How early to take prednisolone in the morning

[Shandon1]

Waking with some arm pain round 1am

Does prednisolone affect sleep

Does pred leave a hangover

[ritter]

Hi dubliner,you should take preds as early as possible and yes they do keep you awake what dose are you on?when I first started on them I use to take them at 7am,but as the years have gone by I don't take mine till 9am now,but I am reducing and have been since last June,they are a bloody awful pill with some dreadful side effects but we need them,nothing to replace them yet,kind regards Anne

[Shandon1 in reply to ritter]

I am on 20mg. It's how to deal with the pain in the very early morning. I feel tired and kind of dizzy now, mid morning. Will go for a walk to try and wake up and feel better. Thanks for comment.

[Badgergirl in reply to Shandon1]

Hi Dubliner1. I was kept awake by pred when I was on 20 mg but as they were gradually reduced I could sleep easily - by about 12.5 mg. As you are having pain in the early hours it might be worth discussing with your doctor whether it might be a good idea to split the dose by taking, for example, 15 mg in the morning and 5 mg in the afternoon. In some people the pred lasts the full 24 hours but in others it tends to wear off as early as 12 hours.

[Shandon1 in reply to Badgergirl]

I will discuss this with my doctor later and specialist next Monday.

[PMRpro Ambassador]

Research was done in Germany that showed that the optimum time to take your pred to deal with early morning stiffness is 2am (it was done on RA patients in hospital for something else and who were being disturbed during the night anyway). A form of pred called Lodotra has been developed in line with that which you take at 10pm and the coating breaks down to release the pred after 4 hours. It is already approved for RA in the UK and they are about to start trials with it for PMR (well, the plans are underway, it might happen in the next 5 years. Maybe.) They hope lower doses will be needed and there may well be fewer side effects. It is already in use in Germany for PMR. I live in Italy and there are different restrictions here and my GP suggested I try it as I had horrendous side effects with the Medrol that is usual here (weight gain, muscle wasting, a fine beard) and I find it brilliant. Are you in Ireland? Maybe they'd let you try it?

One lady on another forum uses enteric coated pred and takes them late at night on her way to bed. She finds that works well for her - they also take about 6 hours to reach the maximum blood level which is the important thing and you want it to be at about 4am - just before the PMR-causing inflammatory cytokines are shed in the body. The only real difference is that the time taken for them to be absorbed varies rather more, some people take longer than other. It works because they pass through the stomach and are absorbed much further down the gut so it takes longer to get there.

One way of dealing with severe night time pain used by some doctors is to split your dose, taking about 2/3 early in the morning and the rest late afternoon/early evening. Whether pred keeps you awake depends on the person - it has never bothered me, others at 20mg are buzzing all day and night. I did have similar feelings of tiredness and dizziness a few hours after taking the pred in the morning depending on what I was doing. One other lady who had the same thing took her ordinary pred tablets at night - at the suggestion of her GP. It worked for her, she slept like a top and he made a note for future use!

If the stiffness is in the early morning - quite a few of us take the tablets as soon as we wake having taken a yoghurt or a sandwich and a glass of water with us so we have something to eat with the tablets (to soften the effect on the stomach) and then settle down for a bit more rest to give the tablets time to work. I was fortunate - my husband gets up at stupid o'clock and makes a pot of tea and then watches the breakfast news in bed drinking tea. (It all started 20 years ago when he was on chemotherapy and had to drink a lot so he had to start early!).

Not sure what you mean about a "hangover" - your body has undergone quite an insult in the last week or so with PMR and now pred. Rest and give it a chance.

[Shandon1]

Thank you. Still feel very heavy and down beat for the first time since starting pred last Friday. But had a lovely park walk and found my secret garden. There are positives out there ( I'm a Dubliner in London).

[bowler]

Up untill 2 years ago I was always prescribed enteric coated tablets, which suited me very well, for years However I was told that I couldn't have those any more as they were too expensive, and was given the uncoated Pred, which dont seem to have as longer lasting effect in my system as the coated ones, I mentioned this to my GP and was told they are both the same, and it was all in my mind.

[PMRpro Ambassador in reply to bowler]

There's a story to that! After the NHS told doctors to cut back on the enteric coated sort the drug companies put up the price of ordinary pred! So they haven't saved as much as they thought. The instruction was to give ordinary pred plus omeprazole - many patients couldn't tolerate that and went back to their GPs complaining. Many GPs have said they wish it hadn't been changed, they hadn't realised how many patients tolerated enteric coated and had no problems but now struggled. Swallowing them is easier too.

You GP is wrong I'm afraid - when you take ordinary pred it is absorbed quickly from the stomach and the peak in the blood is about 1 to 2 hours later, all at once, and most of it is excreted within 4 or 5 hours. Enteric coated takes much longer to be absorbed - it passes through the stomach and is absorbed much further down and the peak rises slower and fades more slowly too - the same amount in total is there but over a longer time so is still there maybe 10 hours after taking it. The anti-inflammatory effect lasts for, say, 15 hours (it depends on the person) so that covers you for the best part of the 24 hours - with ordinary pred the effect may be much less, maybe only 18 hours. There is a difference for many patients. It is also possible to take enteric coated at night before bed, it isn't released for a few hours so you get to sleep and it has been released before morning so your morning stiffness is improved.

[bowler in reply to PMRpro]

I did try last year to get the coated Pred. back, but no joy from my GP. "saying that is all they had" I'm sure if we all had the coated Pred. it would be kinder on the stomach. Why dont they leave well enough alone, as it causes other problem. I was offered Omeprozole, with the non coated Pred, so how is that saving money ?

