Can i switch from double to single dose pred?

[Pierreracine]

I wondered if there would be advantages to switch from daily double dose pred to single dose? I have difficulty getting sleep and thought it could help... I'm actually on 12.5 mg. and have a hard time with the withdrawal. Just 1 mg less and I feel weak unti mid day, but I sleep well, and I mg more and I feel fine but cannot sleep! Would you believe that!? I mg. difference!

Thanks!

Pierre, Canada

 

[kekemonster101]

You might feel weak because 12.5mg is close to the "threshold" dose, which is the amount that your body makes normally. This can be the hardest part to get off of. While tapering pred its best to get rid of the night dose first because your body usually makes cortisone early in the morning normally.

Currently I take hydrocortisone which is a much shorter acting drug. Prednisone can last about 24 hours in your system, while hydrocortisone I believe is more around 8 hours. Maybe taking a different form like hydrocortisone could reduce your symptoms or give you better coverage. The only downside is that you gotta take it more often.

Consider getting a good endocrinologist. The GI docs often aren't as experienced in dealing with these type problems. The endocrinologists can sometimes give you more precise advice regarding your steroids and such. Mine also manages my Vitamin D level, my bisphosphonate infusions (for the bones), testosterone hormone levels, and my steroids. Also try to make sure you take your cortisone at the same time every day. Keep the morning dose higher and the later dose lower. You might also try even 1-2mg at night. That would give you more coverage.

 

[Pierreracine]

While tapering pred its best to get rid of the night dose first because your body usually makes cortisone early in the morning normally.

Thanks so much for taking the time to answer me. Very insightful. But, could you be more specific about "getting rid of the night dose first". How would this translate in terms of dosage? Is this the 1 or 2 mg at night you are talking about at the end of your post?

I'm not stupid, just French...

Pierre, Canada

 

[kekemonster101]

By getting rid of the night dose first, I dont simply mean cutting it out, although if you raise your morning dose you might be able to do that.

I meant when you are tapering slowly, always try to reduce the night dose first, and the morning dose last. If you are still having symptoms you can take a small dose like the 1-2mg because that might be just enough to get you through the night, but preferably you would have no night dose.

Basically, when you take prednisone at night, your body has cortisone in the morning and wont attempt to make its own cortisone. When you "starve" your body a bit in the morning for cortisone, its more likely to try to "wake up" your adrenal glands. Thats why its better to get rid of the night dose first, so your body can start making its own cortisone again. Unfortunately when you are "starved" for cortisone thats when you can feel the symptoms, so its best to just go real slow.

Say if you take 6 in the morning and 6 and night now, you could try taking 10 in the morning and only 2 at night, etc. That way your big dose is in the morning and maybe that will help your sleep patterns, but the 2mg at night should hold you over until the morning's dose so you dont feel the withdrawal type symptoms. You might also consider making it an afternoon dose, taking it around lunchtime instead.

 

[kateel]

Talk to you pharmacist or doctor, but my doc has me taking my entire dose in the morning. I started out on 40 mg, so they told me to make sure that I take it early so I could sleep. I still had trouble sleeping at that high of a dose, but now I'm down to 5mg and sleep isn't as much of a problem.

Best of luck!!