Divided dose or all at once?

I'm currently off prednisone but I took it for more than 12 years for PMR. I don't think there is a single correct way to take prednisone. I refer to the "depends how I feel" method of tapering. It might also be called the "try it and and see method."

I found that splitting my dose worked well. I took approximately 2/3 of my dose in the morning whenever I woke up. There was no set time for when I woke up except more often than not it was about 2-3 a.m when pain woke me up.

The pain wasn't wasn't always the same. When I didn't wake up at 2-3 am that was a good thing. I slept a good 8 hours and 7-8 a.m. was my wake up time.

I would reserve 1/3 of my dose for the evening. The effects of prednisone did wear off for me too. I needed some in the evening but not half of my dose. Usually 1/3 of my "total dose" for the day was enough but not always. I could take a couple of mg more in the evening if I felt the need. I kept track of my "total dose" for the day.

I didn't adhere to any fixed dose. I tried to be consistent and stay on a "staple dose" each day. I didn't adjust my "total dose" until there was a reason to. If there wasn't any "compelling reason" to take more prednisone, I would take less prednisone. I tried to take the amount that I thought my body needed and that was based on how I felt.

At the start of high doses of pred, I took it all at once in the morning. I've been taking it now for three years, along with Actemra. I really roller-coasted with my dosage for two years. I believe when I got down to 20 mg or so, it just didn't seem to 'work' all day, and I would take 1/2 in the morning and the other 1/2 around three.
I've heard many people say the dosage is most effective if taken around 2 a.m. I never tried that; I sleep too well.
When I finally made it to 10mg this year and presently 3mg...I always just popped it in my mouth in the am. Hope it helps; once again, our body is a pretty good guide.💞

I had read about someone taking it at 4am.
Currently on 12.5mgs. I wake up so stiff, take my Pred, and feel better about 10.30am. The last four nights I have set the alarm for 3am, had some yoghurt in bedroom (last night a Weetbix soaked in milk) and taken it with 5mg. The difference when I get up at 7am or 8am is amazing! I then take the other 7.5mg. It is a problem getting back to sleep but worth it.

I started at 20 mg in late November and I’m now at 8 mg. I’ve taken my entire dose by 08:30 from the very beginning. I’ve had sleep issues on and off for the past 20 years and feel like taking prednisone close to bedtime will prevent me from falling asleep.

The sleep issue is one reason why doctors tell us to take prednisone in the morning. Prednisone can also upset your stomach so taking it with breakfast is a good idea. Taking prednisone in the morning with breakfast means it's less likely to affect your sleep and upset your stomach.

When I was able to sleep through the night without pain, I switched to taking prednisone all in the morning with breakfast. When I could go an entire 24 hours on a single a.m. dose, I felt like things were improving.

I don't expect to be completely pain free. I don't take prednisone anymore but I still have pain. I have arthritis and other things that are causing the pain so knowing that makes it easier to cope with the pain. The pain is tolerable now. The pain and stiffness of PMR was not easy to tolerate. The pain seemed like it happened for no reason at all.

How long did it take you to taper off prednisone? I tried to go down to 7 and after a week of not being able to function well I went back to 8 mg.
I really want to get off prednisone. I have quite a few of the side effects, including an ulcer, and also worry about my bones, but not at the price of not being able to function.
I’ve read here to decrease by .5 mg. Did you try that?

I was just diagnosed with pmr in April of 2023 and started on 10 mg. Because I received the script at 4:30, that is when I started taking it, the whole amount, and it has worked surprising well. I was worried about it affecting my sleep but it has not. Initially it seemed like it kicked on fully about 8 pm and I had a good night’s sleep that first night and woke up feeling pretty good. For about the first 3 weeks, as it started to wear off i the afternoon and into the evening, I felt achey and sore but that is now gone. Am now at 9 mg. Incidentally, I also use a pemf mat and hbot extensively to help mitigate inflammation and hopefully support my adrenal glands. So far so good. While I can tell I still have a way to go, am largely back to my old activities though not quite at prior level.

I take about ⅓ of my Prednisone dose around 3 am. Since I started doing that, I wake up with no morning stiffness. I take the the remaining Prednisone dose around 8am. I find taking it early in the morning helps with sleep.

Prednisone is synthetic cortisol, which is centrally involved in controlling the body's sleep and waking patterns. Natural cortisol in the body has a diurnal pattern that peaks in the morning and is at its lowest in the evening. My ingestion of Prednisone is intended to help mimic the normal pattern of cortisol in the body.

Short version of a very long story:

I took prednisone for more than 12 years for PMR. The doses I took were much more than what is typical for PMR only and for a much longer period of time. There were other autoimmune problems so more than PMR only.

I had an online conversation with someone who had an adrenal crisis. She was very concerned about my long term use of prednisone because of steroid induced adrenal sufficiency. I wanted to taper myself off prednisone and my rheumatologist understood that I was trying. I would struggle to get less than 10 mg and interestingly 7 mg was the lowest I could get without a "pain crisis."

The pain was never exactly like my original symptoms of PMR. The pain was similar to PMR symptoms but never quite the same. I don't know why it would hurt so much when my prednisone dose got into single digits.

I was able to taper off prednisone after my rheumatologist suggested a biologic that was FDA approved for GCA. The idea was that if it works for GCA the biologic should work for PMR too. I was skeptical but I was willing to try what my rheumatologist suggested.

The biologic worked! I was able to taper by 1 mg per month for the first 3 months down to 7 mg. I felt well so I then tapered by 1 mg per week down to 3 mg.

I was told by an endocrinologist that if I was ever got down to 3 mg that I needed to have my adrenal function evaluated. My rheumatologist was surprised that I was able to taper so quickly so he told me to stop tapering until I could see an endocrinologist. My cortisol level was low. The endocrinologist said my adrenal function wasn't good but she was encouraged that I at least had some adrenal function left.

I needed to stay on 3 mg of prednisone for about 6 months before the endocrinologist said my cortisol level was "adequate." It was thought that I could discontinue prednisone with safeguards in place. She said I could probably go from 3 mg to zero all a once but I tapered off over a couple of days.

It wasn't exactly smooth sailing after I tapered off the first time. I needed to go back on prednisone but for reasons that weren't related to PMR.

The biologic kept PMR under control so eventually I manged to get off prednisone again. My last dose of prednisone was about 2 years ago. I still take the biologic to control PMR. My adrenal function improved after I got off prednisone.

Sorry ... I tried to keep this short.

12 years on prednisone! Wow! How’s your bone density? What side effects did you have? Did they all go away? Are there side effects from the biologic?