Switched dosing time

[misspops]

Hello all you wonderful people across the the sea. I have been chugging along my journey, taking 3 mg of prednisone, (and feeling almost my old self, half the days). But I have always taken my pred at 1 or 2 am, to make sure it's at optimum strength before the adrenal glands release their hormones. But recently I have been thinking this is not good, because how can the adrenal glands resume their job, when the prednisone is doing it. So, the last four days, I have waiting until 6 am to take the prednisone, and added a half mg to my dose. I have been going back to sleep, but when I wake up, the old PMR aches are there, I can barely walk around again. It does get a bit better as the day goes on. I am hoping my body will get used to this schedule, soon. Does anyone have any thoughts on this one? Thanks so much.

[piglette]

Perhaps you should go up to 5mg and see if that sorts things out. You can reduce again after a week or so say to 4mg if you feel OK.

[PMRpro Ambassador]

Taking it at 2am is not so it is at maximum strength before the ADRENALS release cortisol but so that it is at its maximum before the body releases the inflammatory substances that cause the PMR symptoms.

When you take it at 2am that is actually an optimum time for the adrenal function too - the trigger for the adrenal glands to make some cortisol to top up the pred in the early morning, about 8-9am, is a very low level of corticosteroid in the blood at midnight or thereabouts. By taking the tablets at 2am the blood level remains quite low over that time because it takes about 13-14 hours for the body to get rid of the pred altogether, job done well before midnight. The antiinflammatory effect lasts a lot longer.

So go back to your 2am timing and enjoy both a good morning and give your adrenal function a good chance too.

[misspops in reply to PMRpro]

Wow! I had it all wrong. I was thinking the inflammation was originating in the adrenal glands as well. I will go right back to my 2am schedule and keep tapering to zero.

Thank you so much.

[Theziggy in reply to PMRpro]

So should everyone on Pred take it at 2am?

[Hindags in reply to Theziggy]

I think it might be worth a try for most people. Take it with something to buffer your stomach tho. Yogurt or peanut butter have been recommended.

[PMRpro Ambassador in reply to Theziggy]

A study in Germany found that taking prednisone at 2am was the optimum to reduce morning symptoms in RA - same applies for PMR - as that ensured a peak in the blood by 4-4.30am when the inflammatory substances are shed. It led to the development of Lodotra/Rayos which has a coating which takes 4 hours to break down in the right conditions so it can be taken at 10pm and you don't have to wake up in the middle of the night. Unfortunately it isn't available in the NHS in the UK as it is considerably more expensive than ordinary pred, You can use the enteric coated version in a similar way though by taking it at about bedtime as it isn't absorbed until it has passed through and left the stomach which takes about 4 hours.

Prednisone should be taken at about 2-2.30am and prednisolone (in the UK) can be taken about an hour later since it doesn't have to be processed by the liver to become active as prednisone does.

[Nextoneplease in reply to PMRpro]

Hi PMRproSilly question alert!!

I’m a real night owl and am rarely asleep before 3am, or awake before 9am - so would my body still shed inflammation at 4 to 4.30 or would all my timescales be later?? Bit like being in a different time zone…..😂

And in consequence, would taking pred at 2am work for me, do you think? Oh wise one…..thanks in advance.

Sorry again for the daft question.

Nextoneplease

[PMRpro Ambassador in reply to Nextoneplease]

Not daft at all - and not sure to be honest. The circadian rhythm will affect the adrenal production of cortisol - but I think it will have less effect on the shedding of the inflammatory substances in the early morning. The only way to find out whether the 2am time works ideally for you is to try - and shift the times around a bit to find your sweet spot.

Do you wake up stiff at 9am? When are your symptoms worst? When do you take your pred at present?

[Nextoneplease in reply to PMRpro]

Thanks for this PMRpro 😊I wake up aching at 9am but not stiff really and fingers crossed, my symptoms are generally pretty well controlled currently. I’d say my worst issue at the moment is a deep exhaustion, along with physical and mental tension. Been having quite a few anxiety dreams too, when I do finally get to sleep.

My insomnia is well out of control which is why I think if anything I should try to wake up and take the pred earlier?? Currently I take it at around 10.30.

Basically I’m a mess!!

Thanks again

Nextoneplease

PS Just wrote a birthday card and realised, yes I am somewhat stiff - just don’t notice it so much tapping on a phone!

[PMRpro Ambassador in reply to Nextoneplease]

Have you ever tried splitting the dose? Lucky people like me find the antiinflammatory effect lasts a full 24 hours but it varies from 12 to 36 hours - so if you are at the short end you can extend it by taking about 2/3 in the morning with breakfast and then the rest later enough in the day to cover next morning until the big dollop kicks in. It might only need to be with your evening meal and not much later to giv eyou a better start to the day,

[Nextoneplease in reply to PMRpro]

Thank you - I’ll give it a try

[cycli in reply to Nextoneplease]

you are in good hands with this advice Nextoneplease. Strangely you started right and then went to the specialists default position. It also looks like we share the same issue and I have split my dose to stretch it. That worked well for me but needed careful handling as my dose was marginal to cope with PMR and GCA. I take half the dose 1-2am and half midday to 2pm That worked and fitted in nicely with a midday break and a snooze afterwards while the pred. kicked in. Good luck with feeling better.

[Nextoneplease in reply to cycli]

Thank you cycli 😊I am going to work out a revised regime and will post again with any results (good or bad!)

All the best to you

[cycli in reply to Nextoneplease]

sounds like a plan.

[Calidp in reply to PMRpro]

Your post changed my life. After a few days of prednisone at the 2 am hour my mornings are much easier. I was diagnosed in Feb 2021 and due to me following Dr.'s orders took my meds at my waking hour, 6am - 7am. Joke is on me! I thought I was my own advocate, getting closer to that with this thread. I will continue to wake upon this hour and feel impowered. Thanks to you, PMRpro and all, for your wisdom and a toast to my ability to navigate this wonder called PMR.

😉

[PMRpro Ambassador in reply to Calidp]

Thank you - though to be fair, I was just the messenger. Someone else did the research!

[cycli in reply to Calidp]

reeesult. great

[Pixix]

There is an FAQ on timing of dose..you may find some good information there,too!

[Nextoneplease in reply to Pixix]

Thanks, will take a look

[Nextoneplease in reply to Pixix]

Thanks again, this was very useful

[LemonZest11]

I've been taking mine at around 2am for a couple of years now and it has made all the difference.