Conflict with Rheumatologist over taking Prednisone for PMR in AM/PM

@jlo2252 Loved this interaction. Two (male) physicians have said to me "I've never heard of PMR only showing up in 1 place" which means, I presume, that if you've never heard of it - how can it be! LOL
Well, my PMR settled around r/knee but has moved up into thigh so it's probably an acceptable diagnosis now.

I get up at 6 am, take my Prednisone and then go back to sleep for an hour. Might that be a compromise?

I have to split as well or else by 4/5 in the morning im crippled up again.

I'm new to this. I have just been diagnosed with PMR. I also have latent TB which complicates the suppression of the autoimmune system. They are trying to work out a remedy. I also got violently ill on the drugs to abate the latent TB. I find the discussion interesting about when to take the prednisone. I will discuss this with the rheumatologist at my upcoming appointment. Thank you.

I split my dose after reading about prednisone half life, and my morning achys. I am currently at 17 mg, tapering from an initial 40 last November. I take 10 mg in the AM, circa 5:00,
and 7 mg at supper time. It has not affected my sleep, as I only sleep a few hours anyway.
I am also on Methotrexate now as the initial taper didn’t go well.
That is helping with the tapering at this point.
Hope this helps.

I was told to take the full dose in the morning, not because taking it in the evening would cause problems but because it could cause problems. That was enough for me because having PMR is enough problem for me. I was starting to taper but as luck would have it, I was also diagnosed with SMM this month, so I'm doing a faster than normal tapering. I think that would be much more complicated on a split dose.

Sorry I don’t understand the multiple doses as it’s not a painkiller in the strictest sense. That sounds really dangerous to me. I took it once a day in the morning. It gives so much energy that if I took it at night I wouldn’t sleep. It might be better to follow the specialist advice I think. It’s a really dangerous drug and takes years to get over so caution is advised. Good luck.

@cazwell50

You don't take 2 full doses of prednisone so not "multiple doses." . If you are on 15 mg for example, you save a small portion of your dose for the evening. It helps to get you through the night without the morning 3 a.m. pain people have. If you don't have that early morning pain and your whole a.m prednisone dose lasts for 24 hours, then there is no need to split your dose.

I split my dose and actually needed less prednisone that way. If I needed 30 mg taken all in the morning as one dose, I might still wake up in pain.

When I split my dose I might do well with 15 mg in the morning and 5 mg in the evening for a total of 20 mg and I wouldn't have any morning pain.

The main reason for taking your entire dose all in the morning is to mimick how the adrenals release cortisol in order to decrease the risk of adrenal suppression. However, taking anything more than 5 mg of prednisone for more than a couple of weeks will result in suppressed adrenal function.

@dadcue I understand the two dose strategy but I was concerned at the first post’s comment about multiple times across the day. I guess I was lucky as I started on 15mg in the morning then one month later 10mg and so on for 12 months with the last month being 1mg. I’ve been free for 3 years but I don’t think the immune system ever fully recovers. Stiffness has gone this year so I feel quite normal.

I’ve been taking pred for PMR since 2014. I’ve tried it all, mornings, evenings and split doses. Currently taking 6mgs routinely and trying once again to reduce dosage. (this time with Leflunomide)
What works FOR ME is taking my full dose after dinner. However, when I increase to 8mg or higher for flare control, I find it best to take the amount above my routine dosage in the morning.
As said many times, everyone has different experience with this disease and its treatment.