Pred with or after food

[genius64]

Hello friends

I'm not one for breakfast so have struggled to eat dried fruit and yogurt before taking pred. Would it be alright to have a drink of milk instead.

Merry Christmas. Stay safe keep smiling 😘

[PMRpro Ambassador]

According to pharmacists a glass of milk is enough - all you can do is try and see if it works for you.

[genius64 in reply to PMRpro]

Thanks for telling me, good to know so I'll try it tomorrow.

[diana1998 in reply to genius64]

I take mine at 7pm after food and sleep like a log

[Dambusters in reply to diana1998]

That's my way too. When I missed a dose and took it the next morning. I woke the day after in pain and stuck with that for a few days to see if the pains subsided. They didn't so I worked back to night dose. I wake up with slightly stiff fingers but no other pains and I sleep well.

[diana1998 in reply to Dambusters]

Great. When I suddenly had stiff fingers I increased by 1mg for a week and gingers then fine. Better stiff fingers than stiff hips!

[LWNE in reply to genius64]

I take mine with a glass of Kefir as i dont eat bteakfast, and this seems to work well.

[Frewen1 in reply to LWNE]

Hello, LWNE, I'm picking up on your kefir - I'd been taking kefir for some time, until the makers of mine (a farm in Wales)told me that to take kefir with steroids was counter productive - a bit like driving a car with one's foot on the brake. Does this make sense or not? Any other opinions about this? (I've stopped for the time being and thought I'd start again when my dose was lower).

[PMRpro Ambassador in reply to Frewen1]

Not really - did they explain their belief?

[Frewen1 in reply to PMRpro]

Hi PMRpro ...yes, her reasoning was that kefir ( it’s goat’s I have, quite delicious) functions to stimulate the body’s biome and gut and generally kick-start the body - whereas the steroids are tamping down inflammation and attempting to suppress things, hence the driving with foot on brake analogy...

[PMRpro Ambassador in reply to Frewen1]

OTOH - it may help reset the gut biome, soothe the immune system - and improve things. I think it is a case of trying and seeing how you get on as there is some dispute about how effective the amount of probiotics in a portion of kefir or any other such product can be.

[Frewen1 in reply to PMRpro]

Well yes, that’s how I thought of it, but it was the maker herself ( and she’s losing money by suggesting I stop) who believes otherwise... anyway, shall restart in a couple of months, I think

[PMRpro Ambassador in reply to Frewen1]

I suppose it depends on how effective you believe the kefir can be? I think it is probably good - but THAT good? The number of microorganisms is really not that high.

[Frewen1 in reply to PMRpro]

Interesting. I just love the taste!

[PMRpro Ambassador in reply to Frewen1]

I found one here that is like eating cream!! By mistake I picked one up that had fruit (something I almost NEVER do because of all the other added cr^p) and it was lovely!

[Frewen1 in reply to PMRpro]

Ha ha ...x

[HeronNS in reply to Frewen1]

Found this. Must say I'd never thought of it before. Have been eating fermented foods in small quantities and take my bedtime calcium supplement with a small glass of kefir. However I didn't get on the fermented foods bandwagon (other than yoghurt) until my pred dose was really low:webmd.com/vitamins/ai/ingre...

[tangocharlie]

I don't do breakfast either so take mine with a low-carb snack eg a Baby Bel cheese or a cold pre-cooked sausage or Quorn cocktail sausage

[genius64 in reply to tangocharlie]

Sounds good time, thanks

[Lookingforideas in reply to tangocharlie]

I’m the same. I do ‘brunch’ between 12 and 2pm ish & take the Pred then - works for me - although I generally don’t go to bed until 12 or 1am so maybe I’m just generally ‘behind the curve’ 😂

[DorsetLady PMRGCAuk volunteer]

Yogurt?

[Mary63]

I don’t have breakfast so take mine with brunch some time between 11.30 and 1pm. I think I may be one of those people whose pred lasts longer than 24 hours so that helps.

[genius64 in reply to Mary63]

Thanks for that, I was under the impression that you were to take it earlier so that it doesn't keep you awake at night,.

[PMRpro Ambassador in reply to genius64]

Depends on the person - some people take it in the early morning and can't sleep, others take it before bed and sleep like logs!

[genius64 in reply to PMRpro]

Interesting, thanks

[Mary63 in reply to genius64]

Taken before 2pm I have no problem with sleep. If however I forget to take it until after about 5pm I am in trouble! Of course it seems there are some people who have to take their pred at 2am to ‘get ahead of the symptoms’ so pain does not kick in before they wake up. As I said above, I am lucky!

