GUT issues

[Slosh]

Hi all - me again - I would like some advice please.

Prednisolone thins the mucosal lining in the stomach. I have always taken the non gastric resistant one with a good amount of food - but I now want to go back to taking the gastric resistant version to aid in healing my gut.

I stopped taking the gastric resistant Pred - because I thought that I may be reacting to the dye and coating. I did start washing the dye off but was still worried about the hard coating. This Mast Cell Activation thing is such a minefield.

I am on 5.5 mg at the momemt and take it with a meal at 11am - I decided to do that in hope that my adrenals would wake up.

How can I transition to taking the gastric resistant 5mg at 11 - if it only gets into my system way later? I'm not 100% sure with everything else going on - but sometimes I feel a bit dizzy / faint if I don't take my Pred by 1pm for any reason.

Thanks as usual.

xxx

[PMRpro Ambassador]

Does the effect of your pred last the full 24 hours or do symptoms return before the next dose is due? If it were me switching to e/c now I would take it soon after dinner in the evening - but that is when I eat my main meal so ideal. Then it is working by the morning.

[Slosh in reply to PMRpro]

The effects last 24 hours.Would I just not take my Pred at 11am and then take it at say 7pm.

Or can I take a bit in the morning and then the full dose at night - just to get past that dizzy weak feelingg - which may in fact be from 'allergies' histamine etc taht the Pred controls as well.

[PMRpro Ambassador in reply to Slosh]

Oh sorry - wasn't "seeing" the question in that light! Duh!

You could - but taking the full dose at 11am and it working at 12am as normal and then taking the next dose of e/c in the evening means there will be maybe 12 hours between the two doses. You'll just have a good day with a bit of luck Why risk messing up the first day by taking less than usual? I'd always err on the side of taking more in the 24 hours rather than less.

[Slosh in reply to PMRpro]

Oh right - so maybe take the normal does at 11am and a full dose of the gastric resistant with dinner.Is the gastric resistant absorbed as well as the non? I mean do you get the same amount of active cortisone from both types

[PMRpro Ambassador in reply to Slosh]

Pass! Don't know, some say you do, some say you don't. It doesn't really matter because you titrate to your personal dose anyway.

It is absorbed DIFFERENTLY - plain pred is absorbed as a sort of dump and makes a sharp spike in the blood, rises quickly and then tails off over several hours. e/c is absorbed more slowly - the graph doesn't make a spike but more a hump-backed bridge (if you see what I mean) and I suspect there is still pred being absorbed while some of the earlier dose is being excreted. It stays high for longer so you may get the benefit for longer too but doesn't get as high at the peak as the plain pred spike. Overall the amount you get is pretty similar but the dynamics may mean you need a bit more to get to a higher peak if that is what you need at the time early on.

[Slosh in reply to PMRpro]

Thanks - makes sense

[SnazzyD]

Take the enteric coated 4/5 hours earlier than the desired time of arrival in the blood? Or have I got the wrong end of the stick?

[Slosh in reply to SnazzyD]

Is it 4-5 hours or 6-7 hours?

[PMRpro Ambassador in reply to Slosh]

Depends on various factors from how much food is in the stomach to your personal gut transit time ...

[Slosh in reply to PMRpro]

OK - thanks PMRpro

[SnazzyD in reply to Slosh]

As PMRPro says, it is affected by things like dinner. I never took mine within 2 hours of a meal because I could tell I wasn’t absorbing it properly in the early days when symptoms came back. Once the penny dropped and I took it with just a drink it was fine. For me, 4/5hours was when I could feel the Pred effect at its peak which was feeling shakey and horrible at higher doses. I also found that non-coated didn’t last 24 hours.

[Slosh in reply to SnazzyD]

Ok that is interesting - you are referring the Enteric coated Pred?

[SnazzyD in reply to Slosh]

Yes

[Slosh in reply to SnazzyD]

Also would it affect sleep if taken with dinner?

[SnazzyD in reply to Slosh]

Is dinner lunch or evening meal? If you mean evening meal, it depends how sensitive you are to Pred. Personally I’d avoid having a peak at night because that is when the body decides the cortisol level is low so it needs to get the adrenal glands to work. If you have Pred around your body might decide that it doesn’t need the adrenals to work for the morning.

[Slosh in reply to SnazzyD]

Yes dinner is evening meal - sorry another South Africanism. Thanks that makes sense about the adrenals.

That is why I started taking them at 11 am.

[SnazzyD in reply to Slosh]

In the UK it can be either.

[PMRpro Ambassador in reply to Slosh]

For a while I woke at 2.30-3am which is when my pred releases - all at one time just like ordinary pred but it didn't last and once I got used to it I still wake but it can be any time. The later you can take it, the lower the pred level will be at midnight which for adrenal purposes is what matters. But that also depends on what dose you are at - above 10mg adrenals are not a factor.

[Slosh in reply to PMRpro]

Sorry confused - so one wants Pred levels to be low at midnight - how does taht affect the adrenals. Soory if I am being a bit 'doff' (stupid) as we would say in South Africa

[SnazzyD in reply to Slosh]

It is thought that the low levels of cortisol at night trigger the brain to tell the adrenal glands to produce cortisol which is why the levels are highest in the morning. This is also why when they check your cortisol level they like to do it around 9am, to see what the peak is. Also it is why endocrinologists prefer low doses of Pred to be taken in the morning. If you take it at bedtime and you have an increased level of the artificial cortisol (Pred) in the night, it doesn’t think it needs to make the natural cortisol for the next day. This is fine when you’re on higher doses but when you are on diddly squat (technical term 😉) and there isn’t enough for the day, you really need the extra boost from your natural cortisol made in the night. So the later in the day you take it, the more likely you’ll interfere with that low your body needs in the night.

[Slosh in reply to SnazzyD]

Diddly squat is a perfectly acceptable technical term 😂

[Dydee in reply to SnazzyD]

Oh boy. And I have been taking it at bedtime because that is when I start aching so have a tiny snack with it at 11 PM and head for bed. I was at 8mg till yesterday when I bumped it up to 9 for a couple of days. Lower edge of left rib really got painful, right rib aching a bit too. The increase of 1mg helped. Doc said it could be PMR as a nerve runs along that area from T10 vertebrae. First time it has ever bothered me though.

So I guess I better go back to morning Pred?

[PMRpro Ambassador in reply to Dydee]

Or take it even 1/2 an hour later so it isn't absorbed until after midnight. I feel it is more important to manage the PMR well down to 5mg or so - after all, YOUR personal minimum effective dose might not be under 7mg and there you are often sitting on the fence for adrenal function anyway.

[Dydee in reply to PMRpro]

THANK YOU!!! Sometimes I do get involved on my laptop and it is 11:30 anyway before I take it and go to bed. LOL

[PMRpro Ambassador in reply to Slosh]

As Snazzy says - the low level of corticosteroid at midnight, the nadir, is what prompts the whole set-up to tell the adrenals to make cortisol the following morning. Taking pred late in the day may interfere UNLESS you take it late enough not to be absorbed until after midnight. Which will happen with e/c pred taken after about 9pm

[Slosh in reply to PMRpro]

Oh ok that makes sense. - A quandry indeed.

[Utgorn in reply to PMRpro]

I've recently switched from taking my 7 mgs at 2 am to splitting them 2mgs at 11pm and 5mgs at 9am. Just wanted a break from getting up in the night, but worried about my adrenals after reading this. It's the normal pred. Perhaps I should take the late dose later or go back to 2am....

[ParsnipSoup]

Do you take a stomach protector like Omeprazole

[Slosh]

No - as it interferes with stomach acid and B12 .