I saw my Rheumatologist today, a new one as my regular one is ill, and she said to stop taking my Pred in the early hours of the morning and have it at breakfast. Sorry my memory is not too good, and I can't remember clearly why this was suggested. I thought it was because that's when the inflammation load increased but the rheumy insisted that wasn't the case. Could someone please remind me if this is so, and if it is, is there any research paper that refers to it.
Many thanks
Mary
The empirical evidence on this list alone is probably enough to firmly establish the fact.
However, here is at least one study which lends "science" to it:
openaccessjournals.com/arti...
I can say that split dosing is almost wholly responsible for how well I do.
YMMV as always.
Chris
Very interesting article, at least the bits I understood. After I'd got my pred dose back to what I thought was a reasonable level, forget exactly, maybe around 5 mg, I wanted to return to the more convenient breakfast time dose. However I only did this for a few days because the difference in the way I felt when getting up was quite marked. Hadn't expected this. Throughout pred journey I'd felt the breakfast dose of pred worked well for me, no matter what level. However by taking pred at 2 am I learned that I could feel much better on the same dose and indeed it was helping me taper.
It is because the body sheds the inflammatory substances at about 4am - taking prednisone at 2am (prednisolone a bit later at 3am) means that the pred is there, ready and waiting and so the inflammation never gets hold and morning symptoms are greatly reduced. Originally recommend for RA patients, it is also very applicable in PMR where the worst problems for patients tend to be in the morning.
I fear her denial isn't backed by some of the top experts in the field who DO talk about the circadian rhythm of the production of inflammation
rheumatologynetwork.com/vie...
The research was using RA patients - but exactly the same principle applies in PMR and the production of IL-6 there.
Is there a difference in the absorption rate between prednisone and prednisolone? I normally take prednisolone at 2 a.m. but perhaps I can set my alarm for 3 a.m. instead?
Did your rheumatologist give any reason why you should take your pred at breakfast?
No. She just said there was no reason to take it during the night.
Perhaps she doesn't know that you can have a better result as your body has time to absorb the steroids and you are ready for the day when you get up. I suppose if it works for you at breakfast though that is fine.
Needs to read the links I gave. And there is no need to take it in the middle of the night when you use the delayed release formulation. It's only if you are using the plain non-coated form.
Many thanks Piglet and PMRpro. She obviously doesn't know about the shedding of inflammatory substances in the early hours. She wasn't speaking very definitely, and gave no reason for a different time. I'm taking Pred at breakfast for a week and writing down any symptoms I have, then doing the early morning for a week to see the difference. I don't find it difficult getting up so that's not a problem. Many thanks.
Can you get coated pred in Australia?
Don't knoe Heron. I'll have to check that.
The UK study I posted also used delayed release. It also included only PMR patients for subjects.
Thanks Chris 
It really worked for me. It heads the cytokines off at the pass, so you wake up feeling good.
have a question with regard to the 3-4am cykotines being released, just curious, what happens to your body, with pmr, if you are a shift worker, and have to be awake all night, like work from 11pm-7am, and then sleep through day? Im am not in that scenario, but wondering how this information is determined,
The physiological effect should be for the cytokine releases to be a few hours before waking - the body has what is called a diurnal variation and it does get upset when people work shifts. The best approach to shift work is the way they used to do it with a week, and in the health service weeks, at each shift time pattern. These days they use ridiculous patterns with maybe just a few days of each timing - part of the reason shift workers often have health problems in the long term and sleep poorly. But with regular patterns of behaviour it does adjust fairly well.
I had a relative in New York who worked as a nurse in a hospital and she asked to be on permanent night shift. It worked perfectly for when we visited her. We'd go out together in the evening, for a meal and a play, and then we'd go to sleep in her apartment and she went to work. In the morning she'd get back when we were finishing breakfast and then we'd clear out for the day and she would go to sleep. Her boyfriend worked a similar permanent nightshift with the post office. Only possible for people with no other family obligations of course, but was great for them.
It's worked perfectly well for me
You are correct. I take it around 2 am and it has made a huge difference.
Thanks Jane and others who replied. It's nice to be able to say that it works for other people.
Not only that - a pharma company felt it was worth developing a delayed release formulation and no pharma company wastes money on something that doesn't work.
I took pred at breakfast time for over six years, and it worked fine. With a major flare last year I was trying different ways of getting the most out of an increased pred dose so that I could reduce more efficiently. I tried splitting dose. Then I settled on 2 am. For a while I tried 11 pm, which seemed to work also but was a nuisance because my sleeping potion is a dose of calcium and you can't take calcium and pred together,and I kept forgetting to take calcium early enough. So, back to 2 am. I say from experience that this is the best time for me. I fall right back to sleep after taking it with a small helping of plain yoghurt and a little water. I wake painfree.
😊
I take my early am dose with plain yogurt too. And the yogurt has had wonderful effects on my gut health as a side benefit. 🙂
Yes, I have found the same thing Chris.
I'm back to taking it when I wake up and at lower levels this is actually ok. Up until now however, taking coated at bedtime really improved my mornings significantly. So it can make a massive difference for quality of life.
Yes, I was fine for several years with low dose at breakfast. It was the unprecedented flare last year which seemed to need a different approach, I tried going back to morning a couple of months ago but it really didn't work as effectively as the 2 am time, same dose. I felt I needed to increase dose, so went back to early morning.
So not only are we all different but apparently our experience of PMR can change!
I do a split dose but can't wake up and take it at 2am because if I do, I can't get back to sleep. A huge problem. I did use Rayos for awhile but balk at the ridiculous expense for it here in the states. So, only closest thing I can do is take it at bedtime which for me is 10 or 11pm. Sleep disturbances now that I am at 6 pred in a.m. and 3 pred at 10pm are terrible. Not sure why. I have learned not to drink anything close to bedtime and try all sorts of stuff like melatonin, relaxation, meditation, etc. Ugh. Didn't have an issue which I was at 5 or 6 mg prednisone.
Sometimes you can get away with splitting the dose taking about 2/3 in the morning and the rest later enough in the day to extend the anti-inflammatory effect to the full 24 hours. Doesn't have to be soon before bed which is very likely to disturb sleep. There are people who have bought gastro-resistent capsules for the evening dose - a cheap version of Rayos
Early morning discomfort in chest 
ON 13MG OF PRED BUT VERY PAINFUL ARMS IN THE MORNING
Missed Dose of Pred .. 24 hours didn’t matter?!?
Levels of Pred?
Increase in Pred
