Taking prednisone dose, morning and evening

Posted by amfb @amfb, Jul 9, 2022

I'm down to 2 1/2 mg of prednisone, start at 10mg two years ago. When from 10 to 7.5 to 5 and now 2 1/2 doesn't seem quite enough but 5 has been giving me more side effects. I'm splitting the 2.5 in half, half in the morning and evening. My rheumatologist wanted me to take 5 mg. every other day, told her that doesn't work for me, I pretty much have to have a consistent dose on a daily basis. She insist I take it the way she prescribed, giving no reason why I shouldn't take it in a split dose. I looking for a new rheumatologist. And possibly trying Actemera, maybe. It's a tier 5 drug with my insurance, so probably won't be able to afford it. Is there a problem with taking prednisone it at night? doesn't seem to cause me sleep problems.

Interested in more discussions like this? Go to the Polymyalgia Rheumatica (PMR) Support Group.

Hi @amfb, Welcome to Connect. My PMR is in remission now but the two times it was active I took the dose early in the morning with my blood pressure pills, normally around 6 to 6:30 am. The only thing I had read about is splitting the dosage could cause Adrenal suppression and also affect the sleep. More info on that here:

— Circadian rhythms in rheumatology – a glucocorticoid perspective: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4249493/

I do remember other members here on Connect who have mentioned splitting the prednisone dosage helped them. I als found a study that discussed the topic which was kind of interesting. The one key I read is not to take the second dosage too late in the day. They mentioned around 8 am for the first and around 2 to 3 pm for the second dose .
— Timing of glucocorticoid administration: a cross-sectional survey of glucocorticoid users in an online social network for health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410988/

You might want to keep a daily pain/symptoms log along with the dosages for the day to see how it goes. Do you normally keep a daily pain and dosage log?

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I have seen many on here who split the dose with success; even considered it myself. Rheumatologists in general want us to follow "their schedule". Mine does this as well, but her schedule is not working for my body. Listen to your body. Don't decrease too quickly, as John mentioned. I too am considering shopping around, but waited a long time (5.5 months) to see her. She doesn't want to see me again for 4 months, which is now 3. I'm at 12.5 mg and supposed to go down another mg. starting tomorrow. Put my back out a week ago and it's still out. Seems like I'm tolerating Ibuprofen with food, which I could not a few months ago. I'm feeding a lot of stuff into my body and I don't like it at all but whatever works. I thought Prednisone was supposed to handle all pain, but it is def not helping my lower back. So Tylenol/IB combo for awhile I guess. All the best with your split dosage. Doesn't hurt to give it a shot. Take care ~ Deb

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@milld835

I have seen many on here who split the dose with success; even considered it myself. Rheumatologists in general want us to follow "their schedule". Mine does this as well, but her schedule is not working for my body. Listen to your body. Don't decrease too quickly, as John mentioned. I too am considering shopping around, but waited a long time (5.5 months) to see her. She doesn't want to see me again for 4 months, which is now 3. I'm at 12.5 mg and supposed to go down another mg. starting tomorrow. Put my back out a week ago and it's still out. Seems like I'm tolerating Ibuprofen with food, which I could not a few months ago. I'm feeding a lot of stuff into my body and I don't like it at all but whatever works. I thought Prednisone was supposed to handle all pain, but it is def not helping my lower back. So Tylenol/IB combo for awhile I guess. All the best with your split dosage. Doesn't hurt to give it a shot. Take care ~ Deb

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Deb, @milld835 your back pain may be nerve pain which would be different than pain from inflammation which is what the steroids help with. Talk with your PCP about possibly getting tests to determine root cause of back pain. I am having problems with doctors wanting to assign all my pain to PMR, what I call "piling on". I have had to be a strong advocate for myself over this, in the end I did have other causes for some of my pain. All were successfully separately treated and never would have responded to steroids.

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@jabrown0407

Deb, @milld835 your back pain may be nerve pain which would be different than pain from inflammation which is what the steroids help with. Talk with your PCP about possibly getting tests to determine root cause of back pain. I am having problems with doctors wanting to assign all my pain to PMR, what I call "piling on". I have had to be a strong advocate for myself over this, in the end I did have other causes for some of my pain. All were successfully separately treated and never would have responded to steroids.

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Yes. I agree and I've also become my own advocate at this point. It could possibly a recurrence of a herinated disc from a couple of years ago. I don't have a PCP or GP (mine retired). On a waitlist for a family doc. I just thought that the Prednisone would help any inflammation, i.e. disc in this case. I don't think this is PMR, so I've been trying to take Ibuprofen/Tylenol together which, in the past, has work for this pain. It does help somewhat. Thanks for your help; much appreciated.

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