Does Prednisone effect increase after 4 or 5 days?

The benefits of the meds definitely increased for me over a week or two. I recall complaining to my doctor after the first week that pain had only decreased by about 70%. She said I may have to put up with that.

In the second week after reading here that a split dose can help, I split the dose (then 12.5mg a day) to take 10mg in the morning and 2.5mg in the evening to help with the morning pain. It worked, my morning pain reduced to about 90% pain control on week two, and that has now improved to 95%+.

Doctors who say a split dose is okay also say the majority of the dose should still be taken in the morning with a smaller dose only at night. This has to do with reducing the risk for adrenal insufficiency later on, which can be caused partly by taking too much prednisone in the evening, a time when your body would not normally produce much cortisol.

I've maintained the split dose (current dose 7mg a day), and am taking 5mg in the morning and 2mg in the evening with dinner. I wake with no morning pain and only slight wrist/hand ache in the first week of each reduction.

Your pain relief may not come in the first few days, but it will come.

Have you tried spitting your dose. For many people, pain relief from prednisone doesn't last an entire 24 hours. When I took my entire dose at 8 a.m. the effects of prednisone would wear off in the middle of the night. I would routinely wake up with pain and stiffness at approximately 4 a.m. at which time I took my entire morning dose of prednisone. At 4 a.m. I was faced with a decision to call my employer to say I was unable to work. If I took prednisone at 4 a.m I was able to go to work at 7 a.m. even though work would seem impossible at 4 a.m.

My sleep cycle suffered when I woke up in pain at 4 a.m. because I was unable to go back to sleep because of pain. Prednisone works quickly but not immediately. When I started to split my prednisone dose 2/3 in the morning at 8 a.m. and the remaining 1/3 in the evening before bedtime, I miraculously slept the whole night and didn't wake up with the pain and stiffness.

The added benefit was I could take less prednisone over the 24 hour period. I didn't seem to need a big 50 mg dose of prednisone first thing when I woke up. I managed well with 20 mg in the morning and 10 mg in the evening reasonably well.

I tried to explain this concept to a doctor once. They were of the belief that I should take my entire prednisone dose in the morning. This doctor said whatever I was doing ... keep doing it because it seemed to work for me. Consult your doctor to get their opinion. Some doctors aren't as open-minded as mine was.

The benefits of the meds definitely increased for me over a week or two. I recall complaining to my doctor after the first week that pain had only decreased by about 70%. She said I may have to put up with that.

In the second week after reading here that a split dose can help, I split the dose (then 12.5mg a day) to take 10mg in the morning and 2.5mg in the evening to help with the morning pain. It worked, my morning pain reduced to about 90% pain control on week two, and that has now improved to 95%+.

Doctors who say a split dose is okay also say the majority of the dose should still be taken in the morning with a smaller dose only at night. This has to do with reducing the risk for adrenal insufficiency later on, which can be caused partly by taking too much prednisone in the evening, a time when your body would not normally produce much cortisol.

I've maintained the split dose (current dose 7mg a day), and am taking 5mg in the morning and 2mg in the evening with dinner. I wake with no morning pain and only slight wrist/hand ache in the first week of each reduction.

Your pain relief may not come in the first few days, but it will come.

Have you tried switching back to taking your entire prednisone dose in the morning?

After I managed to get below 10 mg, I wasn't having that much morning PMR pain anymore. Granted, I was taking the biologic to be able to stay on that low of a prednisone dose. The biologic didn't interfere with my adrenal function like prednisone did.

At 7 mg of prednisone, I was more concerned about adrenal insufficiency based on the information I was getting from someone who had an adrenal crisis. I think taking the entire dose of prednisone in the context of adrenal insufficiency is important.

Your adrenals need to be nudged into producing cortisol again. This happens in the middle of the night when you sleep. Your cortisol level should be lowest in the middle of the night. The normal function of the circadian rhythm is for your cortisol level to gradually increase until you wake up.

If pain wakes you up then that is something else.

It just depends on how much PMR inflammation you have on 7 mg of prednisone. Hopefully your adrenals will sense a lower cortisol level in the middle of the night and produce some cortisol. If your PMR pain is controlled during the night, maybe taking your entire prednisone dose in the morning when you wake up would be better from an adrenal standpoint.

The next .5 reduction I'll make is from the evening dose to keep the morning/evening dose ratio good. No, I haven't considered experimenting by removing the small evening dose and taking the whole lot in the morning. Having achieved symptom remission with low inflammation I'm not willing to accept the high likelihood of morning pain returning.

On the other hand, my risk of adrenal insufficiency is relatively low, having started on only 15mg and being on prednisolone for only 6 months so far, at age 65, I'm hoping gradual reduction of that small evening dose will keep adrenaline insufficiency risk low. Time will tell. We're all trying to balance various risks. My doctor agrees with the current plan.