Has anyone tried splitting your doses of prednisone if you are on a total daily dose of say 5 mgs or less?
I am thinking of trying 1 mg in the evening and 3 mgs in the early morning (about 4-4:30 am when I wake up) or maybe 2 mgs am and pm.
Thanks -
After reading some comments on this forum I've decided to try splitting my prednisone. I'm fairly new and still trying to monitor my meds But I take 35mg So I'm trying 25 mg early in am and 10 in late afternoon it seems to make a lot of sense to me since prednisone is not time release. So this is my 1st day splitting
You could even try 12.5/12.5/10 split three ways denise👍👍👍👍
Denise - do you have PMR or GCA? Splitting is generally less to be recommended in GCA as that reduces the maximum anti-inflammatory effect. 35mg is a very high dose for PMR.
The recommended way of using pred in PMR and GCA is in a single dose as early in the morning as possible - for a good reason. The new supply of cytokines, the inflammatory substances that cause the inflammation, pain and stiffness in PMR especially, is shed in the body every morning at about 4.30am. The longer you wait after that before taking the pred the more inflammation will have developed and the so longer it will take to have a good effect. The concentration of the pred in a single dose also packs more punch - the higher dose is more effective.
Pred is excreted from the body relatively quickly, most is gone in just a few hours but the antiinflammatory effect lasts from 12 to 36 hours depending in the patient so the effect lasts until the next morning for the majority of people. Some find splitting the dose to take some at night helps with the morning stiffness - as does taking the dose at 2am! There are people who do that very successfully, especially at the low doses. The longer your body has without pred present the better it is with regard to side effects and, once you are below about 7mg and your body has to start producing its own corticosteroid cortisol again, then taking all the dose in the early morning is less likely to suppress the body's production so it helps the recovery of the adrenal gland function.
Based on EileenH posts long time ago and subsequent research when cytokines are released by our bodies, I have split my dose into late night (~1am) and early morning (8am). There are 2 peaks in cytokines; one is at 4am and second, smaller one is at 9am. I try to take pred ahead of each peak. Ideally you want to take prednisone 2hrs before the cytokines peaks, if the pill is not coated. Coated pills have different release time, so timing has to be adjusted accordingly.
I am at 6.5mg ( 3.5mg @1am and 3mg@8am).
I want to keep an eye on these responses. I split my dose, but I am only in the beginning of this at 10 mg and 10 mg. I will be eagery watchign this to see how it works at lower doses. Donna
Eileen,Thank you so much for your response. Yes I've been diagnosed with PMR. I started off with 20 mg and we kept upping the dose until I start with relief. Really felt the best at 40mg and lowered it to 35-30mg. I'm also dealing with Lyme and on 3 different kinds of antibiotics. So what 'm hearing from you is that it might be better with my high dosage of pred is to be taken all at once early in am. This is all so new to me and I appreciate all of you.
IitheHi eilleenh -just reading posts regarding split doses and i take my 7mg at 2am--but my query is that that my pills are 5mg coated and 2mg uncoated -so how does that work if they are dispersed differently-should i be maybe taking all of them uncoated in1 mgs -would be grateful for any input .jeanb
I would like to try my Pred at bedtime or 2:00 am but at low doses (below 5 mgs) I'm worried about adrenal suppression as our adrenals are working again......and since fatigue is my second worst symptom I want to avoid making that worse.
Eileen, I've made a note that you mentioned some study that found that taking 5 mgs of Pred in the evening suppresses the early morning cortisol production......and I want to avoid that happening.
Im wondering as a compromise if I could split my dose but I don't see forum entries about people trying this who are on low doses.
I Usually take my Pred at breakfast but it takes at least 2 hours for the aches to get better. For the past 10 days I've been taking it about 4 am but by then my shoulders are already achy and keeping me awake and I have no improvement to how I feel the next day.
Hi Nick,
How did you choose the 1 am time? Is that convenient for you or do you set your alarm to take it? I usually go to bed about 11 and get my only uninterrupted sleep between then and about 4 so not sure if I should mess with that.
Also how did you decide to take the slightly larger dose in the evening vs in the morning?
thank you for your comments!
I agree with you. I have seen this explanation on her before about the release of cytokenes, but my sleep is my priority. I have trouble sleeping. If I were to set an alarm to take any mediction during the middle of the night, it would destoy my sleep. Also, with the non coated prednison, it is very important to have food. Eating would even make sleeping harder to get back to. My split is breakfast and dinner. I take a proton inhibitor about 45 mintues prior to those two meals. My doctor is very insistent that I do that. Once I started doing this pattern, I have been totally pain free. Based upon the no pain factor foe me, I am not going to try something that would interfere with my sleep patterns. This may not work for all, but the taking of the prednisone in the middle of the night may not work for all either. I try to listen to my body. I am eager to hear how people splitting their dose when it is a low dose have faired. I am planning to continue doing the split as I go down to a lower dose. Keep me posted as to what you decide to do. Donna
I have been splitting my dose for many weeks, I have been taking 5mg in evening at 8.00pm and 4 mgs in morning at 6.00am. I find this suits me very well.
Today I am dropping down to 8mg daily, 5mg in evening, and 3mg in morning, to see how this goes, unfortunately I tried the 8mg a few weeks ago and had to go upto 9mg again, because of pain in legs and arms.
There is quite a variety of split dose times so maybe the exact evening time isn't that critical....or maybe we just need to experiment to find the best time for our bodies.
That was my feeling too. Being pain free seems to be the main goal. Good luck!!!
All good questions.. I am up late and don't go to bed until 1-1:30AM, so I take pred just before I go to sleep. The study that I have read shows that cytokines peak at 4:30 is higher. To match that, my dose late at night is higher. That was the logic.
However, at the lower dose (7.5 and below) our adrenals are waking up and they also tend to be more active between 2 and 5AM. It is a question if late dose interferes with adrenal production. I have not found clear answer. I think that someone mentioned one study that implies that taking pred late at night could impair adrenal "re-start", but I have seen some comments that it is not conclusive and maybe other factors were in play. Who knows? Maybe it would be beneficial to reduce bedtime dose and increase morning one.
Each one of us is different , so it is OK to experiment and find the best time to take medication to match our daily schedule.
Thank you for explaining your dose timing. More things for me to consider!
Jean b: The 2mg uncoated will be absorbed and start to work in under a couple of hours. The 5mg coated ones will take probably 5 or 6 hours at least to start to work. The uncoated are absorbed very quickly so a graph of the blood level would show a spike whereas the coated ones are absorbed much more slowly and would form a rounded curve on the graph. This theoretically makes it possible to take the coated sort before going to bed and they would still work nicely the next morning. If you wanted to stop waking in the night you could try that - it's what I do with the special coated sort I take and they are designed to do just that.
4am is a bit late to prevent the early morning aches - the optimum time for that for uncoated pred tablets is 2am. To be honest - I suspect that 4am is early enough to suppress the adrenals a bit anyway so trying it earlier probably wouldn't make much difference to what you are now.
That is a very high dose for PMR, the recommendations for management of PMR say that more 30mg/day is not to be recommended - but I suppose if you also have Lyme it might affect things. The general feeling would be that if you needed 40mg that there may be something else going on besides "just" PMR - such as an arthritis. However, some people don't absorb or respond to pred as well as others and need a higher dose simply because of that.
PS to MrsCJ - forgot to say: your adrenal glands will start to work even at 5mg whatever time you take it and you have to worry less about suppression simply because you have been on so much for so long and you are going to have to wean off slowly anyway. The study was aimed more at people on short-term pred - once you have been taking it for more than a couple of months, whatever the dose, there is adrenal suppression.