Best time to take PRED

[SRIXON]

Im wandering is thier any benefit in taking my 13mg Pred at night instead of in a morning with my other meds for high BP and type 2. My PMR ia worse early morning, at present taking all my meds in a morning I feel abit "vague" after taking hence my query on changing my time for taking my Pred.

[DorsetLady PMRGCAuk volunteer]

You have a couple of options -

a) take your dose before bed - but it might interfere with sleep, or

b) split your dose, taking approx a third at bedtime (or more - it’s your choice) enough to help with the morning pain (which is quite normal, for most people it’s worse in mornings because of the daily shedding of substances causing the inflammation around 4 am) and the remainder in the morning.

It’s often a matter of trial and error, and what suits one doesn’t suit another. But you need to trial whatever you do for a couple of weeks to know.

[SRIXON in reply to DorsetLady]

Thankyou. Col x

[SnazzyD]

Hello. Many take their Pred either before bed or in the early hours to catch the peak inflammatory cytokine production around 4am because mornings are their worst time for pain. I had GCA and took mine before bed because at higher doses it made me feel more than vague! Lower down the scale it made me feel a bit fuzzy. Some split their doses if they get pain later on in the day. However, once you get to 5mg and below my Endocrinologist said morning is best to help regain the natural rhythm of cortisol production. With all this, the actual timing of your Pred needs to take into consideration your Pred and whether it is coated (1-2 hours to the bloodstream) or uncoated (4 hours or more) . To add more complication you also need to avoid taking it within a couple of hours of antiacid meds or calcium amongst others.

[SRIXON in reply to SnazzyD]

Thankyou. Col x

[PMRpro Ambassador]

The received wisdom is that pred should be taken in the morning in a single dose. Pretty much everyone finds that their PMR is worst in the morning: this is because the inflammatory substances are released in the morning at about 4.30am. The longer after this you take the pred, the more inflammation has been created and the more work the pred has to do. In addition, it takes about 2 hours for prednisone to get into the system and be processed in the liver to become the active form prednisolone. The optimum time to take pred to minimise morning symptoms is 2am. Some people do that by setting an alarm, I do that by using a specific form of prednisone called Lodotra in Europe and Rayos in the USA (where it costs a fortune!) which is taken at 10pm with food and it releases 4 hours later. Doctors seem to think taking pred at night will disturb your sleep - it might but there are others who are made sleepy by pred so taking it at night makes sense.

A study found that 5mg at night suppressed adrenal function more than 15mg taken at 8.30am. This may be significant for people on a short term course of pred which is how it is mostly used in general practice - but for us it will make little difference as we are on enough pred for long enough for adrenal suppression to occur anyway. Once we get down to 5mg and below it may be better to take the pred in the morning to encourage return of adrenal function. In the meantime it makes far more sense to take it when it works best for you and causes fewest problems.

[FixThis in reply to PMRpro]

Great discussion! I’m in the camp trying to encourage return of adrenal function, at 1mg. I generally take my dose between 9am and 10am. Would taking it closer to 4am be more beneficial based on cytokine rhythm?

[PMRpro Ambassador in reply to FixThis]

2-3am is regarded as the optimum time to take pred in relation to the cytokine shedding at 4-4.30am. But if you are down to 1mg and are experiencing no symptoms in the morning when you get up I doubt it makes much difference.

[SRIXON]

Thanks for those comments, I think I will look at taking my 13mg early morning. Col x

[PMRpro Ambassador in reply to SRIXON]

One suggestion we used to make regularly was to take it a couple of hours before you would normally get up and settle down for a bit longer in bed to allow it time to work. Many people wake in the early morning to go to the bathroom - that is ideal if it fits. A bit of experimentation may be called for.

[SRIXON]

Agreed thankyou.

[Meggsy]

I take mine at 4am with a banana, ready for the charge of the cytokines, and by the time I get up all is well. I used to hear ‘The ride of the Valkyries’ playing in my head, only the cytokines are not going to carry me off to Valhalla (hopefully). Sometimes I wake at 3.30 so I turn off the alarm and take it then. The early morning suits me as I have no trouble going straight back to sleep. I hope you find a good time for you. 🌻🌻

[SRIXON]

Thankyou

[jaycee444 in reply to SRIXON]

I had problems on 15mg uncoated Prednisolone which taken at 5am left me with with pain kicking in during the early hours of the next morning. I solved this by taking 10mg uncoated and 5mg of gastric coated at 5am (the coated kicks in later and leaves me pain free till the following dose.) I still do this (in proportion) whilst I am tapering. It has worked for me.

[GOOD_GRIEF]

Lots of folks have left you great info on timing your pred dose.

But something else concerns me.

I am not a medic, but I'm wondering if you should be taking pred, at any dose, at the same time you're taking BP and diabetes medication.

I would consult a pharmacist and the doctor(s) who prescribed these medications.

Not everything goes together, and some things conflict with one another making one more or less effective when taken together.

[SRIXON in reply to GOOD_GRIEF]

Thanks for your concern, from the getgo i.e. in March 2017 when first ID with PMR I noted a surge in my sugar levels. (Been dieabetic since 2003) i.e. very quickly from around 6 to 14. I did consult with my GP and they have changed my meds around quite a bit in the last 18 months for my type 2 and BP.

