Taking full dose of Pred in morning?

[Doorstep]

Apologies for asking this question as I am sure I have seen it answered somewhere but can't find it. My GP prescribed 15mg of pred to be taken 3 times a day. My sleep quality is really bad, waking up every hour. Is there any detriment to my taking the full dose in the morning? Will this help me get more sleep?

[PMRpro Ambassador]

If the pred has been prescribed for ?PMR (has it been confirmed yet?) then it should be taken as a single dose in the morning. The usual recommended time is about breakfast time but some people do better taking it earlier and a study suggests the optimum time to minimise morning symptoms is 2am so it is in the system before the inflammation starts up about 4am. Pred spread throughout the day is almost never used in PMR. Why don't they check the prescribing information for the relevant disease?? There is no shame in not knowing - just in not making sure ...

[Doorstep in reply to PMRpro]

Thanks for replying. Yes, GP diagnosed PMR. ESR was at 49. Another blood test next week to check ESR has reduced with pred.

[PMRpro Ambassador in reply to Doorstep]

You need a high enough dose to combat the entire inflammation - and a dribble of 5mg at a time is rarely as effective.

[Doorstep in reply to PMRpro]

Thanks. I'll try and see how it goes. I need to sleep. I'll speak to GP too.

[mgrogers99 in reply to Doorstep]

Are you saying 15mg three times daily?

[Doorstep in reply to mgrogers99]

No. 3 x 5mg

[SheffieldJane]

It is far more usual to take your Pred dose altogether as one dose. Early morning is a good time to take it. This way you will find much more pain relief all day, and better sleep.I was taking my Coated Pred at bedtime but then started snapping awake at 3 am. I swapped to early morning and I am getting about 6 hours without a break and am able to doze off again - bliss!

Have a look at treatment protocols for PMR in FAQs to confirm the single dose advice to show your doctor. Once everything settles, I am sure you will feel much better. Later on you may find a better time to take your Pred - as I have done a couple of times over the years. Pred is not curative it just controls the inflammation that causes the pain and stiffness. Best to get on top of it all at once. Good luck!

[Doorstep in reply to SheffieldJane]

Thanks for your reply and pointing me to the FAQs.

[piglette]

I am so sorry that you have PMR. Sadly steroids do have a lot of side effects but they are preferable to the excruciating pain from PMR. Also no one gets all the side effects or even that many of them. Has your GP prescribed vitamin D with calcium? Also have they arranged a Dexascan to measure your bone density. I cannot understand where they got the idea of pred three time a day for PMR. It would be interesting to know!

[Doorstep in reply to piglette]

Thank you for your reply. I was only diagnosed about 8 weeks so I think it's a learning curve for both me and my GP. I am now taking folic acid. My blood test next week is to check ESR and any vitamin deficiencies caused by steroid. I'm starting to get the moon face side effects from pred but not gaining weight, it seems to be the fat redistributing itself to my face and tummy. Also getting cramps, muscle weakness and a bit of depression after the first burst of euphoria in initial stages of pred. It's definitely a balancing act between the side effects versus the pain that is relieved.

[PMRpro Ambassador in reply to Doorstep]

Why folic acid? Are you on methotrexate?

[Doorstep in reply to PMRpro]

No. I was found to have a deficiency during my initial investigative blood tests.

[PMRpro Ambassador in reply to Doorstep]

Oh right - has it helped any?

[Doorstep in reply to PMRpro]

It's early days, apparently folic acid takes about 4 months to take effect. However, it seems to have helped in certain areas which may nor may not be connected to PMR ie., not experiencing eye twitching and tingling needles and pins feeling under skin legs and arms as much (peripheral neuropathy, I think).

[piglette in reply to Doorstep]

I was told a gluten free diet with no simple carbs stops the moon face. It worked for me, may be just luck. I am not sure if you are starting to have a moon face already you may be a bit late. At least it gets rid of those wrinkles.

[Doorstep in reply to piglette]

You're right about losing the wrinkles - not loving the double chin though! (Partner says he can't see any difference!)

[piglette in reply to Doorstep]

I often think we are much more aware than others are. My cleaning lady had a facelift costing a few thousand pounds (on her credit card!) and I could not tell the difference, but she was happy.

