Hi there I would be very grateful to get peoples opinions on the best time to take meds.
My husband has been recently diagnosed with PMR and started on 15mg of prednisone this did help him after a few days on visiting the GP he increased it to 20mg per day with some more repeat bloods that we are waiting for the results of.
Although the recommendation is to take the meds on waking with food he finds that they take a couple of hours or more to kick in so he has great afternoons/evenings but then the discomfort kicks in during the night and he is at his worst in the morning.
Does anyone have any advice about taking the dose at different times of the day allowing it to be most effective over a 25 hour period ? Do people split the dose they are on ? Take it morn or night or whenever?
Any information or help would be greatly appreciated thankyou.
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alysonkerry-
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As you say recommended time is am - with or after food - and most start at that.
Can I ask a few questions -
How long hubby on medication
Why increased
Is he carry on life as normal thinking he’s cured
What were symptoms - and why further blood tests - just to check inflammation markers or something else ?
The answers may tell us why he’s not getting relief as would be expected.
It does take a couple of hours to get into the system.
For some Patients it’s immediate relief, for others it can take a few weeks.
We do sometimes advise to split dose - approx 2/3rds am:1/3rd evening - If it doesn’t last 24hours - but you do need to give it chance to work.
Sometimes we suggest taking meds around 2am - they are then in the system when the substances (cytokines) that cause the inflammation are released around 4am.
But a bit more info on his history etc might help.
Thankyou so much for your reply . He has been on meds for a week his I think cpr & esa inflammatory markers were raised all other bloods taken at that time normal kidney/liver function normal chest x ray clear.
He hurt his shoulder a few months ago and pain started in shoulder progressing down arm into wrist ( he had a sore wrist approx 5 years ago had mri no sign of athiritis and given 2 steroid injections which helped as a side note). He had also had shoulder ultrasound which diagnosed rotator cuff tendon damage and a shoulder x ray whereby he has a chipped bone.
As for the PMR he presented with hip/groin pain shoulders /neck pain and bilateral wrist aches doc thought it was potentially PMR and gave 15mg pred. He was shuffling walking which has improved and is sleeping a tad better yesterday he had a good day after taking meds at 3am but then split dose and today not so good.
We were back at docs yesterday more bloods taken to check if inflammatory markers have reduced at all as well as checking thyroid B12 vit D and also rheumatoid factors.
He has not been to work for over a week and is just resting at home keeping warm and taking meds.
Hope this has helped create a bigger picture and Thankyou so much for taking the time to give your thoughts and advice.
Yes has helped a bit. Trouble with PMR and it’s sister in crime GCA - it’s very often a matter of eliminating other illnesses first - there is no specific test solely for PMR.
The rotator cuff issue sometimes muddies the waters a bit - but the bilateral pains and raised CRP/ESR do indicate possible PMR. As does the shuffling walk.
As I said in my link he should be getting at least 70% relief from pains - but if he’s a big guy the initial dose may not be enough - which is why the GP has raised it to 20mg. Has that given any marked improvement? If not, then maybe it’s not PMR - hence more tests.
He is doing the best thing by resting, but a little exercise, a short walk if he can manage it might stop him going stir crazy!
If he finds taking the Pred at 3am helps more, then continue with that regime. As said the daily burst of inflammation starts around 4am, so the sooner you can get on top of that the better.
As PMRpro says there are recommendations for timings - but sometimes you have you find what suits you best - we are all different - so if you find the best time - stick with it.
Please keep us informed - and well done you - it’s not easy for loved ones - we know that.
Welcome - it is good to see spouses who care enough to come and join us.
If you look at the righthand side of the page you will see a list of related posts - with almost identical titles. They will give you a lot of information and experiences.
The best time to take pred is the time that works best for you - not one of us or your neighbour. Everyone is a bit different in how they experience PMR and also pred.
Initially he needs to get to know his body and how he responds - and returning pain in the early morning is normal at the start. Once the existing inflammation has been cleared up he may discover that 1x daily dosing is actually enough - but to do that you need the entire dose in one go to get the maximum effect.
The inflammatory substances that cause the symptoms are shed in the body at about 4am and start to create inflammation after that. The longer you wait after that time, the more new inflammation is there to be dealt with - more for the pred to do so it takes longer. The ideal time to take pred to avoid this is 2am - the inflammation never gets hold in the first place and doesn't take the inflammation level up to where it causes pain and stiffness.
If you can't face waking at 2am for him to take the tablets he could try taking them a couple of hours before you intend to get up - that will be at a point with less new inflammation and by the time he wants to get up it will have started working - plain white prednisolone takes an hour or so, prednisone nearer 2 hours. A glass of milk, some yoghurt or half a banana is plenty to take the pills with.
Once you think the inflammation is better controlled, despite a return of symptoms in the morning you could think of splitting the dose to extend the antiinflammatory effect to 24+ hours. The usual suggestion is 2/3-ish in the morning and the rest later enough in the day to take you 24 hours. The trouble is that taking pred later in the day MAY result in poorer sleep, especially if you take it in the evening. It may not - some people take their pred immediately before bed and still sleep like a log. You do have to experiment a bit to find what works best for you. Some doctors get very upset about patients splitting their dose because they are concerned about the suppression of adrenal function by taking the pred later in the day - the body's natural corticosteroid is at its lowest about midnight which triggers the adrenals to release it in the early morning. If you take you pred in the evening, the level will be higher at that time. However, if it really is PMR he will be on pred at a high enough dose and for long enough that adrenal function will be suppressed - the morning dosing advice is less relevant for us than it is to patients on pred for a couple months at most which is far more usual.
I'm assuming he is on plain white pred? If he is on coloured gastro-resistant pred there is a different argument.
Just ask if you want more explanation - this post is long enough for a start!!
Thankyou so much for taking the time to reply I will take it all on board and discuss with my husband it’s very much appreciated think it’s early days for us but hoping we can manage the pain and get him back to so normality in the not too distant future. Thanku again :))
I take mine around 5 / 6 am - wake up, take the lansoprazole, read for a bit and then have breakfast ( cereal, yoghurt, berries), then the steroids, them go back to bed. I have found that in the first few days of a taper ( I am currently at 9 mg) I wake up earlier about 4 / 5 am but I still get up as I reckon the sooner I get the Pred in my system the better and I can always nap in the afternoons as I took early retirement before the pmr surfaced. Used to take a while to take effect but now seems quicker but I also have a warm bath with frankincense oil to get me going in the mornings. Preds seem to last all day pretty much, early mornings are the worse but I guess that is when inflammation is at its height and steroids have worn off, best wishes
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