I am currently on 6.5 mg of prednisone, taking 5 mg around 6 am and 1.5 mg at 7 pm. I used to take more in the evening but tried dropping the evening dose as I tapered below 8.
I'm finding I'm very stiff in the morning. I'm thinking I should up my evening dose and drop down on the morning dose or even take it all in the evening at 7 pm.
My concern is that I've heard that as you get to lower doses you should take it all in the morning for the sake of your adrenal glands. Does anyone work with an endocrinologist and what do they say about the timing of dosage at lower doses?
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Hello there, my endocrinologist said that definitely by 5mg the Pred needs to be taken in the morning, but I was seeing him when I was already on 4mg. Personally I could feel my adrenals needing to work at 7mg. However, from the sounds of it, you may well have dipped below the dose of Pred you need for the amount of inflammation you are producing at the moment. Was there a dose where you felt comfortable?
Thanks for responding. I've always had some pain even at 15 or 20 mg, but it was better. The stiffness came back at 7 mg but my inflammation markers are better than ever.
The important factor is to have the lowest level of pred in the blood at about midnight - so taking it mid-evening is likely to affect that, That said - only a small dose at 7pm shouldn't be too critical as the half life of pred is IRO 3 hours - 2mg at 6pm (if that works?) would be down to only 1/2mg by midnight (it will actually be even less because you don't absorb 100% of the oral dose). I don't know if you have ever thought about taking the whole dose at 2am or so? Still sorts the early morning problem and the blood level will be right down at midnight.
Thank you for responding. Your response led to a few more questions.
1. What happens at midnight with the adrenals? Is there some longer explanation you can point me to?
2. When you say 2 a.m., what is the earliest and latest it could be. I might be able to do that if the time is somewhat flexible and could be sometime between 1 and 3 am. I almost always have to get up sometime around there to go to the bathroom. If I had to get woke up by an alarm, I would never get back to sleep.
3. If I did take it at 2 am, could I take the majority then and a little at, say. 2 pm? I think I metabolize it pretty quickly so it never seems to last a whole day.
4. Can you continue with the 2 am dose all the way through the tapering until off prednisone or does the timing have to change at some point.
I've always been reluctant to do 2 am because I have trouble sleeping if I have to get up and do too much in the night. Since I have to take it with food and then feel like I need to brush my teeth, my fear is that I'll only end up getting 4 hours of sleep a night.
It's just the physiology - like the thermostat on your central heating. When it is cold, it switches on heat production, when cortisol is low it switches on the complex feedback system that makes the adrenals produce cortisol. There is also a timing element like the timer on the heating - it is called the circadian rythm and since cortisol is needed at its peak soon after waking, it is about midnight that the switch flicks and the mills grind into action.
As long as it is after midnight it shouldn't interfere with the adrenal function as it takes an hour or more for the tablets to be broken down and absorbed. Alternatively, taking the pred a couple of hours before you want to get up will also make mornings less stiff. The inflammatory substances are shed about 4-4.30am so having the pred in the system as soon after that as possible is also an option. Many people need to get up to the bathroom about then anyway. But if you have the problem with the effect not lasting the 24 hours the primary object is to get the later dose either smaller or sooner so the blood level has fallen as far as possible by midnight.
Providing the later dose is relatively low and away from late evening I see no reason why it should have to change again and you just need to experiment a bit to find the best time and the best split for YOU because everyone is different.
I've been thinking about your advice. I've been trying taking 5 mg at 2 am or there abouts and the other 2 mg around 1 pm. However I have to eat with the prednisone or I get stomach issues and I find that eating a snack at 2 and then going back to bed is causing some acid reflux. I'm thinking I could try just getting up for the day at 4 or 430, eating, and then staying up to see if that works better stomach wise. So many permutations.
Do you have to get up? We used to suggest waking early, taking the day's dose with a yoghurt or a sandwich and then settling down for another couple of hours by which time the pred should be in the system and starting to work.
I split my dose as well due to morning stiffness, but found getting up at 2am a challenge (for a variety of reasons). We don’t have access to enteric/coated pred here in Canada, so I bought enteric coated empty capsules which I stuff with my 6mg of regular uncoated pred, but I take it at 11pm. It gets in my system around 2am. I take my second dose (3mg reg pred) at 11am. All good here thus far. Very little pain and stiffness.
I understand as I taper down I may need to phase out my 11am dose and try taking the complete dose at 11pm.
Good luck finding a solution that works for you. Indeed it took me a variety options before I settled on something that worked well.
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