When to take the tablets

[slewis]

I've only recently discovered this site and have now learned a great deal about PMR. I wish I'd found it when I was first diagnosed in March.

My question is, when is the best time to take the tablets? I've read in some posts that it is recommended to take a single dose early in the morning. However, I didn't know this and have been spacing my dose during the day, and managing well. A few days ago I tried taking 10mgs early morning and 2.5 early evening, I was fine in the morning but by late afternoon was exhausted. So my problem is should I persevere with this or try experimenting with different dosing times.

It seems to me from reading the posts that people react very differently to prednisone, and it is sometimes a matter of finding what suits the individual. However I'm a newcomer to the disease and am willing to be advised by more experienced sufferers.

[Zellamze]

I got told to take mine as soon as I wake up. 8.00am approx. I do get exhausted throughout the day but I take little rests with a cuppa. Hope that helps you. 🌻

[betty1943]

I was diagnosed with GCA in Nov. 2014. Was put on Pred. 4 months at 40mgs by a neuro. Consultant then a reduction gradually. I am now down to 2mgs.

I have always taken my tabs. In split doses. My thoughts are if it works for you then carry on, it strikes me that pred. Needs to be taken at whatever time and dose suits the individual.

Do remember you need to rest quite a bit part. late afternoon and try not to get exhausted, as soon as you feel tired take some rest and split your chores.

Hope this helps. Good luck it takes time but all will be well.

[Gosingen]

Hi, in my experience it's trial and error to see how your body responds. Personally I take my dose in the morning after breakfast. I did try splitting the dose, but after a horrid nightmare that night (probably coincidental) I decided to stick with just the one dose in the morning.

You've really answered your own question. Best of luck and I hope you stay well.

[DorsetLady PMRGCAuk volunteer]

Hi,

Mornings are usually recommended - that's normally the time of day when they're need most, but lots of people do split their doses - two thirds in morning, one third at bedtime. But as others have said, it's what suits you really.

Yes, if you take the full dose in the morning, you may feel fatigued later in the day, but if you know that, it's easy enough to work around.

The only thing I would say, is once you start reducing it might be easier if you only have one, or two at the most, doses to sort out.

[Skihexen]

.I was always told to take first thing in the morning as the pred could impact negatively on my sleep, although I have to say I had a very bad sleep pattern prior to diagnosis mainly due to long term pain issues but also shift work.

As said by others there seems to be variation but at the end of the day what suits you is best for you

[slewis]

Thank you for your replies. I will continue now with 2 doses, larger one in the morning. This seems to suit me, but I'm really grateful for your advice. It's really nice to have complete strangers being kind!

[nickm001]

Here is the logic about taking dose in the morning.. The main source of our pain are cytokines, which body releases while we sleep, usually about 4:30AM. This is why doctors recommend early morning dose. Ideally you should take your dose 2-3 hours PRIOR to cytokines are released, which would require us to get up in the middle of the night.

Possible compromise, is to take some (say 1/2) before sleep and the rest in the morning. This works especially if you go to sleep late ( in my case is usually 1AM). In that way, there is some cortisol in the blood stream before cytokines are released and the rest is taken care with morning dose. So I do take 2 doses, usually at ~1AM and about 8AM.

Best is to experiment and find out what works for you. Just make sure that you have full dose for each 24hr period.

[BettyE]

Because of intolerable reactions about two hours after taking my dose ( thumping heart, panicky, desperate weakness ) my GP suggested I try taking them at night. Like Nickm001, I am a late sleeper. My sleep was not affected, no panic, no heart thumping, and it made my daytime life liveable again. GP said he'd store my response for future reference. Don't know if he ever tried it on anyone else.

[PMRpro Ambassador]

The best time is when works best for you.

The line about "take it all in one go about breakfast time because of your adrenals" really applies for short term courses - if you are on pred for a few weeks and you take it all in the morning not only does it have a bigger kick but the effect on the adrenal glands of taking 15mg in the morning was found in studies to be less than taking 5mg at night. For us that doesn't really apply since we are taking pred over months and years at a level that will lead to adrenal suppression when taken for longer than 3 months.

On the other hand, usually the worst stiffness/pain is in the morning because a new batch of inflammatory substances is shed in the early morning - the earlier you take and the more you take the better the effect for the day ahead. But the effect lasts for 12-36 hours, depending on the person. If you are a 12 hour person then the effect will be wearing off by evening. Then many doctors (particularly in the USA) suggest splitting the dose, about 2/3 in the morning and the rest later. If it works for you, good. The same applies to you taking it as 3x5mg. But you may find reducing that total dose problematic - and that is something you should probably be looking to do by now after 12 weeks. Most schemes suggest 6 weeks at the starting dose before starting to reduce very slowly to find the holy grail in PMR: the lowest dose that manages the symptoms as well as that starting dose which is where you will then remain for some time probably (always trying to reduce a bit every few months to see if the disease activity has waned).

[slewis in reply to PMRpro]

Thanks for the advice, I am now trying 7mgs very early morning and 5mgs at night and it seems to be OK. I have reduced my dose, I started on 20mgs, and am now following the very slow reduction method recommended on the site. There is so much help here, reading the posts is very interesting as well as useful.

[christine2715]

I was told to take Predisilone and all my other tablets except the Aliendronic acid, after breakfast but I have GCA so take 50 gms Pred. Recently I was told to change. This to 40 mg in morning and 10 mg afternoon after a flare and this now seems to keep my symptoms in control and I seem to sleep a bit longer , until 4 or 5. I was getting up atb3.30.