Let's talk about temper and nerves....anyone expe... - PMRGCAuk

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Let's talk about temper and nerves....anyone experiencing problems in the evening while on Prednisone and Amitriptyline?


I take 18.5 mg of prednisone in the morning and 17.5 mg amitriptyline at bedtime. I've noticed a pattern-- I'm short-tempered, get hot flashes, and extremely jittery by 5:00 in the evening. Sometimes I'm overly tired. This isn't the case all the time though, and it really bothers me. I'm wondering if I should reduce/increase the amitriptyline. Perhaps this is still prednisone doing a job on my mental processes.

Thanks all!

15 Replies

Hi Blurry

Do you take a nap or a rest in the afternoon? If not that may help.

What time do you take your Amitriptyline?


in reply to MrsNails

Hi Mrs nails, I usually take it about 6:00

in reply to Blurry62

I take mine about 6.30pm ~ some people aren’t aware to take it earlier in the evening.

Hi Blurry!

At the moment I am on 12.5 Pred taken in the morning, for PMR ( 4 months since DX). and I am the same as you from 11:00 am until late afternoon, so so jittery and anxious.

I find the only thing that helps is a sleep in bed in the early afternoon.

I am back to normal in the evening thank goodness, as I play bridge at clubs!

The hot flashes are an absolute bugger in bed at night though as is the fractured sleep pattern!

Pred gives and takes!! 🤪

Hope that helps a bit and every good wish on your journey! Big hugs xxx

in reply to Smokeygirl

Have you ever tried taking it at night? I know a couple of people who had the jittery thing until they took the pred at night. Then they sleep through the dodgy bit.

in reply to PMRpro

Thanks PMR pro. I haven’t tried it yet as it is such early days for me and I am a tad nervous about experimenting yet! I thought I’d have a go in the New Year! Xxx

in reply to Smokeygirl

Well, misery loves company. It helps to hear I'm not the only one. I have possibly-probably- underestimated the effects of this prednisone dose.

Need to work the naps back in,too. I forget to lay down! Thanks


Last year I was waking up in the night with leg pains, one of the various things I have passed through in Pred reduction, fortunately gone away now. My GP suggested 10mg Amitriptyline in the evening before bed. I took 10mg about 8p.m. I only took it for three days, I had disturbed nights with vivid dreams and I was completely knocked out until about 3p.m. the next day, didn't dare drive and couldn't work, no focus, no concentration, I felt terrible. I thought they were horrible tablets. Have you discussed this with your doctor and asked if there is something else you can try for whatever you take them for. As for hot flashes, I have had these for 3.5 years since I started on Pred for GCA. Currrently on 8 mg and still having them like a second menopause. I think, from this forum, that is pretty common with pred.

Nortryptylin is better, does not have the side effects but is more expensive so reluctant to prescribe it.

Hi I was on 50.mg prednisone for a year and 10mg amitriptyline or Endep. Decreased prednisone finally to 4mg daily but increased amitriptyline to.25.mg. Prednisone usually have to take Methotrexate as well as Folic Acid. Your question needs an answer. Yes it makes you quick tempered, unreasonable, your sex life will go out the window and you get agitated and pissed off with yourself and everyone around you most of the time. Thus increase in amitriptyline. Calms you down. I have PMR which was triggered by inhaling chemicals for.over 9 hours unbeknown to me. Get a great Rheumatologist and he or she will do you right.

in reply to PoisonedinAus

"Prednisone usually have to take Methotrexate as well as Folic Acid."

That is not correct - many of the participants in this forum don't take methotrexate as it is not necessarily required in PMR since it doesn't work on the mechanism. Amitryptyline is also not always indicated in GCA and PMR.

There are many causes of the symptoms we call PMR - yours is a particulalry unusual one so probably requires a different approach.

Thank you for answering. Yes, I started at 10 amitriptyline and it was wonderful for relieving pain as I tapered the prednisone. As you say, as I dropped pred the amitriptyline required rises.

I got jitters at 17.5 amitriptyline and 18.5/19 prednisone.

Since my reply there have been a few unhappy responses. Get that. Prednisone works for most of us, and we are all.on different regimes of meds and doses. Seems like.you and I are on similar, though doses different.

Hi . I take 11.5/ 11.00 mg of Pred and 25mg of Amitriptyline. I take my Pred about 7 am and take the Amitriptyline at 7pm. I must say that after initially getting used to the Amitriptyline ( felt a bit spaced out for a short time) I was so thankful that at last the peripheral neuropathy pain was managed .I was so pleased to take it and have a positive result. I do take the Amitriptyline early ( which Angela had suggested as G.P. didn’t) and this I think has really helped. I do have vivid dreams but not unpleasant ones, in fact innocent bizarre ones at times, but that hasn’t been a problem. I have reduced the Amitriptyline from 30mg to 25 mg and I did have some withdrawal symptoms but I reduced at a time I was not tapering my steroids so I could see what was happening in my body. I have tried to further decrease the Amitriptyline from 25 mg to 20 mg. but had a reoccurrence of shooting pains in my one leg. I’ve therefore decided to stick at 25 mg.for the time being. “If it ain’t broke don’t fix it “being my motto!

Hi, this has been an interesting debate. I have had no mood changes on Pred and am firmly in the camp that I would never take amitriptyline or any associated medicines in that group again. There is no amount of pain would make me experience the effects it gave me. So I reckon I must just be sensitive to it.

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