I had asked a multilevel query in the previous post . And Thankyou fir the kind replies to that .
I am still confused about the best time to take the 3.5 mg pred dose ......
what is the best time for the pred dose really to ensure the damn adrenals start functioning ?
TIA
After midnight - it is the low level of corticosteroid at midnight that triggers the whole feedback system to produce cortisol. The earlier then it is taken in the 24 hours to midnight, the lower it will be at midnight. The half-life of pred is 2-4 hours so will effectively be at zero after 5 half lives, a maximum of 20 hours.
Nothing will ENSURE it, just give them the best conditions.
Can you say that again as if I’m a 2 year old. 😂 Sorry.
The trigger for the body to produce a dollop of cortisol in the morning to get it going for the day is that the level of corticosteroid in the blood is as low as possible at midnight. That is what flicks the switch. The body doesn't care if it is natural cortisol or synthetic pred.When you take a drug, any drug, the level in the blood halves in what is called the half-life, For pred it is somewhere between 2 and 4 hours. So after 4 hours it has halved, another four hours halved again and so on. After 5 half lives there is effectively none left in the blood stream. So after 20 hours absolute maximum, the blood level is at what is called the nadir, the lowest possible level. Take the pred between midnight and 4am - none left at midnight
I am not sure that the time of the dose will actually affect the adrenals, it is the amount of the dose. Unfortunately we need to reduce our pred dosage which will affect our adrenals more and more as they have to wake up and work.
I don’t know the answer to that question. I’m at 3.5 and the best time for me seems to be around 9 a.m. after breakfast.
That’s what I worked for me too & is what GP suggested I got right down and then off them completely which was almost 6 years ago 🤞🤞
After many trials I have found that 2-3am is the best time for me. I set the alarm go to the loo then take my 5mg Pred usually the sleep through till 8.
So true, I don’t have PMR so have not noticed the early morning aches. I’ll stick to 9 a.m. since it works for me.
"With prolonged suppression, the adrenal glands atrophy..."
Could you say a bit more about what "prolonged" means here? Do the adrenal glands immediately begin to shrink after a few weeks use of corticosteroids, for example, or is that delayed for some months?
Also, does the tissue have to regenerate for function to be recovered?
Hi. My mum has GCA ( not PMR) and sadly totally blind but still prone to flare ups which is headaches and tingles in head I read before about timing because she can’t sleep well so we were going to try to different times of day. She has an amazing rheumatologist and we asked her about it and she said for mum it’s best to take on morning with her breakfast. She’s down to 7mg X
It takes about 18 months to come of steroids if not a little longer it is so important to reduce very stederly and you will still get withdowel symptoms but you must just ignore them if not to servier
Sadly mum will be on for a long time. 17 months already
"I have asked similar questions to my doctors --- How much is too much? How long is too long? The best answer I received was --- nobody knows."
Thank you for your wonderful but rather sad answer. I had rather suspected that this might be the case. Apologies for grilling you - - anxious about the whole business, as so many of us are.
Yes, I'd be interested in links to other discussions. There are resources online that explain what happens, as you say, but I've found that forums, Q&A sessions, etc, can contain more detailed information and give a better feel for any topic, not just medical ones.
PRED 50 mg ~ Time of Dose Changed
PMR - Pred doses and best timings
Pred dose question (GCA)
When is the best time to take pred, I’m on 7.5 mg
GCA splitting pred dose 