[Karendeena in reply to piglette]

Piglette I have had to go on wheat/gluten free diet as started with bowel probs which they think came from the PPI Lansoprazole

[piglette in reply to Karendeena]

I can quite belief Lansoprazole caused your bowel problems. I am so sorry, how rotten.

[Viv54 in reply to Doorstep]

It certainly is ! In the early days of starting Pred i spent a lot of time trying to balance side affects some much worse than others ! But it does even out when the dose lowers. My sleep was terrible, even though its still not good , its a lot better than it was . I gave in and followed these lovely people and have a nap in the afternoon some days it helps. and buy the way i take all my dose in the morning, mainly at 2 if i wake up ! Good luck, things do get better . Best wishes Viv🌷

[Doorstep in reply to Viv54]

Thank you so much for your reply and encouraging words.

[Karendeena in reply to Doorstep]

Hi Doorstep, I have been on pred since May, started at 15mg and had almost instant relief. Tapering has got me down to 2mg per day but pain is coming back as I expected it would. My doctor and consultant gastroentorologist want me off it as I have suffered a lot of side effects (hence the gastroentorologist), depression and mood changes, sleep disturbances and finally GI problems which may be from the PPI Lansoprazole which I have now stopped taking. Unfortunately I am one of the unlucky ones who suffers side effects.

[Woodly]

Having been on various amounts of Pred for more than six years I soon found that taking them late in the day does interfere with sleep so have always taken the full amount at breakfast time, so I agree with the view that is the right time to take them,.

[Doorstep in reply to Woodly]

Thank you for replying

[Sharitone]

GP told me to take it all with breakfast to protect sleep, but also gave me sleeping tablets, which have given great relief. As the pred comes down, I am able to reduce the sleeping tablets as well, so not too worried about dependency. It's really difficult to get well if you're waking up every hour, and I hope it soon improves for you.

[Doorstep in reply to Sharitone]

Thank you so much for taking the time to share your experience.

[HeronNS]

What the others said. That wee small hours time is a optimum, but lately I've found 11 PM with plain yoghurt or kefir works even better for me. But for years it was with breakfast, and no sleep probs with any of the times. Avoid taking any calcium supplements at same time as pred. If you take pred early in the day you may find taking a dose of calcium, again with a small snack, a little while before bedtime may help you sleep.

[Bcol]

Morning, sorry afternoon Doorstep, I'm one of the early morningers, is that a word? and take mine around 02:00ish with some Greek Yogurt and usually a banana, sometimes some berries and/or honey. I have no real problems in the morning and it seems to last all day.

[cranberryt]

Most of us are instructed to take the full dose in the morning. That said, for about 2-3 months, i still had trouble sleeping but eventually I adjusted and was able to sleep fine again. Several times during my journey I have had to split my dose, half morning half bedtime but that was as i got under 8 and had trouble with relief not lasting through the night.

[Boss302Fan]

I’m surprised it’s broken up in 3 doses. Shortly after starting by taking it all in the morning I was waking up around 3 am in pain so my Rheumy split the dose to morning and evening to carry me through the night and it worked. When I got to less than 10mg I started combining the dose and moving it back to the morning only.

I never had any issues with sleeping even when started at 80 mg / day.

[Peptink]

Are you taking 15mg three times a day (45 total) or 5mg three times a day (15 total)? Does the pred seem to be working?

[Deb_M]

Appears the majority consensus that patients are advised (if at all) to take the full dose in the morning. That Said…you wil also find many patients on these forums who have been advised to spit the dose to AM and early PM (5-6pm to avoid insomnia IF that is an issue) if its wearing off too soon - or even into 3 doses.

I started out taking all in the morning and that did Not work for me. I started splitting the does - taking 1/2 with breakfast and the other half at 6-7pm and that has worked for me - it extends pain relief to nearly around the clock. I guess I am fortunate that prednisone doesn’t cause insomnia for me - where PAIN does.

Bottom line if your doctor has no firm preference, do what works for you. We have have unique systems that react and metabolize medications differently. Point is to reduce inflammation while the disease runs its course, mitigate pain, and bee able to have a life! 😊

[Pr0jection]

My rheumatologist told me to take mine all in one dose after breakfast, around 8.30 a.m.