[PMRpro Ambassador in reply to Mary63]

Mmmm - but when you are taking it so late in the day, the early morning is likely to be good. And then you get moving before any residual stiffness can set in.

[Bcol]

I have mine with a banana and yougurt around 02:00, works well for me but may not for others.

[genius64 in reply to Bcol]

Thank you.

[SheffieldJane]

I expect so. I used to get a lot of stomach pain etc. Until I switched to Gastric Coated Pred. I have never looked back. You do need to alter your timings though. It takes about 6 hrs to get into your system. I take it at bedtime.

[Hildalew in reply to SheffieldJane]

That's the Gastric Coated Pred that takes 6 hours, is it?

[Alchemy8 in reply to Hildalew]

I would like to know if there is any notable difference between gastric and non-gastric in terms of absorption. I seem to have had more reflux probs with gastric coated than the other but maybe it is just a question of length of time being on preds (10 months between 11.5 and 20mg) .

[PMRpro Ambassador in reply to Alchemy8]

You absorb about the same amount but more slowly - a slower rise in blood level, a time fairly stable and then a decline over time. With uncoated pred the blood level rises quickly in a spike and then declines over time in much the same way. The main difference is the highest level achieved - likely to be lower with enteric coated/gastro resistant and possibly a problem for some but some pred is present in the blood for a lot longer time with e/c. If you have stomach problems with e/c it could be due to the colouring used or a different filler in the coating or inside. It isn't just the pred that causes the problem.

[Alchemy8 in reply to PMRpro]

That is really helpful. Thank you! I feel that my stomach stuff seems to have come on with the enteric. I might try and mix the two. So in other words one shouldn't necessarily take the enteric at 2 am as it won't hit the storm at 4.00 - 4.30 am? So the times for both would be similar in terms of effectiveness - not in terms of hitting the spot. I note that Hildalew says 6 hours so one should be taking it at 10pm rather than 2am? And the normal pred at 2.00am as it works in 2 hours?

[PMRpro Ambassador in reply to Alchemy8]

Enteric coated taken at 2am is too late. Before bed would probably work well. I take Lodotra, the delayed release version, at 10pm, it releases all at once at 2am. Prof Mackie and I wondered whether you can use enteric coated in the same way given it takes 4+ hours to be absorbed once it has left the stomach. Apparently there was a move to compare e/c with Lodotra but the Lodotra company declined - which made us suspect we were right!!Yes - ordinary prednisone at 2am as it must be processed by the liver as well, prednisolone you can probably take a bit later is it is the active substance and doesn't need to be processed by the liver first.

[Alchemy8 in reply to PMRpro]

This is so amazingly helpful. No mention of it on the Pred info sheet or from the doctor. This is pretty basic information I would have thought but then I wasn't told about the 4.00am storm either. Thanks so much! Presumably it is OK to mix the two types of pred, or not advised?

[PMRpro Ambassador in reply to Alchemy8]

It doesn't matter for most things pred is used for - RA and PMR are different in having the 4am cytokine dump and morning stiffness. The work done that identified 2am as the ideal time for taking pred to minimise morning stiffness resulted in the development of Lodotra, the delayed release format. It was approved for use in RA in the UK - but then withdrawn, no doubt on cost grounds (it is pricey!). In other European countries where it is used there is often a much more restricted list of medications paid for by the healthcare system - and a copay towards the difference between approved generics and the fancier version. Or people have "top up" private insurance.

You can fiddle about with it - take the e/c at night before bed and the plain stuff with a meal, breakfast or lunch if the effect doesn't last the full 24 hours. Whatever works best for you.

[Alchemy8 in reply to PMRpro]

Thanks again for helpful advice!

[SheffieldJane in reply to Hildalew]

For me, yes.

[genius64 in reply to SheffieldJane]

Thank you for the advice. Good to know how long coated pred takes to kick in. I've just switched to coated pred due to gut pain.

[MsDirecto]

I have tried morning, evening, and splitting doses between morning and evening. When I first started (February 2020), it kept me awake if I took it at night, but not anymore. Since I tend to stay up late (midnight +), taking the pred when I go to bed seems to get me through that 4:00 AM inflammation. I was taking a PPI to keep from gastritis, but don't want to stay on it, so I eat some yogurt or cheese. Eating late at night is not best for weight loss. Oh well 😄

[genius64 in reply to MsDirecto]

Good advice. I've only been on pred 15mg for 3 weeks and am due to cut back to 12.5mg due to gastro pain, also take omeprizol 40mg. Just switched to coated pred, it's helped.

[PMRpro Ambassador in reply to genius64]

If you do decide to try without omeprazole don;t just stop - taper the dose there too or you risk rebound acid production.

