Best time of day to take medication?

[PMRpixie]

I have read in the past that some of you take your prednisone in the evening. I have always been hesitant to do that because prednisone is known is known to keep one awake. Also, I sometimes feel like the pain reduction wears off mid evening when taken in a.m. - so wonder how long it would be effective the next day if taken the evening before. Lately I have questioned my routine because I seem to have more energy in the evenings. Am wondering if I should give pm dosage a try. Am I making any sense here? Those who have tried it seem to like it. Any advice?

[Meg1711b]

I have been taking my pred in the evening, 9-10 pm, for the last 3 months. It works for me. My sleep dramatically improved-no issues falling asleep or staying asleep. I do get up to use the bathroom, but fall right back asleep.

There are a few days I noticed slowing way down in the evening, but most days are fine.

I have always reacted a bit differently than most to medicine. I figured it was worth a try, and have been very happy with the results.

[Celtic PMRGCAuk volunteer]

Yes, perfect sense, Alison! It is generally recommended that the best time to take steroids is as early in the morning as possible to keep nearer to the time when our bodies are used to making their natural supply of cortisol. Like you, I used to experience a spurt of energy later in the day - it all depends on how long the steroids take to get into your body to both take effect and for that effect to last. I did stick to taking all of my dose in the early morning but some people have found they fare better, especially early-morning stiffness-wise, if they take two-thirds of their dose in the early morning and the other third in the evening. It's very much a case of finding what works for you.

[PMRpro Ambassador]

It all depends on what works best for YOU - it is your pain and your quality of life. As Celtic says, some split 2/3 and 1/3, some take it all at night, others wake very early to take it at least a couple hours before betting up, settling down for another couple of hours. Not everyone finds taking pred immediately before bed keeps them awake - I effectively take mine at 2am, it is a timed release pill taken at 10pm, I wake very occasionally at 4am, never at 2am, and mostly about 6am.

Doctors will sometimes try to tell you pred should always be taken in the morning so the adrenal gland function isn't affected. That should be advice more for people on short-term pred, a couple of weeks or so. We are on pred for years - our adrenal function is going to be affected after a couple of months anyway, whatever time we take pred, so the important aspect is when we eventually wean to below about 7mg when the adrenal glands have to wake up again and the slower you wean the dose, the more chance there is that that will work. The time to take your pred is when it works best for YOU - and if it upsets your doctor, just don't tell him.

[tinwoman in reply to PMRpro]

do you need to eat when take steroids in night?

[PMRpro Ambassador in reply to tinwoman]

Depends on the person - and just a glass of milk or a yoghurt is usually enough to protect the stomach anyway. If you are taking a PPI it doesn't really matter so much either. A lot of people take a glass of milk/a yoghurt/a sandwich to bed with them.

[tinwoman in reply to PMRpro]

Many thanks for this I am very stiff in the morning so might try altering time of meds. what do you think?

[PMRpro Ambassador in reply to tinwoman]

Someone else has already said much the same today - a bit of adjustment to times is a good idea to find the optimum time for YOU. Which is what is important. PMR almost always involves morning stiffness, that is the new dose of inflammation for the the day. If you can take the pred earlier, you will usually have a far better morning. The form of pred I take is designed to be taken at 10pm at night, it releases at 2am - I NEVER have morning stiffness and the pred effect still lasts all day.

[PMRpixie]

Thanks everyone. My doctor recommends taking the prednisone anytime before 9:30am. She said I could feel free to divide doses or whatever works for me. I take 10mg each am. I didn't realize the relationship of the adrenal gland function timing . You all are so informative!! I just thought I needed to get the anti-inflammatory action going first thing to reduce pain for the day. The dosing in the evening therefore made no sense. Obviously for some it works well. Just wondered why I seem to get a spurt of energy in evening. Then can't sleep!! On the other hand, sometimes I'm worn out to? Sometimes response and circumstances are hard to figure out. One thing I do know is that trying to reduce from 10mg is the hardest reduction yet. Have done the 1mg/month fine until this. Stuck on 10 for 3 months now. 😕

[DorsetLady PMRGCAuk volunteer in reply to PMRpixie]

Hi Alison,

Just a thought if you're stuck at 10mg (although you're not unusual in that, it seems to be a difficult dose to get through) - are you using a slow reduction plan, or do you drop from one dose to the next overnight? Or it could just be the winter, I think the cold puts a bit more pressure on our bodies, and with PMR or GCA we don't need any extra pressure.

If you do the "overnight" drop it might be worth trying to reduce over a period of weeks - there are various ways of doing this. If you are already doing a slow reduction, then maybe you should only try 0.5mg a time - white uncoated tablets are easy to cut. Pill cutters can be bought at any chemist from about £1.

[Charlie1boy]

That's an interesting post Alison! I've had pmr for a year now, and have chopped and changed about 3 or 4 times about when I take the pred. I still can't decide what is best for me.

I started at 30mg, and for the first couple of days took pred at breakfast time. However, as it took some 4 to 5 hours to kick in, and, following good advice from PMRpro, I changed to 0230hrs to 0330hrs. This worked well, as I became clear of pain for most of the day. I stuck with this for two weeks, by which time I felt I had a degree of control over the symptoms, and reverted to breakfast time.

When I got down to about 10mg, I split my dose half and half, because the pred lasted only 12 hours. (I took the other half at bedtime). No sleep problems, but I did start getting cramp in my legs every night, so I changed back to am only.

More recently, at 8.5mg, I again split the dose, as I was getting more stiffness pain in the mornings. However, I forgot on more than one occasion to take the bedtime dose, so I am back now to am only! The stiffness is no worse, and does ease off when I get myself moving.

I feel my main problem is that the preds take a long time to kick in, then don't last much more than 12 hours or so. As others have said, our metabolisms are all different, and, also, pmr does not seem to be consistent in the way it behaves!

Not really an answer to your problem, but you did ask for our experience.

Good luck.

[alfredbrian]

I have ben told by my GP that Prednisone takes 5 hours to be absorbed into the system. I currently take first thing in the morning and feel better by lunch time. I am considering taking in the night (At my age 79 I'm always up once if not twice in the night.) so that I feel the benefit upon waking/getting-up.

Alfredbrian

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Hi PMRPixie

I have only recently started splitting my dose as we were going on holiday that involved some early mornings!

I tried it for about a month before we went & found I was much better in the morning, I have remained on this regime & am disinclined to go back to taking it all in morning.

I split it 2.5mg coated at night &

4mg in a morning, so far, so good!

Mrs N

[mckee]

i am young 73 year old lady started prednesoline 10mg but only take half .i take it in morning .fine all day .when i go to bed i get restless and cant sleep a wink .should i try takin it at night .i have polymylyga.