Morning or evening for preds?

[MaryWR]

I've been taking prednisolone for 3 weeks or so now. I started off taking it with my evening meal but after discussing it with my gp I switched to the morning. He said I might sleep better, also I was feeling wobbly and shakey in the mornings. Now I am sleeping just as badly if not worse, still get a bit shakey but most of all find the pain control isn't as good. what are all you other fellow sufferers doing? Is there a recognised "best time of day" for medication? I really appreciate the help and support I find on this forum.

[Rjw2014]

My rheumatologist advised me to take mine when I wake up in the middle of the night, generally about 4 a.m., with a full glass of milk. Since doing this I have been able most nights to get back to sleep fp another couple of hours. I also don't get up feeling weak and wobbly. She explained that i was being woken up by lack of steroid in my system, which meant that from when I woke until I took my dose with breakfast was too long.

[northants in reply to Rjw2014]

I take mine around 4-30 and then when I get up I can move easier if i am going out early I set the alarm. I find if I take them at breakfast time it takes me awhile to get moving sometimes about 2 hours

[PMRpro Ambassador]

The usual advice is to take your pred as a single dose as early in the morning as possible. The main reason for this is that it causes less suppression of the system that triggers the adrenal glands to secrete cortisol, the body's natural corticosteroid. A study has shown that the most effective time to take pred to avoid morning stiffness and pain is at 2am - the pred reaches its peak in the blood about 4am, just before the body secretes the cytokines, the substances that cause the inflammation that leads to the pain and stiffness in PMR, they never get a chance to do their worst. I take a form of pred that was developed to do this without you having to wake in the middle of the night - I take it at 10pm and it releases 4 hours later. Unfortunately it isn't available in the UK for PMR except privately and it is expensive but I think it is brilliant (I live in Italy)!

Many people take their pred with a sandwich and a drink (which they take to bed with them) when they first wake in the early morning then settle down for another couple of hours - by which time the pred is working and the stiffness less of a problem (as rjw2014 does). Using an electric blanket BEFORE you get up makes the muscles better able to cope with moving, as does a warm shower.

I know several people who wake and take their pred at 2am and it works well for them. It also depends a bit what sort of pred you are on. Ordinary white pred tablets release immediately and the peak blood level is just one or two hours later. If you take enteric coated pred (red or brown tablets) they take much longer to release because they pass through the stomach into a lower part of the gut first and their effect can take up to 6 hours or more to appear.

When to take your pred depends on how it affects you. Most people find they don't sleep so well when on pred but nor does the time make much difference. Others find taking it at night before bed means their side effects (like wobbliness) happen overnight and their days are better. One lady couldn't concentrate or keep awake in the day so tried taking pred before bed - the result was she slept well and her days were better! It is fine to experiment a bit and find the optimum for you.

[Jora]

I always take my Prednisilone in the morning. The last thing I want at bedtime is an adrenalin boost. I'm pretty shaky in the morning, so have breakfast as promptly as possible, when I take all my other meds. It's a very individual thing, really, but I might try RJW's regime. It never occurred to be that waking at around 4.30was related to steroids. J

[bumpermac]

Must say I played arund with timing of pred . Started in Nov at 40mg and took very early n morning but would be v shaky during the day. As I tapered I changed to waking at 2am and went straigt back to sleeo....no shaking next day. Now I am at 9mg which I take about 11or 12 pm and sleep quite well. Am a bit achy towards bed time but can cope with that. Good luck with finding a time that suits you. Mandy

[PamOakes]

Hi Mary

I've been taking the pred as soon as I get downstairs with a yogurt about 9am each morning (day 6 of steroids now 20mg) I've been fine taking it this way with a little stiffness mornings & evenings but nothing I can't cope with at the moment, night & day sweats are quite intense & make me feel a bit claustrophobic though. If I start to struggle especially when the dose starts being reduced the I'd consider trying the 2 to 4am dosing & see if that works for you.

Good luck

[Trenny]

I have always taken my prednisolone after breakfast ie about 9am, at the same time as thyroid tablets. I usually sleep very well.

[Charlie1boy]

Seems we are all different, and have to experiment a bit which time works best. I started at the 2am time, which was great to keep pain free during the day. Gradually, I have got down to taking preds after breakfast about 8 to 8.30am, and this now works fine.

For me the best advice came from PMRpro volunteer.

Good luck