Prednisone time to onset

[Ozark]

I'm curious to know what other's experience has been concerning how long it takes pred to provide relief after the initial morning dose? In my case, it normally takes about 4 1/2 to 5 hours to experience significant relief. Is that about average? Also, if I switched to prednisolone, the metabolized form of prednisone, would that provide quicker relief?

[JulianJ]

I take gastro resistant prednisolone at about 10pm, I'm pretty good when I get up at 5, but things start going South around 8:30-9:00pm.

Not in the best of shape when I have to get up for a walk in the night

[Soraya_PMR in reply to JulianJ]

Snap Julian!

I take between 10pm and midnight, (gastro resistant), though closer to 10pm gives me more ‘washed out’ evenings; I’m better closer to midnight. At 6mg now, so take 5mg evening, and save 1mg for the morning, it helps.

I’m dipping my toe into 5mg so I thought I’d try cutting the plain tablet into 2x2.5, it didn’t work! Seemed to miss that ‘cytokine rush’ and I generally felt worse over my 4 day ‘trial’.

I guess I’ll have to try and squeeze 2.5 mg GR tablets from my GP. He’s not going to understand is he?!

[JulianJ in reply to Soraya_PMR]

I get 5, 2.5 and 1 mg tablets from my doctor, been doing .5mg steps f

or a while now

[jinasc]

Taking your Prednisolone.

If possible, when you wake up, take your prednisolone with a cuppa and something to eat. Then snuggle down for an hour or so and give it time to work. This gives the prednisolone time to work.

Your adrenal glands generally around 2am-3pm work to get your adrenalin ready for the next day............so you need to take them and give them time to work. A hot shower also helps to relieve stiffness. And there is nothing like 'slither sheets'.

[leajamesi]

Hello Ozark, I have Prednisone and I feel the difference in about 25-35 minutes...never had prednisolone.... I think in different countries they prescribe one or the other.When I asked my GP the difference she told me it is the same thing......but now I do not think it is the same.....received Kate'book today and studying all and for me it is not the same. Good luck to you from Switzerland.Lea

[PMRpro Ambassador in reply to leajamesi]

Prednisone (which is inactive) must be processed in the liver to form prednisolone (which is active) and that obviously increases the time it takes to work.

I appreciate that as far as the GP is concerned it DOES the same thing - but it is NOT the same thing.

[SheffieldJane]

I take Prednisalone and experience a relief from stiffness in about 25-30 minutes. I do find that it is wearing off mid evening now I am down to 5.5 mgs.

[Hidden]

Hi Ozark

Depending if you are taking coated or uncoated Prednisolone, the uncoated works within an hour, l take mine in bed, have a cuppa tea, catch up on my emails, Health Unlocked etc & wait for it to kick in.

Do you take the coated version, as that would take about 4 hours.

MrsN

[DianeA1]

Hi Ozark,

I was diagnosed Jan 2018 with PMR and because of advice on this site, I take my uncoated Pred at 2am with unsweetened applesauce to get a headstart on the 4am release of cytokines. Being a good sleeper, I nod right off again. When I awake at 6am, I am ready to go after some stretching.

I wish you well.

[Mrs-CJ]

Hi Ozark,

I’m on plain prednisone. When I am being a bit more active (gardening for example) I feel less stiff/achy after about an hour, sometimes 1 1/2 hours. Now that I’m thinking about this, maybe the longer time is in cooler weather.

[Charlie1boy]

Hi,

That's exactly what happened with me. Four and a half hours to get pain relief on average; sometimes five hours. And the relief lasted for about 12 hours.

I think you will find though that it varies enormously person to person.

Good luck

Paddy

[Pollypuds]

For me I find getting up and having a cuppa and slice of toast and taking it then around 3am works best, I go back to bed and pain relief lasts mainly ok. If I take it later say 7am if I sleep in I'm not so good all day.

[Sheilamac]

For me its within 3 hours.

