1. < Polymyalgia Rheumatica (PMR)
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Do I need a higher dose?

Posted by retiredphil @retiredphil, 4 days ago

I started having stiffness and pain in hips and shoulders about 4 weeks ago. Dr Google said I likely have PMR. Went to see my Dr and he agreed, took blood tests, and gave me a prescription for 15mg Prednisone. CRP very high (80) confirming likely PMR. Took first dose of Prednisone that same morning and feeling much better by that afternoon. The following day no symptoms at all, but the next day and this morning I had quite a bit of stiffness and some pain in the shoulders. Should I be taking a larger dose? and if so can I take 15mg morning and another 5mg before bed? Thanks for any help

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megz | @megz | 4 days ago

15mg is the standard prednisone/prednisolone start dose for PMR in Australia. It's usually enough, though some people may take a week or two to feel the full benefits, I know I did. Morning stiffness may stay for some people though it usually isn't too bad. As you suggested, some people split the dose to take a smaller part of it later in the day to relieve any persistent morning pain or stiffness. I used to take 2mg of the dose in the evening with no morning pain at all. Don't be in a rush to raise the dose too soon. It can make it harder and longer to taper down.

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linnead | @linnead | 3 days ago

I would split the dose for sure. Sorry you have joined this club.

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John, Volunteer Mentor | @johnbishop | 2 days ago

Hello @retiredphil, I would like to add my welcome to Connect along with @megz, @linnead and others. I was started at 20mg for both occurrences of my PMR but I think it may depend on other factors for each of us. There are quite a few other members who have found good results splitting their dose although I personally never needed to do that. I usually woke up the next morning with some stiffness and a little pain but it was always less than a 2 on my pain scale of 0 to 10. I kept a daily log of dosage and level of pain when I got up in the morning to use as an aid for tapering off of prednisone.

You might find the following discussion helpful:
-- How to Slowly and Safely Taper Off Prednisone but ... no set rules.
https://connect.mayoclinic.org/discussion/how-to-slowly-and-safely-taper-off-prednisone-but-no-set-rules/

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superfly999 | @superfly999 | 2 days ago

15mg Prednisone eliminated all my symptoms within hours with the exception of my left shoulder joint, which would still hurt badly enough in the early mornings to interrupt my sleep.

After 3 days I asked my rheumatologist if I should increase to 20mg, and he advised me to give 15mg more time to work. By the very next day my shoulder pain had resolved and I'm still at 15mg and counting the days (15 left) until I attempt my first taper.

As far as dose splitting, I did 12.5mg in the morning and 2.5mg at 5:00 p.m. for a while, but have resumed taking all 15mg in the morning after reading that this timing is least disruptive to the circadian rhythm.

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