Timing of Pred dose and adrenal recovery

[Cross-stitcher]

PMR diagnosed March 2019. I had successfully tapered down to 7.5mg by October, but then seemed to get stuck for 3 months. Every time I tried 7.00, pains returned. However, since mid-January, I have been able to get to 7.00 and am now slowly tapering to 6.5. Experimenting early on led to my taking the Pred dose around 2.00 am each morning. However, some comments recently on this forum suggested that as you get near the physiological dose of Pred and want the adrenal glands to start working again, it might be better to change to an evening/bedtime dose. I take quite a lot of other meds in the morning, before or with breakfast, so am unhappy about adding Pred to this mix (Levothyroxine, Losartan, Atorvastatin, Metformin, Omeprazole, Premique Low Dose). I take calcium, magnesium, vitamin D3 and vitamin K2 with lunch. All comments and advice welcome. Thank you.

[Arflane97G]

I am currently on 6 mg of steroids which I take around 4 / 5 am in the morning which seems to work best for me but I do go back to bed afterwards! I take vit k2 and d3 but was told by my Bowen therapist to take them at least 4 hours apart to gain the most benefit. I have also just started taking hemp tablets and I keep a drugs diary to make sure I take the right pills at the right time. I do feel increased stiffness and fatigue after i taper but it subsides over a week or so, and since I took early retirement before pmr kicked in I can nap in the afternoons. Was diagnosed in sept 2019 and started at 15mg btw, best wishes

[PMRpro Ambassador]

"some comments recently on this forum suggested that as you get near the physiological dose of Pred and want the adrenal glands to start working again, it might be better to change to an evening/bedtime dose"

I think you may have got hold of the wrong end of the stick. The important factor in the return of adrenal function is that the level of corticosteroid in the body should be at its lowest possible about midnight which is what triggers the pituitary to signal the adrenal glands to produce the morning dollop of cortisol. Taking pred early enough for the blood level to rise before midnight will mess that up. Taking pred at 2am, on the other hand, means the level will be low at midnight which is what you want.

[Cross-stitcher in reply to PMRpro]

Thank you PMRpro. Your replies are always helpful and informative. Yes, I think I may have got 9am (quoted in a previous post) confused with 9pm, as the writer talked about taking the Pred "later in the day".

I will continue with 2.00 am for the time being as it does mean I wake without early-morning stiffness. But if my insomnia improves with lower doses, I may need a loud alarm-clock !!