Taking prednisone before 4 am

[Jane424]

Thanks for advice. It really helps taking my prednisone at around 2 am before the cortisol dump. Saturday night I missed waking and took it at 4 am. I was so bad I could hardly move on waking at 6.00. Last night, I took it at 2 am and this morning am moving so much more easily. Everything else, like humidity, was the same both days. My GP said no point, but it really does help. I have been doing it for a time and this one failure really made the point. Jane

[PMRpro Ambassador]

It isn't a "cortisol dump" - it is the inflammatory substance, a cytokine called IL-6, which is shed in the body at about 4-4.30am. Your GP is wrong - the fact was established in a scientific study and led to the development of a delayed release form of prednsione, marketed as Lodotra in Europe and Rayos in the USA.

[Jane424 in reply to PMRpro]

Thanks for the info. Bless you.

[piglette in reply to PMRpro]

Perhaps a “cytokine dump”!!

[Jane424 in reply to piglette]

yes, I think I muddled that. I thought the suggestion came from this group. Would it make sense that it helped? Jane

[piglette in reply to Jane424]

I was actually joking!! A “cytokine storm” even.

[PMRpro Ambassador in reply to piglette]

Oooh no - don't want one of THEM!!

[HeronNS in reply to PMRpro]

Does this cytokine have a positive purpose in the body?

[PMRpro Ambassador in reply to HeronNS]

I think so, yes.

ncbi.nlm.nih.gov/pmc/articl....

See the legend for Fig 1

[HeronNS in reply to PMRpro]

So this would be why anti-inflammatory drugs like pred and especially TCZ make us more likely to succumb to infections. Seems we need to keep working on the problem....

[PMRpro Ambassador in reply to HeronNS]

Oh yes ... But anything that sorts out an autoimmune thing runs the risk of reducing immunity in some way

[piglette in reply to PMRpro]

It is all the fault of climate change!

[HeronNS]

I've found this helpful too.

[Sharitone]

My rheumy also said it makes no difference when you take it. Probably just to put me in my place!

[Jane424 in reply to Sharitone]

I was told that the morning is best as it is close to our natural cycle. According to the U of Michigan, cortisol rates rise in the early morning, peaking around 7 am. This may be where I got 4 am from. The idea was to put the prednisone in before the natural cortisol rise - to preempt? I know that with me prednisone effects go up and down during the day.Any other light on the matter would be very helpful. Jane

[PMRpro Ambassador in reply to Jane424]

If you are on a short-term course of pred then taking it before the natural cortisol spike is useful - because it is likely to lead to less suppression of the HPA axis that governs it. That usually take some weeks, depending on the dose, so being on pred for a month isn't likely to cause a major effect, especially when you take the pred early in the day. However, we are on pred for at least months, mostly years, and at doses high enough to have an effect since we are on above 10mg for long periods.

[Prof99]

My Rhemy explained about the cortisol cycle and I concluded by saying "so 4am would be the best time to take my Pred then?" He replied "Yes" but seemed very surprised that I was prepared to wake up at 4am each morning to take the tablets - it made me realize that these professionals have no idea the level of pain and discomfort we are in. He didn't seem to understand that I would do anything to ease my suffering. You don't say what dose you are on but when I got to 3.5mg I tried different times to take it. Now that I am down to 2.5mg - I find I can take it with my lunch which has the advantage of me not having to take Omeprazole any more. I don't believe it is terribly harmful, I just want to be taking as few medications as I can. Good Luck.

[PMRpro Ambassador in reply to Prof99]

You're right there - they really don't have a clue more often than not. I think my rheumy here does - not just PMR. He was giving me injections for trochanteric bursitis pain and the nurses were busy warning how much they'd hurt - we were both laughing at them and we said in almost the same breath that they were nothing compared with the bursitis pain.