Insomnia with Dexamethasone

[Juleslancs]

Hi I was diagnosed with PMR in January. I was prescribed Predisolone at first which caused stomach problems. I am now on Dexamethasone which gives me Insomnia. Has anyone else found this and have they found anything that helps ? My GP prescribed Melatonin but I haven’t found this particularly helpful.

[Hidden]

I had Dexamethasone plus my Pred when l was on Chemo, what a wide awake happy little bunny was l?

What time of the day do you take the Dexamethasone & how long have you been on it?

[Juleslancs in reply to Hidden]

About 6 weeks. I take it straight after breakfast.

[SnazzyD]

Did you get medication to prevent the stomach problems? Was enteric coated suggested? Pred causes insomnia also but in my experience not as extreme as Dex.

[Hidden in reply to SnazzyD]

It may depend on the dose, as it has a longer half life, so it can become cumulative & l was on both!........

[Juleslancs in reply to Hidden]

Thanks for your reply. What does it mean half life ? I'm new to all this medical jargon. Hope you're feeling better with your medical condition.

[Hidden in reply to Juleslancs]

Hi J, Sorry about that ~

‘Half-Life Defined. A medication's biological half-life refers simply to how long it takes for half of the dose to be metabolized and eliminated from the bloodstream. Or, put another way, the half-life of a drug is the time it takes for it to be reduced by half.’

Dexamethasone has a longer half life than Prednisolone, which has a longer half life than Hydrocortisone.

So basically your Drug has not completely left your body before you take your next dose, nothing to worry about, it’s just the way it works -

“Because of its long biological half-life (36-54 hours), dexamethasone is especially suitable in conditions where continuous glucocorticoid action is desired. Corticosteroids, are, in general, readily absorbed from the gastro-intestinal tract.”

medicines.org.uk/emc/produc...

Hope that helps.

MrsN

[Juleslancs in reply to Hidden]

Yes thanks

[Juleslancs in reply to SnazzyD]

I'm taking Esomoprazole and Ranatadine.

[SnazzyD in reply to Juleslancs]

I had problems with acid that kept coming back after a week or two of meds for it. It was relieved 80% by enteric coated. I topped up with Gaviscon.

[PMRpro Ambassador]

I imagine most corticosteroids will lead to insomnia but I fear you won't get much personal experience here, although I have met people using hydrocortisone for PMR I have never come across anyone on dexamethasone.

It has a very long halflife - will that not tend to increase the blood level over time if you take it daily? Which would contribute to the insomnia.

But there are other ways of dealing with gastric problems, Snazzy mentioned some, there is also the option of using Depot-Medrone injections, an i.m. injection every several weeks, and which is mentioned in the 2015 Recommendations for managing PMR:

rheumatology.org/Portals/0/...

Recommendation 5

[Juleslancs in reply to PMRpro]

Thanks for your response. I have been taking Esomoprazole for some time. My GP added Ranatadine. I had a Gastroscopy to check for a stomach ulcer which proved negative. Even a dosage of 5 mg Predisilone causes me stomach pain. My Rheumatologist mentioned the IM injection which I discussed with my Neurologist that I see regarding Migraine. Both seemed to be of the opinion that this could also cause stomach side effects. The Dexamethasone is working as my inflammatory markers have improved as have the PMR symptoms. It's just the lack of sleep.

[PMRpro Ambassador in reply to Juleslancs]

Oh yes - I imagine it has a great effect for PMR! But it has other problems!

The cumulative dose bit means that since it is excreted from the body much more slowly there is still some there when the next dose is taken - so it starts from a higher baseline. The half life is the time it takes for half of the dose to be excreted. Effectively it takes about 4 to 5 half lives for all the drug to be excreted. Pred has a half life of 1-2 hours - it is all gone well inside 24 hours so you always start from zero. Dexameth takes much much longer to halve so there will be some left after 24 hours, the baseline level slowly creeps up and the peak levels reached rise too.

You are in the UK? Did they not try gastroresistant pred?

[Juleslancs in reply to PMRpro]

Yes that was the one I was on