When to take your pred

[poppetpain]

Just another thought from my journey with PMR. I would be in pain when I woke until my morning pred kicked in abetween 10 and 11am ☹️. So I started taking my pred at 2am after reading a post here that the inflammation rears its head at approx 4am. I had no pain when I woke! Eventually though I took them just before bed with a yoghurt and I was still pain free on waking next morning. x

[Blearyeyed]

Thanks for sharing your experience it's very helpful.

Did you have coated Pred tablets to help taking your Medication at night easier on your stomach?

[Pixix]

Joining in! I changed, too, after reading something similar on here, & now take mine at 3am with two Ritz crackers and a lansoprozole PPI tablet. No pain on waking later on, & more alert in the mornings. After doing this for about 7 weeks, I will say that I take it between 2.15 and 3.30am, but a lot of nights I wake at near enough 3am...perhaps your body just adapts to these things? I sleep badly due to other ailments, anyway, so it’s not a huge problem. S x

[alysonkerry-]

Hi Poppetpain my husband who has PMR was exactly the same as you waking in the morning in pain and having to wait till lunchtime late morn for pred to kick in if dose taken when he woke up. He has a brilliant rheumy who advised taking them around 2am which he did and woke up pain free. He is further on in his journey now & gradually took them later and later & now takes them when he gets up about 8am he is tapering now & is down to 15mg but has been on methotrexate too for a while but fingers crossed all going well. His Rheims advised him to do what’s best for him take pred when it suits and has the best results for you split the dose of necessary and as we know each patient is different do whatever the guidelines only you know what works in your favour. Hope your health continues to improve and thanks again to everyone on HealthUnlocked who share their experience it’s such a help and support to people who are suffering and their families :))

[PMRnewbie2017]

The very much simplified scientific reason is that the cells which release the Interleukin 6 begin peak their production at around 4am. Therefore by taking the Pred at 2-3am the tablet can dissolve, be absorbed and begin it's anti-inflammatory effect before the inflammatory cytokine has a chance to wreak havoc. Natural cortisol is at its peak at around 8-9am, but as we are adrenally suppressed this becomes reduced.

When taking lower doses of Pred (5mg and below) it makes sense to switch the time we take it to later, around 9am. This means that there is little synthetic corticosteroid in the body at the time when we want our adrenal medulla to think about pushing out some natural cortisol which begins at around 2-3am and has peaked at around 8.30am. Too high a level of pred early in the morning at this stage would continue to suppress. Obviously we are all different and this theory depends on us being well controlled and heading towards remission. Medicine, unfortunately, is not an exact science even though we would like to think it is!! Plus other hormones are also involved including Melatonin (the sleep hormone) so the whole process is very complex. New research is being published all the time.

I found this article which goes into much more detail.

Circadian variations in clinical symptoms and concentrations of inflammatory cytokines, melatonin, and cortisol in polymyalgia rheumatica before and during prednisolone treatment: a controlled, observational, clinical experimental study

Henrik Galbo & Lisbeth Kall

Arthritis Research & Therapy volume 18, Article number: 174 (2016)

[PMRpro Ambassador]

The 4am time has been shown to be when the inflammatory cytokines are shed in the body and that taking your pred at 2am is optimal for the improvement in morning stiffness. A German study led to the development of Lodotra/Rayos.