medicalxpress.com/news/2018...
Paper explorers how and when cortisol normally leads to fat being deposited in receptor cells. It then looks at what happens when stress etc leads to cortisol being released at other times. Thus the optimum timing of prednisolone are explored.
Bottom line, the wisdom of the aunties is validated.
"the wisdom of the aunties is validated" 😊
Which bits...
But it is interesting - the version of pred I take peaks at 4am having released in the body at 2am, remains high for a few hours and then falls away. I really do have next to no side effects.
Hah! Exactly. I tried to read that paper but it went way over my predhead 😣 Too tech for me. Would have been good to have been able to understand it.....,
PMRpro, be a love and put me out of my misery. What sort of pred is that and at what time do you take it?
If I am stuck with the basic prednisone or prednisolone what time are they saying that will work best, I do usually wake at 3-4am. Would that be any good.
I have printed artical out in hopes that it may go in on 2nd, 3rd,4th.......
It is a time delayed release form of prednisone marketed in Europe as Lodotra, Rayos in the USA. It is prednisone in a specially designed coating which you take at 10pm, within 3 hours of your evening meal or with a substantial snack of ham or cheese and bread (it's a German development needless to say). The coating breaks apart after 4 hours in the right stomach conditions, still in the stomach, and the pred releases all at once, exactly the same as normal uncoated tablets do just 4 hours later.
A study found that the optimum time to take pred to minimise morning pain and stiffness in RA was at 2am so that the blood level is at its peak at about 4am which is when the inflammatory substances are released in the body. Because the pred is already present the inflammation never gets going, so the morning symptoms are reduced. However - who wants to wake at 2am to take their pred? (I do know people who do mind you!). So a German company developed this version of pred. It is, needless to say, rather more expensive... But I think it is brilliant.
I know it is available in Germany and Italy, it is not available on the NHS but you can have it privately in the UK and I know a few people use it. It is unbelievably expensive in the USA but is sometimes covered by insurance!! In Europe 30 tablets cost about 27 euros I think so the monthly cost will be up to 100 euros-ish for doses at 15mg and below (it comes in 1, 2 and 5mg tablets and must not be cut).
I used prednisolone in the UK with no problems at all but here in northern Italy they usually use methylprednisolone and it caused awful side effects for me without achieving much symptom control. The only other alternative here is Lodotra, no prednisolone, and my GP suggested we try it to see if it was better with regard to side effects. I lost 35lbs of PMR and methylpred-associated weight gain, the beard disappeared and I am no longer Cushingoid. Result? I think so. I also got to a lower dose than ever before.
As I say, 2am is felt to be the optimum time for most people but for simplicity we have always suggested as early in the morning as possible and then settle down for another couple of hours before getting up - by then the steroid should be working. Most people our age are up for the bathroom early - and many take their pills then. Wouldn't work for me - I rarely need the loo at night thank goodness.
How interesting. Thank you for posting.
Sorry to ask for even more clarification(simplification!) PMRpro, I have read it twice now, and still can't work out if you are saying the best time to take the normal (uncoated) prednilisone is 4am? Does this count as night or daytime?
The article finishes with
'Our results suggest that even if you get significantly stressed or treat your rheumatoid arthritis with glucocorticoids, you won't gain weight, as long as stress or glucocorticoid treatment happens only during the day. But if you experience chronic, continuous stress or take glucocorticoids at night, the resulting loss of normal circadian glucocorticoid oscillations will result in significant weight gain," she said.'
I know it may not be important in the grand scheme of things, but having struggled to maintain a healthy weight ALL my life despite being very active (reduced exercise because of pain adding to this problem for the last 5 years or so) now being likely to gain weight again whilst on prednilisone is greatly adding to my stress......and that it would seem will result in weight gain too!
You mean MY explanation? You TAKE the uncoated pred at 2am so the level is rising from about 3am and achieving its peak at about 4am - which is approximately what the natural progression is. Taking it a bit later probably does much the same too.
The article I'm sort of convinced by - except you can avoid weight gain to a great extent by cutting carbs. And then it is less significant when you take your pred. Because to achieve the best symptomatic management you may have to take your pred at times they perceive as non-ideal.
You are no different from me - I have also struggled with my weight all my life. I'm still overweight now despite having achieved an age where a BMI of IRO 27 is felt to be ideal. But in the great scheme of things, I can live with it even if I don't like it. If I were more consistent with very low carbs I could probably lose more.
Thank you for that, I think I could manage taking it at 3-3.30 am as I am usually awake by then anyway- I seem to be stuck in that routine from when I was waking because of the pain. Am I right in thinking a few spoonfuls of yoghurt will be enough ‘food’ to take it with? I have been trying to follow the advice re low carbs.... 😩
Interesting, thanks.
This explains why I can’t shift weight off Cushings dog, her cortisol levels have been high 24/7. Just reached good blood levels, let’s see if we can shift some fat cells before she goes pop!
Interesting visit with Rheumy - fat not edema!
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