Pred change from evenings to mornings?

[SnazzyD]

Good morning to UK and whatever else it is in other places.

I am wondering if that at some point my dose taken in the evening will be a bit low to be very sustaining for a day of life in general. Therefore, how likely is it that I'll need to make what I do have more available during the day? I am assuming when my adrenals need to start fending for themselves further down the line I'll need to change, but what about before then? I'm on 20mg (GCA) having taken 4 months to get here. Currently taking enteric coated Pred at 6pm (eat at 8pm) to avoid any food, as it definitely affects absorption and Pred wobblies which are much less intense on this dose. With a big holiday in 6 weeks I'm conscious that I'll need all the juice the the tank I can get at the right time.

[DorsetLady PMRGCAuk volunteer]

Hi SnazzyD,

Having never taken enteric tablets or dose at nighttime, not sure what the answer is, but sure plenty will though.

One thought, can you not take your medication just before bed, or does that interfere with sleeping. Taking it say 4 hrs later might get you through the day better?

Because you've got GCA it's not recommended to split the dose, but as the effect is not lasting 24hrs have you discussed this with Rheumy?

Not much help - sorry.

[SnazzyD in reply to DorsetLady]

GCA symptoms wise, the enteric coated covers 24hours where the non-enteric coated definitely didn't by about 4 hours. I used to take it at 10pm but found my slower digestion on the Pred meant my stomach was still full and that definitely affected the absorption. I then tried eating earlier or having a smaller meal instead, but then I was waking in the middle of the night ravenously hungry. The other option was taking it in the early hours like some, but I am one of those ghastly morning people and if I wake after 3am I'm ready to go, even when my body thinks it's a stupid idea.

I'm assuming that as the dose lowers, I'll be less affected by the dopey effect and be able to ride it out if I have to take morning doses to get me through the day better over all. I guess with the delay of enteric coated I'm going to always put me into the early hours thing to some degree.

[PMRpro Ambassador]

If you are on enteric coated have you tried taking it later? Taking it at 6pm it will be taking effect at about midnight (doesn't it disturb your sleep?) - if you were taking it immediately before bed then it would be starting to take effect in the early morning and then would last longer into the day.

But otherwise - who knows. Everyone is so different.

[SnazzyD in reply to PMRpro]

See reply to DL above. I take it I the evening because it is like a sleeping tablet after about four hours until about 5-6am when the perky bit kicks in which is about 12 hours after taking.

Generally at what dose level do people find it doesn't last all day? I realise that the everyone is different thing is going to plague me.

[DorsetLady PMRGCAuk volunteer in reply to SnazzyD]

Answer to that - your guess is as good as anyone else's. Not being flippant, but I don't think anyone can say.

I took uncoated tablets in the morning all the way through, and don't think I can recall any specific time when the effect didn't last until I went to bed. Maybe I was just lucky, or maybe my body reacted differently to yours.

The only time I had problems fatigue wise, was adrenal gland time - for me 6mg down to 3mg.

I always think, maybe completely wrong, but because I started v. high, and I took it very slowly my GCA (once diagnosed) was well controlled - no flares, no symptoms. Also because it had been brewing 18 months before being diagnosed had it actually reached its peak at diagnosis time?

To be honest, the more I read on here, the less I think it follows any "normal" pattern - it seems to have so many variants and reacts to so many outside influences, that it's very difficult to predict your own, let alone anyone else's progress.

The only expert in your illness is YOU! But it takes a little while to get to know it!

Take care.

[PMRpro Ambassador in reply to SnazzyD]

It isn't so much the dose - it is the person. The antiinflammatory effects lasts from 12 to 36 hours depending on the person. So you and I might take the same dose, I will be fine because I know I'm a 36-hour person (I even managed on a alternate day regimen for a long time, not to be used in GCA) - but you might not if you are a 12 hour person. But that can apply at a high dose too.

If the pains are returning the first place to look is "Am I still at high enough a dose?"

[SnazzyD in reply to PMRpro]

Ah, when I refered to getting through the day, I meant general cortisone availability and running out of steam, not symptoms. Interesting though, I didn't know about the inflammation thing. Where can I find out about that?

[PMRpro Ambassador in reply to SnazzyD]

As far as the cortisone availability is concerned - the physiological dose is about 8mg - but since some people absorb 50% and others 90% of the pred they take the actual point at which you notice varies, anywhere from maybe 12mg down? Usually it manifests as increasing fatigue as you reduce - where you would think you would feel better with less pred. At that point slowing the rate of reduction may help your body catch up - at least waiting until you feel pretty good before reducing again.

One problem is that you normally produce cortisol early morning, later morning and in the afternoon. -ish, you also produce it in response to stress. So when hydrocortisone is used they give it to you 2 or 3 times a day to mimic that. With a single daily dose of pred it obviously isn't quite so well matched.

Is that what you meant?