morning but that is really more relevant to short term use of pred - up to a couple of months. If you are on pred for years there will be suppression so it makes sense to use the pattern of dosing that gets the best result for the lowest dose and consider trying to get to morning only dosing once you are down to about 7mg/day. But once you are low enough it will usually come back anyway.
Diet, omitting carbs and sugar above all, pacing, trying to avoid too much stress and overdoing things in general. Avoiding too much activity with repetitive muscular actions or doing them in small bites helps. It is a bit different for everyone but keeping a diary relating activities and diet to dose and symptoms is often helpful. Learning what YOUR triggers are is very helpful - providing you then take notice!
Thank you
when you started taking pred, in how many days you felt better? Understand that lot of people get better from 1st day, But read an article that said median response time is 10 days.
Any advice for me? I am 68 yr, have occasional low grade fever, ESR is 90.
Thank you
when you started taking pred, in how many days you felt better? Understand that lot of people get better from 1st day, But read an article that said median response time is 10 days.
Any advice for me? I am 68 yr, have occasional low grade fever, ESR is 90.
Thank you
when you started taking pred, in how many days you felt better? Understand that lot of people get better from 1st day, But read an article that said median response time is 10 days.
Any advice for me? I am 68 yr, have occasional low grade fever, ESR is 90.
Thank you
when you started taking pred, in how many days you felt better? Understand that lot of people get better from 1st day, But read an article that said median response time is 10 days.
Any advice for me? I am 68 yr, have occasional low grade fever, ESR is 90.
Thank you
when you started taking pred, in how many days you felt better? Understand that lot of people get better from 1st day, But read an article that said median response time is 10 days.
Have bumped my dose to 15 in morning and 5 at 3 pm. Still no relief. Only on first dose, it was a little better.
Any advice for me? I am 68 yr, have occasional low grade fever, ESR is 90.