Of late my BP has been raised, this initially started with ankle and feet swelling in Dec 2018 , In Feb this year they took me off Felodipine as they said this was the likely culprit and started me on 2mg Doxazosin.

My BP still high i.e. 178/100. They raised me again to 4mg Dox but with my feet now ok suggested that as well I bring back the Felodipine so around May on 10mg Ramphil, 2.5 Felodipine and 4mg Dox.

As of today I am on 10mg Ramphil, 5mg Felodipine and 6mg Dox.

On top of this am on Glitzide 2x 80mg a.m & 1x 80mg p.m + 500mg a.m & p.m.

To top it this week increased my pred from 10mg to 13 mg as really suffering again, this morning felt really out of it, anxiety and a real feel of intreperdation, I have felt better this afternoon, my PMR also feels better i.e. fatigue and heavy legs much better.

Yesterday had my 6 monthly bloods done so will be going back in a week to discuss as I feel in a bad place at the moment.

Is the answer really to take more medication for these chronic ilness. Col 😧 x

[PMRpro Ambassador in reply to SRIXON]

Are you under specialists or just the GP? I think you should be on far closer monitoring than 6 monthly - and with specialist input.

[SRIXON in reply to PMRpro]

GP for PMR. Diebetic nurse for type 2.

[PMRpro Ambassador in reply to SRIXON]

Not good enough. Just saying.

[SRIXON in reply to PMRpro]

Not a problem, appreciate where you think I should go and what specific tests. My main 2 concerns being what is causing my high BP, and why after 28 months my PMR has got ugly again, i.e. fatigue, tiredness and weak legs.

[PMRpro Ambassador in reply to SRIXON]

That's why you need a specialist opinion - or opinions. It is too much to hope they will talk to one another, but you are a complex patient and the average GP isn't up to it.

[SRIXON in reply to PMRpro]

On top of all the above last year tests x2 for raised PSA. If i was a horse they would have shot me by now.

[PMRpro Ambassador in reply to SRIXON]

Nah - OH has far more wrong with him, his raised PSA just triggered radiotherapy which has been pretty successful despite a long term side effect that is nearly dealt with Not the end of the world ...

[SRIXON in reply to PMRpro]

What kind of specialist-S would you recommend.

[Purplecrow in reply to SRIXON]

My experience is similar, in that after 2-3 years, I began experiencing more severe fatigue, weakness in legs and tiredness. The obvious here, is that I am not exercising enough, and my muscles fatigue quickly. After 6 years of PMR, and 6 or 7 flares which resulted in pred increases, I am still on 7.5 pred.

My biggest complaint now is Fatigue/tiredness. It just doesnt seem to remit.

I am seeing specialists for asthma and allergy, hoping to get some relief there.

Anyway, good luck, 💜💜💜

[SRIXON in reply to Purplecrow]

Thanks, you to X

[SRIXON in reply to Purplecrow]

I do feel exersise is key, i try to go swimming twice a week, this defo helps. Also play golf although last 3 weeks finished after 9 holes due to real fatigue/heavy legs. Increased my pred by 3mg on monday, played this afternoon, completed 18 holes much better.

[Joan-E-D]

I started taking my Pred. at around 11.30 p.m. because when I took it in the morning I felt "fuzzy" and ached all morning and only felt well later in the afternoon and evening. I began doing this when I had reduced down to 12.5 mg and have continued this way for the last two and a half years. It doesn't disturb my sleep any more than usual. I'm now almost down to 2 mg. using DSNS method and I feel O.K. I think my adrenals could have kicked in by now too as I'm not feeling fatigue etc. I was prescribed 15mg of Pred. when PMR was diagnosed in Oct. 2016.

[Heinrich7 in reply to Joan-E-D]

Hi! I’m also on 2mg Prednisone. Take with breakfast. Started with 12.5 in July 2018. Weaned slowly and went off for 2 weeks but started having symptoms so went back on this low dose. Seems to be enough. I just learned from Forum today not to take with calcium. So I’ll take that one now at supper. Guess your doing okay on 2 also?

[SRIXON in reply to Joan-E-D]

Thankyou Joan x

[4840]

I take the full amount of 9 mg prednisone at bed time. It actually tends to make me sleepy. It does not keep me awake at night. I am a morning person, and do not want to be in pain and get things done.

The dosage tends to wear off in the afternoon, but this is the time when I relax anyway and the discomfort does not me bother too much.

[SRIXON in reply to 4840]

Thanks for your response x

[SRIXON in reply to SRIXON]

Thanks, pointing me more to taking at least a percentage at night, I generally am tired an hoyr after taking pred around 7.30a.m.

[Mayadill]

Always been a night owl, so taking Pred at 2 am-ish then curling up for sleep, which I do like a log, but I do notice for less long, wake up feeling bright-eyed and bushy-tailed at 8.30ish/9 rather than 10ish. Split dose. Other instalment at 5 pm. 'Food' in the early hours of the morning is usually a couple of swigs of protein shake, or a glass of milk, a couple of biscuits, piece of fruit.