Morning or evening dose?

I've read on this forum that some people get benefit from taking their daily dose of pred before bed or even at 2am when the cytokines kick off, so last night I tried taking half my 13.5mg dose before bed and setting my alarm for 2am to take the rest with a glass of milk.

I was delighted to find myself in far less pain (mainly my shins) and less jittery when I started the day but it's now 4 pm and everything is starting to hurt.

Any Thoughts?

6 Replies

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  • Hi Zebedee44,

    I think most people either spilt their doses - or put alarm on for 2am, not both! See you're going belt and braces!

    Maybe if you tried splitting approx one third before bed, and then 2 thirds either first thing (breakfast) or 2am you might find the effect lasts longer into the day.

    You don't really need that much to get you through the night, but what you do want, if you can achieve it, is enough when you get up and to last through the day.

    Sometimes it takes a bit of trial and error to find what suits YOU!

    Good luck.

  • I think that that is a confusing way to take the steroids - body-confusing, I mean. You will not be covering the 24 hours consistently and really it's not surprising that you have pain back in the evening.

    You do have a few options open to you if the am/breakfast times (the usual and general suggested time to take steroids) don't suit you, e.g. split it in half am and pm or 2/3 in the am and 1/3 in the evening, etc etc.

    Some of the problem may be that you are not absorbing it wholly - the absorption rate is as individual as everything else with PMR.

  • Good question Zebedee44. I can relate, and I'm sure you'll get a lot of responses to this one.

    As polkadotcom says, part of the issue might be to do with Pred absorption rates apart from other factors. I've tried all the options including: All at bedtime / All at silly o'clock in the morning / All after breakfast / Make it up as you go along / Don't bother at all (..only joking..) etc. - and I can't come to any meaningful correlation between 'When / how taken' and 'Efficacy' with the darned things!

    I guess the (your) 64 dollar question is: how can you gauge when and how to take the Preds for maximum effect, apart from Trial and Error? Also, how big a part (or not) of the equation is this in terms of the many other variables that affect the day to day efficacy of the Preds?

    Confused of Weston super Mare :-/

  • Try taking the second lot during the day - if you have taken some before bed you probably don't need anything at 2 am - it is either/or not both together. The pred will be there for the early morning.

    Lots of people try 2/3 in the morning and 1/3 before bed - which is enough to make the mornings more comfortable but it still lasts through the day. Others take part of their dose at 5-6am and settle down for another couple of hours by which time the pred is in the system and starting to work,

    But no - not all at midnight and 2am!

  • Thanks to everyone who has commented so far. I'm shocked how much pain I am in this evening, and looking forward to taking my next dose.

    From the advice given, I think I will try the 1/3 and 2/3 approach, if I can work out how to achieve that with a mixture of 5mg, 2.5mg and 1mg tablets.

    I note that Kate Gilbert finds regular paracetamol to be beneficial and wonder if others use it for reduction of breakthrough pain?

  • It doesn't have to be accurate!

    Kate is the only person I have ever heard say paracetamol helps with PMR pain. It isn't an antiinflammatory - and even NSAIDs don't do much for PMR, and shouldn't be mixed with pred. Mind you, paracetamol never did anything for me! Recent Australian studies have shown that it is no better than placebo for back pain - and has a LOT of unpleasant side effects too.

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