Pred times

hi people never really posted before but was just wondering if anyone takes there pred in 2 eg 30mg in the morning and 30mg at night. i was taking 60mg of pred once a day have bin for years and years but went 2 clinic 2day consultant suggested takin 30mg in the morning and 30mg in the evening cause symptoms very bad at night on average wake up 5 or 6 times needing a neb anyway he said this might be because effects of pred work off during the day n suggested 30mg in morning and 30mg at night so the effect lasts all day does anyone else do this and has it made a difference?

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Some point in the dim and distant past I was moved to taking my pred at night in the hope it would help with the morning dips. Made diddly squat difference and the RBH moved me straight back to AM pred saying the taking at night was rubbish. One more thing, are you on 60 cos you have an absorbtion problem cos I have yet to find anywhere that thinks there is any difference between 40 and 60 unless you have specific problems. I only say cos less pred = less side effects got to be a good thing

Bex

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hi bex im usually on 40mg maintainence dose sorry i meant bin on pred continuosly for 6 years but bin on 60 for last 5 months n not able 2 reduce dose back down 2 40mg without big probs my lungs dont like it lol!

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I agree with Bex, i been on 40mgs for 4 yrs upping to 60mgs when acute but makes no difference, local costa still do but regional lung centres dont go above 40 unless proven to have an absortion problem? these people tend not too have the side effects off moon face, weight gain etc dispite large doses? maybe worth mentioning to cons re absorbtion. I too tried split doses as was needing hrly nebs at nite but like Bex made no difference what so ever.

Andrea xxx ps is hope im now down too 25mgs!!!!!!

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Hi Clare

I've tried this too because of bad morning dips and it made absolutely no difference, except that it stopped me sleeping (although even that was probably psychosomatic).

Not to get too technical, but because pred works on gene expression in the nucleus of the cell rather than receptors on the outside of the cell like a lot of other drugs, you don't theorectically need to have good blood levels of it all the time to get the maximum benefit, in the same way as you do for theophylline, for example.

I have had absorption studies at the Brompton and have some degree of absorption problems with both pred and theophylline (delayed absorption with pred; reduced absorption with theo). I queried with them whether some of my vast day to day variability and unpredictability could be due to variable absorption of pred and they basically told me the above. As long as you are getting enough pred into you most of the time (and I am, because I'm Cushingoid, as they kindly pointed out!) it should be enough to be effective. They also said what others have said below, that doses above 40mg are not usually any more effective.

Having said that, I am certainly not telling you to go against what your doctor has advised; everyone is different and anything is worth a try! Many of us on here find that taking some of the meds differently from the manufacturers' recommendations (under medical supervision of course!) is more effective.

If you are not Cushingoid (ie moon face, central weight gain etc) then it certainly might be worth talking to your consultant about whether you have an absorption problem. There are only a few centres nationally that do absorption studies. It might also be worth considering one of the steroid-sparing agents (eg ciclosporin, methotrexate, azathioprine), if you haven't already, since you are on such a big dose and are struggling to get it down.

I am wondering who looks after your asthma. I suspect looking at your profile and the drugs which you are on, that you are probably already under a tertiary referral centre which specialises in the management of difficult asthma, but if not, that might be something else to consider.

Hope this helps

Em H

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hi emily

thanks 4 the advice everytime ive had pred levels checked they have bin ok so dont think i have a problem wiv absorbtion on 60 since admission in feb n usually able 2 bring back down 2 40 wiv no probs but having big probs this time. i always get conflicting advice from local hosp an RBH was at local hosp yesterday will try this spilt dose untill i go RBH next month n c wat they say about it! i do not like suggesting new treatments as i always feel a right prat!!!!

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I've been advised against splitting the dose because pred at bedtime can make it hard to sleep!

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Hi Clare, and everyone else!

Like most folks here I tried splitting splitting daily dose of pred between morning and late evening in an effort to reduce early morning breathing problems. Didn’t make any difference, and the doc just raised a sort of metaphorically bemused eyebrow when I tried to explain my rationale. (Think the cortisol circadian rhythm is hammered into doc training consciousness)

What did make a slight difference was moving from the ‘coated’ tablets to the plain uncoated ones, which I only started a couple of months ago after three years more on than off of taking this drug in its ‘coated’ format. ( Prior to that had been taking short courses of pred for approx six years)

This change has made all the difference to my absorption rates, i.e. now absorb pred far more quickly, - obvious or what? - and with more immediate relief. (Taking the tablets after a bowl of stomach protecting porridge and a bar of G and B’s best also seems to have reduced abdominal symptoms associated with pred.)

I’ve been able to reduce my previous daily 40 mg dose down to a more acceptable 20-25 mg per day based around 0.5 mg per kg.

If you aren't already taking the uncoated tablets could be worth a try?

Mia

xxx