[Hidden]

I take mine as soon as I get up with a milky coffee. I do it in the microwave so it froths the milk 😊

[genius64 in reply to Hidden]

Ideal. I take omeprizol first thing and wait an hour, however no I've switched to coated pred maybe I can cut out omeprizol. Thanks

[sampete]

I take my split dose 1/3 teatime 2/3 bedtime with a couple of plain biscuits and have no trouble sleeping.

[genius64 in reply to sampete]

May be I should give it a go and see if I sleep ok. Thanks

[Flosy]

Hi.i take mind around5am til 6am with a yoghurt,then if I am not working I go back to bed for couple hrs,and still sleep at nite.some bite its takes a while before I go off.

[genius64 in reply to Flosy]

Thanks for your advice. I work also so need to take pred before work, in saying that now I gear from so many of you that taking it later in the day us an option I'm keen to try out.

[CricketMonkey]

I’ve never been a breakfast ... nor indeed an early morning ... person. I’ve always needed to be awake for a hour plus before being ready to contemplate breakfast. So, apart from a brief period when I started on 40mg and was waking up at 6 o’clock and was wide awake straightaway, my usual time for pred is between about 10 and 10:30 after coffee, and then a slice of toast and banana, or cereal and yogurt.

I haven’t found that pred affects my sleep ... although we very rarely turn the light out until after midnight, and too much caffeine is far more likely to keep me awake.

[genius64 in reply to CricketMonkey]

Thanks for replying, I'm an early riser but will try most things.

[Hidden]

Hi I take mine with a Banana it keeps by the bed ok and helps the pills slide down good luck

[genius64 in reply to Hidden]

Thank you for the advice.

[Hildalew]

Could you cope with just having the yoghurt? The little white paper in the pill box says: You you can take Prednisolone tablets before or after a meal.

As I understand it, the yoghurt provides a defensive barrier between the stomach lining and the pred and so prevents the side-effect of 'upset' stomach that some Pred-takers suffer.

So I usually take a good couple of spoonsful of yoghurt, the first one 'neat', the second one with the pills buried in it.

Then there's a bit of a gap before I move on to porridge oats with defrosted berries cooked in a little coconut water (2.5 mins in the microwave), But if I'm not hungry, it can be quite a while before I eat anything.

I have been on Pred for 2 years now. The only stomach 'problems' I've ever had were related to eating a grapefruit. Before and since that incident, I've had absolutely no problem.

If you don't like yoghurt, I'm glad to see that milk* is an OK replacement.

But that reminds me to mention that my system doesn't like 'standard' cow's milk so my yoghurt is made from goat's milk.

*PS As LWNE says: Kefir is good as well - but if you don't like yoghurt, it may be too 'strong' a flavour for your taste.

[Alchemy8 in reply to Hildalew]

I am a goats' milk girl too!!

[genius64 in reply to Hildalew]

Thanks for your advice. I'm finding everyone's comments very helpful and interesting. Thanks

[Alchemy8]

Dried fruit is quite sweet I would have thought re one's sugar limits Genius64?

[genius64 in reply to Alchemy8]

Yes I need to watch my sugar intake. Thanks.

[Frewen1]

That puts it very succinctly

[artfingers]

Well, I take mine with coconut yogurt or sometimes crackers (past few days with Soy egg nog yum!) Something like 3.5 prednisone in morning and 2.5 prednisone at 11 or 12pm when I go to bed. I had done the coated (Rayos here in the USA) but it was way way too expensive and I couldn't justify the exhorbitant rate they were charging my insurance company.

[Hidden]

I'm a bit of a stickler for taking my Pred at the same time every morning. I have blueberries, raspberries and blackberries on my bran flakes with plain bio Greek yogurt at breakfast time. Seems to work well for me.

[Singalong1]

Oh dear! Since starting Pred a year ago, I’ve been taking it with Kefir yoghurt, to protect my stomach. I also take a pro-biotic supplement daily!! I don’t appear to have problems with this - I’ve been slowly tapering down from 15mg, currently at 7.5mg. It would seem, however, that I should stop taking Kefir and pro-biotic or risk reducing the effectiveness of the Pred, especially as I reduce further? What about ordinary yoghurt?

[PMRpro Ambassador in reply to Singalong1]

If it is working now there is no point changing it. That is actually the point of the tapering - to find the right dose for YOU and YOUR lifestyle ...

[Singalong1 in reply to PMRpro]

Thank you for you reply, PMRpro. I think I’ll keep up the pro-biotic supplement, which I take first thing in the morning, but replace Kefir yoghurt with ordinary yoghurt mid morning (when I have late breakfast and take Pred). Thanks to everyone for their views on this, very informative.