Need advice

[Judyta]

I'm taking 6 mg.. 4 mg in morning and 2 mg in evening. I wake up extremely weak and fatigue is crazy. Wondering if I switch it around. 2 mg morning and 4 at night or 2 mg 3 times a day. ?

Any ideas?

[PMRpro Ambassador]

I think you should ask your doctor if he will get a synacthen test for adrenal function done on you. Below about 8mg your body has to start producing its own corticosteroid in addition to the pred you are taking to achieve the amount the body needs to function properly.

Extreme fatigue and weakness are amongst the symptoms of adrenal insufficiency - there are others but you only mention that. This is something you need to discuss with the doctor. I assume you have a good reason for not taking all of the pred dose in the early morning which is the usual recommended way?

[Judyta in reply to PMRpro]

I've never really been told when to take Pred. I just started when I went down to 4mg. ( which I took once a day). But symptoms just seem to get worse so I added 4 mg twice a day. Now I decided to decrease to 6 mg... ( no pain just extreme fatigue/ weakness ).

Guess I'm just thick but this morning noticed after I took the 4mg the fatigue lessened sooooo much. This PMR is such a challenge ....

[PMRpro Ambassador in reply to Judyta]

Which does suggest your adrenal glands may not yet be up to snuff and the synacthen test would be a very good idea - the treatment for adrenal insufficiency is replacement therapy with something like pred or another corticosteroid.

Do discuss it with your GP. He may be under the impression you have to stop pred before you can have the test - no, it just needs to be assessed differently. If patients had to stop pred first they would have a lot of very poorly people with an adrenal crisis!

[Celtic PMRGCAuk volunteer]

Judyta, you haven't said for how long you have been on steroids and how you have been reducing. If you have been reducing by too much and too soon then that could be the reason for your present fatigue - you may simply have reached and gone beyond the dose at which the inflammation was being controlled.

I struggled to reduce from the 5mg dose and had to increase to 10mg to get the building inflammation under control again. Once back at 5mg I was advised to remain there for many months before trying further reductions. This obviously allowed my adrenal glands to kick slowly back in with their normal pre-Pred production of natural steroid (cortisol) as I was then able to reduce successfully to zero, albeit this time at a snail's pace, tapering in just half mg decrements.

[Asbeck]

Judyta: In a different post PMRpro talked about 2:00 AM as a possible optimal time to take Pred (if you don't have a time release one). She said (or I read somewhere) that this is the time that that endocrine system begins to kick in for normal people. Then in the morning they are up and running. Also for people with Rheumatoid Arthritis (and maybe for us, she said) that's the primary time when the detrus from the arteries being attacked begins to circulate, causing pain. I tried taking my Pred at 2:00 AM (since I don't sleep well anyway). My mornings are much peppier. Might be worth a try. I apologize if I misquoted PMRpro, but she'll "fix" it.

[Judyta in reply to Asbeck]

Thanks, Asbeck, I'll give it a try !