Low dose pred timing

[Jontie]

Hi All. I've just read a pinned post re pred timing. It explained the advantages of taking pred at night. However the last para said this might not be advisable for low doses. Could someone explain why please?

By the way, I've been on pred for 3.5 years. After many unsuccessful attempts at reducing below 5mg I've finally managed to get to 3.5 without too many adverse effects. Ironically, if it wasn't for coronovirus my consultant would have put me on methetrexate by now. I've always taken my gastro resistant (presumably slower release?) pred before I go to bed. But having read the pinned article I'm wondering if I should switch to taking it first thing in the morning?

[DorsetLady PMRGCAuk volunteer]

If I were you, I’d stick to evening with your slower release meds, especially if that suits you.

I’m guessing, that some concern is that taking them at night may interfere with the normal production of cortisol, which varies throughout the day. See below -

Blood levels of cortisol vary throughout the day, but generally are higher in the morning when we wake up, and then fall throughout the day. This is called a diurnal rhythm. In people that work at night, this pattern is reversed, so the timing of cortisol release is clearly linked to daily activity patterns.

Not sure how much the evening dose will upset your system working correctly, if at all, but the last thing you want is to upset your PMR by changing medication times.

Sure someone with better medical knowledge will be along idc.

[Jontie]

Interesting. Hadn't thought of splitting the dose. May be best of both worlds. Cheers.

[PMRpro Ambassador in reply to Jontie]

Splitting the dose with e/c pred is rather more complicated - you have to allow for the considerable delay in the absorption which is anything from 4 to 7+ hours longer than with plain pred

[PMRpro Ambassador]

No, I wouldn't. I'd say what you are doing is perfect.

Most people would be taking plain pred and before bed at (say) 10pm. Plain prednisolone is absorbed within an hour or so, the peak in the blood will be just before midnight. e/c coated pred taken at the same time won't be absorbed until well after midnight, about 4 hours later than the plain variety so the blood level at midnight will still be low.

A low level of corticosteroid at midnight is the signal to the feedback set-up that tells the adrenal glands to produce cortisol in the early morning which is what normally happens. If the pred level at midnight is high, that signal isn't given and the adrenal glands have a sleep in and don't produce that morning peak. It doesn't matter because you are on pred - but once you get to a low daily dose of pred the hope is that the low level will allow the return of normal adrenal function. With plain pred taken at night that is less likely.

Does that make sense?

[Jontie in reply to PMRpro]

Yes that's a great explanation, thanks. So because I'm on low dose e/c pred, continuing to take it at night shouldnt stop the normal adrenal system kicking back in.

[PMRpro Ambassador in reply to Jontie]

Exactly

[Gunflash in reply to PMRpro]

Is it therefore better to take standard uncoated pred at bedtime?

[DorsetLady PMRGCAuk volunteer in reply to Gunflash]

Not necessarily - the recommendation is to take early morning - particularly at the start of treatment when Pred is higher than your body would normally produce (approx equiv 7.5mg). So your adrenals have “gone to sleep” anyway.

Plus higher doses may well affect sleeping patterns, so you don’t really want Pred to start working when you want to sleep.

[PMRpro Ambassador in reply to Gunflash]

NO! At least not when you are lower doses and looking for adrenal function to return. Read what I wrote more carefully - if you take it up to a couple of hours before midnight then the blood level is at its MAXIMUM at midnight so the body won't make cortisol early next morning. It must be at a MINIMUM at midnght to flick the switch.

[Jontie]

No worries. I appreciate your input 👍