[Badgergirl in reply to bowler]

Hi bowler. I'm not sure how true this is but there is a belief amongst doctors now that the damaging effects of prednisolone on the stomach are via the system (bloodstream) rather than a local effect on the stomach, which is why they think there is no added protection from enteric coated ones.

[bowler in reply to Badgergirl]

Thank you Badgergirl, and PMRpro for your info.

All good reading,

[PMRpro Ambassador in reply to Badgergirl]

Yes - that had been thought for some time. The main argument was that the enteric form was felt to be erratic in giving up the pred - as I say, it is over a longer period of time and some patients take longer. That isn't a problem in PMR, in fact it is possibly an advantage but it had been a problem with patients with Crohn's disease and the like - but their guts are unreliable anyway.

Technically they are right there should be no difference - but the enteric sort are far easier to swallow and you never get the horrid taste in your mouth which is almost impossible to get rid of. Those may have been factors in people getting on better with them - plus omeprazole really upsets a lot of people. The carriers are different too - the filling substances can make a big difference sometimes.

[Badgergirl in reply to PMRpro]

The taste really is disgusting. Sometimes I get the half of 1 mg (cut with a pill cutter) stuck in my throat and that bitter taste just won't go away!

[PMRpro Ambassador in reply to bowler]

Omeprazole is cheap as chips, same as ordinary pred was. He's fibbing too - it isn't "all they have", it's all they choose to charge to their budget! They were told that if the patient needed the coated form for any reason they could have them on request.

[trevorfandg21]

I have had it affect my sleep . I've had some nights I can sleep and then I get a couple of nights I only got 3 hrs of sleep .

[Shandon1]

I am thinking of splitting my 20mg pred dose to 10mg in early morning and 10 in afternoon. For the last few days I have been very heavy, a'wiped out' feeling for most of the day.

[Thomas45]

I started taking prednisiolone 31 years ago to get my breathing right when I had severe asthmatic attacks. I always took it when breathing was difficult, 40mgs in one dose, and then fell off to sleep. After 6 hours I felt the beneficial effects of pred.

With PMR I started at 20mgs and am now down to just over 9.5mgs a day averaged over 7 days. From the start of being diagnosed with PMR I was given enteric coated pred. The only drawback of enteric coated is that they only come in 2 strengths, 5mgs and 2.5 mgs, so I may have a problem when I want to get below 2.5mgs unless I take them alternate days. I will cross that bridge when / if I come to it.

My doctors prescribe me 200 of each strength whenever I need them so I can manage my own reduction system.

I used to take them first thing in the morning, but now tend to take them last thing at night when I take other tablets.

They have no effect on my sleep, though I rarely sleep for more than 4 hours continuously due to my cat waking me at stupid o'clock to be let out.

[Hidden in reply to Thomas45]

Thomas

I started on 15mg of Pred for enteric coated PMR but when I got down to 10mg my GP switched me to uncoated to save money. I was taking Omeprazole. However I developed terrible stomach pains after only one dose and I was put back onto enteric coated ones.

I got off the Pred completely in Oct 2013 using a three day rotation method devised by my GP. For example after 2.5mg, I then dropped to 2.5/2.5/none and stayed there for at least 4 weeks. The next drop was 2.5/none alternate days for at least 4 weeks followed by 2.5 every third day for 6 weeks then 2.5 every fifth day for 6 weeks and then stop.

Hope this helps.

PatM

[PMRpro Ambassador in reply to Thomas45]

Yes - Pat's GP was using the same principal as the reduction scheme I have posted a few times - theoretically it will work the same for 2.5mg reductions as it does for 1mg. If you are sensitive to the drops you might need to take longer about it rather than less time. PatM's reduction was still asking your body to take a 33% drop going from 3x2.5 to 2.5/2.5/0 - which is a lot.

[Thomas45]

Thanks, both. At the moment I'm taking 7.5 on Sundays and 10 the rest of the week. Soon it will be 7.5 on Sundays and Thursdays and 10 the rest of the week (9.3 per day averaged over the week), then when I'm happy with that dose 7,5 on Sundays, Tuesdays and Thursdays, and 10 the rest of the week (just under 9 per day averaged over a week), and so on until I'm taking 7.5 every day. I haven't a pre-determined timescale. I'll see how it goes, so it will be some time before I get to 2.5. I'll probably go none on Sundays and 2.5 the rest of the week, and then lower it by one day at a time when I can, but that's some time away

[polkadotcom]

For all those having difficulty getting bits of Pred stuck in throat - try taking those little crumbs with a mouthful of food, i.e. put them on the mashed potato, muesli, porridge, soup - anything you can swallow whole and they are not nearly so likely to get stuck. I use this method for all uncoated pills as I have a very dry mouth anyway and I find even soft or large capsules can get stuck.

[Skinnyjonny]

Hi Dubliner1 ... I was advised right at the start by my Support Group to take my pred first thing in the morning with a yoghurt (Nestle Munch Bunch are an excellent size!) and then very importantly to rest-up for up to 45mins. In the last 10 months I've gone from 20mg to 4mg. I've maintained a daily health/fitness log and this regime has really worked for me. As an early riser for many a year (blame my fitness regime) I take the Pred around 5-5.30am most mornings. Real pluses are listening to the morning chorus, read a good book, sets you up for the day ... and the Munch Bunch yoghurt is lovely. Good luck my friend

[mapco]

Hi Dubliner I have reduced from 20 down to 9 over 18 months I now split my dose. 5 @ 6am, 2 @ mid to late afternoon, and the last 2 just before bed. It works for me alongside the BP pills they put me on to combat the side effects of the prednisolon. Good luck.