Timing of medication

[alfredbrian]

My GP told me that Pred. takes 4-5 hours to become effective after taking. I am 79 years old and usually have to get up around 2.00am for the usual reason at my age. I am wondering whether to take the Pred. then so that it is becoming effective when I get up around 7.00. Has anyone tried this and if so did it work?

[piglette]

Do you take the coated variety of pred or the common or garden white uncoated variety?

[HeronNS]

I have not done this myself, and don't need to, but a lot of people do. Just make sure to have something at hand to eat at the same time to protect your stomach. I've heard that people keep a little tub of yoghurt ready beside their pill just for this purpose! Have you found yourself to be a lot stiffer in the morning than the evening?

[Wyoming]

I have been taking prednisone at 2:00 am for 16 months now (out of a total of 19 months). I have tried many approaches, including splitting the dose (which I still do; I am now on 7mg, and take 5mg at 2:00 am and 2mg at 2:00 pm). This is an arrangement I arrived at after a lot of experimenting, and it is the one that works best for me. I am a morning person and I like being physically and mentally productive from the moment I wake up. I would prefer not to have to split the dose, but my prednisone tends to wear off in the evening (even when I did not do the 2:00 am thing), and I had many nights going to bed stiff in the early days and did not sleep well. Everything seems settled for some time now and I am enjoying an almost pre-PMR life. Initially I worried about not being able to get back to sleep after waking at 2:00 am, since I have never been one to drop easily off to sleep. But in the early days of PMR, I was so tired all the time, this was not a problem, and perhaps it was an advantage in training myself. In fact, now I do not even turn on the light or sit up to take the medication. I have my pills in a small container on the night table and next to that a small amount of yogurt (about 2 tsp) in a small cup with a small spoon. I have learned to take these while still lying down in the dark. This was not a skill I acquired overnight. But now I am quite robotic in carrying out this business. In fact, on some occasions I have awakened with a start at 6:00 am in the morning worrying that I did not take my medication (I had!). If I could take my prednisone early in the morning at one go and feel great, I would certainly not complicate my life with split doses and taking medication in the middle of the night. However, these are now routines in my life and there is no hardship involved. I would never recommend my approach to others. All of this is very personal, and therefore requires a unique approach every time. In your case, I certainly recommend experimenting if you are not satisfied with your body's response to the medication. I also recommend that you proceed with caution. I see it as a matter of fine-tuning rather than a trial and error process. (Never rock the PMR boat needlessly, I say.) I think you are definitely a good candidate for trialling the 2:00 am run, since you could take care of other business at that time. Just sharing my experience as you requested. Hope you will soon find a satisfactory balance.

[lucky12]

Hello I take my pred 4am with some natural yoghurt mixed with a little water so that I can just drink it down with my eyes still shut 😴. I soon fall back to sleep. As others will say it is really up to you to experiment good luck .

[Polylinc]

Hi alfredbrian

Welcome to the club ... 😉

I was diagnosed start of November 2015 and following GP advice, was taking Pred when I woke around 6am but, no relief until around noon !!!

So ... I started taking Pred BEFORE retiring to bed (after a very small bowl of porridge) And hey presto... wake in the mornings with no pain and get out of bed easily 😊

I am sure you will receive more advice and tips on here, but just experiment and see what suits YOU. Hope all goes well for you x

[barbthy in reply to Polylinc]

I have tried different times to take pred - and results are next day. If I take whole dose in morning, I am sore and stiff next day with little relief. If I divide dose 2/3 in morning and 1/3 at 9PM I have no soreness next day but cannot sleep. I am newly diagnosed ( about 1 month) and am trying to find best time for me. My PCP (second course of pred) started me on 20mg for 2 weeks, 15mg for 1 week (current dose) and then 10 mg for 1 week and back to see him. Tired of being tired and unable to do anything, I was a very active 80 year old until I fractured my metatarsal

[alfredbrian]

Thank you all for your replies and encouragement. I shall start taking my Pred when I wake around 2.00am as some of you do and let you know how I get on. The idea of taking with a yogurt sounds an excellent one for the stomach protection.

To answer Piglette, I take the white uncoated variety. This is the British NHS!!

I must say I have found this site most encouraging and helpful. I live alone and so value the support. Thank you all.

[PMRpro Ambassador]

Your doctor isn't quite right - it takes about 2 hours after taking it to reach a peak in the blood and it is already working then.

However, a study in Germany found that 2am was the ideal time to take uncoated white pred to avoid morning stiffness in RA - and the same applies for PMR. Cytokines (The substances that cause the inflammation and hence the pain and stiffness) are shed in the body at about 4.30am. If you take the pred at 2am it is there, ready and waiting for the cytokines when they emerge into the blood stream and the inflammation never gets going - so the morning pain and stiffness are far better.

