2 A M prednisone?

[Aleish]

I saw information re dosing at 2 AM and was wondering if anyone has been doing it and how it works?

[PMRpro Ambassador]

A study showed that the optimum time to take pred to avoid morning stiffness is 2am: the inflammatory substances that cause the inflammation are shed in the body at about 4.30am and by taking the pred at 2am it is there at its maximum level in the blood in time to prevent inflammation getting hold. This means the morning symptoms are reduced and you have a good result far earlier in the day than if you take it when you get up.

I actually am on the version of prednisone that was developed in response to that study, Lodotra - it is coated, you take it at 10pm within 3 hours of food or with a snack, and the coating breaks down exactly 4 hours later to release the entire dose all at once. I have no morning symptoms at all and the effect lasts all day for me. Unfortunately Lodotra is not available on the NHS and is quite expensive (up to £75-100 per month depending on your dose if you need 3 or 4 tablets). There are people in the USA who are on it - but it is even more expensive there so it depends on their insurance.

I know a few people who set an alarm or who get up in the night anyway and take their pred then - not necessarily at 2am. Those who do it say it works well.

[AnneP01]

Some months ago I changed to 2/3 am (when I have to make the nightly trip to the bathroom). I take my pred with a yoghurt and although my tummy is not good it has been ok. I have felt tons better on waking at 8/9 am and it has been the biggest positive in my 6 year journey with PMR.

Good wishes to you on your journey.

[SusyTe in reply to AnneP01]

This is probably a silly question but those taking their pills in the early hours, do you have a mini-fridge in the bedroom or something? Or do you just put a yoghurt or similar (would an Actimel drink suffice?) by the side of your bed when retiring so that you can eat it when you wake for the 2 am dose? I know if I padded down to the kitchen at that time I would not get back to sleep again.

[Rugger in reply to SusyTe]

Not a silly question - it's a question of quality of life, or sleep in this case! If my husband wasn't asleep in the same bed, I'd do as you suggest and have an alarm and a mini-fridge or coolbag whatever. Instead, when I wake naturally, in the early hours, I creep downstairs and have my yoghurt and pred and sit for half an hour or more to let them go down - I do the crossword or Sudoku! Often I can't get back to sleep quickly, but then I'm fast asleep at 8 or 9 o'clock! Luckily, I'm retired. However, I feel this is a small price to pay for getting the pred into my system when it's needed and like AnneP01, I really feel the benefit and have noticed the difference if I sleep all the way through the night and have to take the pred with breakfast.

PMRpro is lucky being able to get Lodotra in Italy. Maybe I shouldn't have stopped doing the National Lottery!!

[SusyTe in reply to Rugger]

Thanks, Rugger. I am still working and have to be up at 6 to get ready so sadly that wouldn't work for me. Roll on retirement! I too am envious about Lodotra!

[AnneP01 in reply to SusyTe]

Hi SusyTe as I am up already I get my yoghurt from the fridge in the kitchen but I do live in a small flat. I too am retired and as I live alone there is no problem with disturbing anyone else.

If you try it I hope it works for you. Best wishes

[PMRpro Ambassador in reply to SusyTe]

Since I date from a childhood without a fridge - the coolest place in the house was the big slate slab in the dairy - I'm rather laid back about keeping stuff out of the fridge for a few hours A yoghurt is alive - it would be sour if it weren't - so having it by your bed is only the same as culturing a new one. Sandwiches made with a lot of fillings will be fine for a few hours - not tuna or prawns though!

If you are in the UK you can probably do the Lodotra approach using enteric coated pred as it takes 5 or 6 hours to peak in the blood - I discussed it with Sarah Mackie. There was a suggestion enteric coated should be put head to head with Lodotra but the company wouldn't play ball! Which made us a bit suspicious

[pszak72]

I am also having good results by taking my pred dose about 3am. I had been taking my 12.5mg at 5 am and had a terrible flare after I slept in till 6:30am one morning. I read about the early am dosing and tried it. I now awaken about 3 am and take my pred. Seems to be working very well. Have a bit of morning stiffness but goes away by 8 am and good for the rest of the day.

[nuigini]

I took prednisone between 2 and 3 am for quite some time. Like others the timing coincided with regular nightly trips to the bathroom so no alarm required. I did this as I was having debilitating brain fog a couple of hours after taking the prednisone. Taking it in the wee hours enabled me to sleep through the fog. I would leave the tablets and a small amount of yogurt close to my bed.

Once I got to a lower dose I returned to taking the medication at my normal waking time of 5 or 6 am.

[Joan-E-D]

I take my uncoated pred. with a small snack at about 11.30 p.m. just before I go to sleep and feel fairly O.K. by the time I wake up at about 7.00 a.m. apart from slightly aching legs. I improve during the day, but need to have a rest most afternoons for an hour. After that the dose lasts until towards the end of the evening when my arms and legs start to ache again, but as I'm normally resting then it doesn't matter too much. I tried taking it at 2.00 a.m. but often couldn't get back to sleep afterwards and occasionally overslept and woke up in the morning feeling very stiff and aching. Taking it just before going to sleep means the muzzy Pred. feeling takes place when I'm in bed anyway. I'm creeping down to 9 mg now.