Divided dose or all at once?

@alissahe --- "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?"

My bone density is good except that clinical correlation is advised. My lumbar spine has a bone density that is 4 times higher than normal for a male my age. My problem is too much bone but a spine surgeon doesn't think it is "good bone." The surgeon wants to remove much of the bone and fuse my lumbar spine. The goal is to create more space in my spinal canal. My exiting nerve roots are also being crushed by extra bone so that problem needs to be addressed too.

My knees have a problem with heterotopic ossification which happened after knee replacement surgery.

"Heterotopic ossification (HO) is a diverse pathologic process, defined as the formation of extraskeletal bone in muscle and soft tissues. HO can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478587/#:~:text=Heterotopic%20ossification%20(HO)%20is%20a,complication%20of%20trauma%20and%20surgery.
Future surgery isn't recommended because the problem might get worse.

Not all of the side effects from prednisone have gone away but they are slowly improving. My blood pressure is controlled by one medication instead of three medications.

My cholesterol level has improved but it got too low so atorvastatin was stopped. Then my cholesterol level was too high so now I take half of my original dose.

I was never officially a diabetic but my insulin level was very high. My endocrinologist says I have insulin resistance and metabolic syndrome caused by long term prednisone use. My endocrinologist is treating me with a weight loss medication. The endocrinologist says diet and exercise might work better than the weight loss medications. Generally speaking, I have hormone imbalances which may never improve.

I had cataract surgery a long time ago so my vision is reasonably good. I had steroid related ocular hypertension that has improved. It is now called glaucoma and being treated.

My cortisol level has improved and my symptoms of adrenal insufficiency are much better.

I haven't had any infections since coming off prednisone. When I was taking prednisone in combination with other immune suppressing medications, I was getting infections. Leflunomide was stopped because of infections but my rheumatologist said prednisone was contributing to the problem too. Prednisone couldn't be easily stopped.

The biologic (Actemra) can be stopped for any reason. I haven't had any side effects or infections that warranted stopping Actemra. I had to stop taking Actemra because of supply chain problems during Covid. My PMR symptoms returned gradually over time. It wasn't like a flare or "pain crisis" like what occurred when my prednisone dose got too low. I had to take 10 mg of prednisone again for 6 months when I was off Actemra. After Actemra was restarted, I tapered off prednisone again in 2 months instead of 12 years.

@alissahe Sometimes, our body lets us know what works for us...we are all unique. Since you had sleep issues previously, you may be right!!💞

I started at 20 a day in the morning for a week and tapered to 15 a day in the morning the next week. The result was that I had 2-3 good mornings followed by 2 bad mornings, in both weeks.

9 days ago, my rheumatologist increased my dosage to 20 in the morning and 10 and night, and the results so far have been much better. I had immediate relief from the pain in the mornings, and my mornings have been almost routine since. The dosage in the evening seems to have been a game-changer for me.

My symptoms are not completely gone, but almost negligible, and have been since the new dosage. I'm now waiting for a recommendation on the taper, regarding whether I should wait a few more days to see if there's a chance "all" symptoms disappear first. Unfortunately there is still just enough soreness in my shoulders to prevent me from side-sleeping again (so I haven't slept normally in weeks), but it's been at the same level since the beginning of the split dosage. So maybe that's as good as it will get. I will try to keep you posted on how it goes.

I take mine in the morning. My symptoms were always worse in the am till early afternoon. I had very little pain past early afternoon.

Just be careful taking at night it will mess with some people’s sleep schedule.

I was taking my prednisone in the morning but found that the pain on waking up at the end of the steroid’s 24-hour cycle made the AM very tough. So I began taking it during the night on my one bathroom trip, usually around 4:00 AM or so, leaving the tail end of the medicine’s effectiveness to the time when I’m asleep. It made my wake-up time a little bit better.

My pharmacist says to always split the dosage. Too much stress on adrenal system
to take all at once !

I'm doing the same thing, 40 mg taken as 2 doses in am & pm 20 mg tablets, because if I took it all at once it wore off and I'd be in pain.
In the past I've been told to take it all in the morning but the reason given was because the prednisone side effects (agitation) could interfere with my sleep. I never asked my Dr. if there was any other reason to take it as 1 dose.