[PMRpro Ambassador]

The time it takes to work will depend on several factors - prednisone must be metabolised to prednisolone which takes a bit of time. It also depends on the state of the stomach - full of food takes longer than empty. And how much effect it has will also depend on how much activity of the cytokines (the inflammatory substances) there is to clear up. So the sooner it is there and acting after about 4am when the inflammatory substances are shed in the body - the sooner the better.

[survivalist]

For me it takes at least a couple of hours for any effect at all to be felt from Prednisolone.

For it to work though reducing pain etc more like 3 - 4 hours.

I have taken Pred at 2am and it makes a Huge difference to taking it at 8am.

I now think this large difference specifically in me it due to the time it takes to work in me perhaps because of my size ? Not just the release of Cytokenes and the timing of the PMR inflammation around 4am .

I have in my family two medical consultants and they both think I take too little Pred and they both think this is why I feel the need to take it at 2am to in effect scrape a bit more effect out of the low doses of Pred I have been taking. ….. Probably see me as kind of a great big baby fussing about not wanting to take all his medicine and daddy really has to learn to do as his children tell him to do !

They don't think a few mgs matter one way or another in someone like me well built 6 ft + XL male at over 90kg. They told me last night in the past people were given large doses of steroids circa 40mg a day for all sorts of things but now they both feel below 10mgs is the point where they see the dose as low and not so important. They are concerned about blue cards above 10mgs but are much less concerned below 10mgs.

So what you might like to think about is the time pred takes to work against body weight in muscle and also in body fat. Fat people will react a bit differently ( some medication gets absorbed in the fat before it works in the body ) than highly muscled people its not just about body weight. But body weight without a doubt effects the time it takes for Pred to work.

This is one reason why some studies state 0.2mg per Kg of body weight as a starting dose for PMR medication.

[Twopies]

5 hours for me--split dose didn't make any difference at all. I'm useless in the mornings--have to wait for the pred to kick in. I don't take it in the middle of the night because I have such sleep problems with the pred that if I'm able to sleep at all, an alarm would keep me up the rest of the night.

[Ozark in reply to Twopies]

Your situation is very similar to mine. I have sleep problems as well. I'm a bit stiff first thing in the morning when I get up but after I take the pred within about 4 or 5 hours I'm relatively okay. I'm now on 9 milligrams of pred up from 7.5 and I'm doing better apparently after that dose level. How long I'll stay there I can't say for sure but I don't intend to go back down to the 7.5 dose anytime soon as I've only been on the 9 mg dose for only four days now.

[Noosat]

I cannot imagine taking prednisone in the middle of the night ! I am taking 5mg sometime in the morning, when it is convenient, and take 1.25 at night for total of 6.25mg each day. This morning I felt a little achy. Perhaps I can taper to 5mg daily some time soon. Of course, we are all different, and it depends, I think, on what some of us perceive as pain versus discomfit. I must have MD write prescription for 1mg pills as it is "hell" trying to cut the little 2.5s in two, even with a pill cutter.

[Ozark in reply to Noosat]

I agree with you concerning the pain versus discomfort contrast. In my particular case I would say I have stiffness in my muscles but not the kind of deep pain that I initially had. I just got on 9 mg of prednisone for the last 4 days and that seems to be relieving my primary complaint of extreme fatigue. We'll just have to see how long this lasts--the relief that is not the fatigue.

[bunnymom]

I had exactly the same problem and felt terrible all morning. I now take 2.5 at bedtime and the other 5 when I wake at night between 2- 4 and I have regained my mornings. I do take something to help me sleep. It seemed once the inflammation took hold it was very hard to clear up.

[Noosat]

Yes, initially, before being diagnosed, the slightest pressure on my leg muscles was very painful. My low point with fatigue is after lunch. If I am at home I lie down and read for an hour or two. If I am a little late in doing so, my dog Lily nudges me toward the bed.

[Ozark in reply to Noosat]

Thank you for your reply. My fatigue has been pretty much all day from the time I get up till the time I go to bed. But very lately since increasing my pred dose from 7.5 mg to 9 mg my level of fatigue seems to be decreasing for which I am very grateful. You are very lucky to have such an attentive dog by your side. Dogs seemed to sense when we are doing well and when we are not. So my best to you and to Lily.