I know a few people who take/took their pred at 2am or so and it works/worked well for them. I have a fancy version in a delayed release coating - I take it at 10pm and it releases at 2am. I have had no morning pain and stiffness since I started taking it! The hope is also that by optimising the time you take it, you can get away with a lower dose and fewer side effects.

[nettiefowler]

Hi

I have GCA & have been on high doses of Pred since July 2014 - yes all that time.

I heard about taking my Pred 4/5 hours before rising to take better advantage of it's effect in the mornings.

I started to take it when I too woke for the usual reason between 1.30 & 2.00 am. The difference was marked and I still take it at that time as I decrease my dosage VERY slowly.

I adjusted my timings very gradually over a period of weeks with nos adverse effects.

Good luck

[Caro12line]

Interesting posts. Thank you all. I was always led to believe that you had to take Pred at 8am. To do with body's natural rhythm and natural release of cortisol. Some days when I am working I get up at 4:30am but wait until I get into work to have breakfast and Pred. Sounds like I am doing it wrong!

[HeronNS in reply to Caro12line]

Actually, Caro12line, if that time works for you, you aren't doing it "wrong". I get up around 7 and try to take my pred by 8, and that works for me. If I found, as some on the forum do, that I was experiencing unacceptable pain or stiffness at some point during the day I too would be looking at a different schedule.

[PMRpro Ambassador in reply to Caro12line]

The 8am recommendation was due to a study that showed that taking 15mg at 8am suppressed the adrenal function less than taking only 5mg before bed. That's fine for many of the things you are taking pred for where the inflammation you are targeting is there all day and the pred is only being given short term until the inflammation is gone (chest infections or asthma). Then you stop and need normal adrenal function asap.

In PMR the inflammation is worse in the morning and you are aiming to improve the patient's morning - wait until 8 or 9am and many people wouldn't be able to move freely before lunchtime. Which is a bit pointless really! You are going to be on pred for a LONG time, certainly more than the 3 months at any dose which is pretty well guaranteed to stop normal adrenal function - a month is often enough. So you might just as well take your pred when it works best for YOU - and everyone is a bit different.

[Caro12line in reply to PMRpro]

Thanks PMRPro... I have GCA. Been on Pred 13 months and from about 3 days in the GCA headpain stopped and has never returned. So I never know how inflamed my GCA is, as it gives no symptoms. But in the 13 months on Pred all my pain and illnesses have been through random infections (which I blame the Pred for). Currently feeling very despondent ... Managed to taper down to 7mg and now have Pluerisy (3rd time in a year) and yes.... antibiotics and Pred increase to 30mg for a week, with a two week quick taper back down to 7mg. Hopefully that will work, but I do seem to be taking one step forward two back!!

[PMRpro Ambassador in reply to Caro12line]

Happens to us all! I've had PMR for 11 years and been on pred for the last 6 and a bit (I think, I've lost count now). Been up and down and was on 4 or 5 all last year - a few weeks ago I realised I really didn't feel as well as I had been and on Friday agreed with the GP that back to 15mg was on the cards.

But honestly to have got to 7mg in just over a year with GCA is very good. I know it doesn't feel like it though.

[Caro12line in reply to PMRpro]

Thank you for words of encouragement. X. After a bad few months in Autumn UTI/Pluerisy/Shingles I was so pleased with myself to conquer the 10mg barrier, be put in the "clinical remission" gang and get down to 9mg for Christmas ready to hit the New Year going for 8mg (using dead slow method) ... I felt I had turned a corner ... and now this! Grrrrrrrrrrrrr. But once the Pleurisy has cleared I will be back on the case! I hate what the Pred is doing to me. 😳 But also really appreciate what it has done for me.

[Hidden]

My instructions were to take with food before 9am. My prednisone is generic and I do try to take it at the same time every day or 30 min. one way or the other. Breakfast, prednisone and a hot shower and I'm good to go! I'm 76. I am sore in the early morning hours but that is nothing compared to the pain before prednisone!

[spiritusuk69]

My mother has GCA and still on 35mg of prednisolone. She is struggling with the side effects but her GP doesn't want her to split the dose or take the dose at a time other than early morning.

Can I ask the people who are experimenting with the timing of the dose as to whether they have done so with their doctor's approval or are they just deciding for themselves ?

I've been tempted for my mum to take the preds much later so the side effects kick in whilst she's asleep but the GP was quite emphatic about when she needs to take them.