Best Method Changing to Enteric Coated Prednisolone To Be Taken Early Morning.

[Rostom]

Hi Eveyone.

I am five months into my PMR journey and am due to taper down to 10mg. I now have a supply of enteric coated prednisolone and would like to try taking them at around 1.30am (my normal bed time. I know, I know, but that's the way I was made!).

I am aware that it is generally held that prednisolone can give insomnia however, I am on a cocktail of drugs for other conditions and it is extremely difficult to actually take them as instructed: some after food, some not within two hours before or after food, twice a day and of course, Evacal which can't be taken anywhere near the others (and many thanks to this forum for that piece of knowledge).

I have had in mind for a while trialling early-hours prednisolone but wonder if I can change all at once or should it be tapered?

I normally take pred after breakfast (a very small one!) around 9.00 am-ish. Can I just take the next day's dose all at 1.30am the following morning, approximately 8 - 9 hours early? Is there a 'best' or preferred method of doing this?

I have looked but can't find a questions similar to mine. Any responses would be gratefully received.

Many thanks if you can help.

Regards

[SnazzyD]

Hello, May I ask what the reason is for wanting to change from 9am to 1:30am? It might change the advice given. Bear in mind that enteric coated gets into the blood stream around 4/5 hours after taking them and non/ coated takes 1/2 hours.

[Rostom in reply to SnazzyD]

Hello Snazzy. It is all to do with the timing of my medications.

I take Lansoprazple, wait half an hour and have the pred with food - a small breakfast, egg or cheese etc.. I then wait two hours to take various pills on an empty stomach. I then have to wait another two hours before eating lunch. That's around five hours.

I have to fit it the Evacal in, too, obviously not near either of the two lots of four hours of emptying stomach pre-pills. Sometimes Evacal is taken in the middle of the night as there has for one reason or another not been the opportunity to take it at another time!

I then have a similar regime in the evening re. eating supper, having a small mid-evening snack then waiting for two hours to empty my stomach before taking pills again.

I am obviously extremely grateful for all that the medications are doing for me but it is exhausting as I am continually thinking about timings.

I thought that there must be a better way and taking the prednisolone enteric-coated early hours (when I am going to bed) and letting it do its stuff four-five hours later, would leave me free to take morning pills on an empty stomach, thus saving me four hours of my day.

Or something!

[PMRpro Ambassador]

I would just change the time and take it early - you will at best have a slightly better day, at worst no difference.

But anyway - when you take the e/c pred at about 1.30am, it won't get into your system for another 4 hours at least, the coating means it passes through the stomach and isn't absorbed there, so it won;t be 8-9 hours early, just 4 hours.

[Rostom in reply to PMRpro]

Hello PMRpro

Apologies, I must not have made myself understandable! The 8-9 hours I refer to is the number of hours before my usual time of taking the pred.

I currently take them at 9.00 am-ish and wonder if it is OK to take a following and subsequent dose at 1.30 am the next day? That would be 8-9 hours earlier than at the moment. This would benefit me as in the morning the pred would have had its 4-5 hours to do its stuff, my stomach would be empty meaning I could take the pills that require an empty stomach first thing. This saves me four hours on my current regime. I was wondering about the first dose really, as after that I would take them at the same early-hours time (unless I have raging insomnia in which case I would just have to grin and bear it and carry on as I am currently doing!).

If it is safe to take the new dose all at once at that time I would adhere to the 1.30 am timing for the future.

Apologies if this is convoluted. It hurts my brain trying to work out what to take when!

[PMRpro Ambassador in reply to Rostom]

No I understood you correctly - I was pointing out that, since plain pred is absorbed within about an hour and the coated pred takes 4 to 5 hours - is is effectively only going to be 4 hours early getting to the bloodstream.

It's fine to take it a bit early for once - at best, you will have a slightly higher amount of pred for a short time and have a bit of a boost. Nothing worse. And since it takes quite a while to get into the system - it shouldn't disturb your sleep either.

[Rostom in reply to PMRpro]

Ahh, with you now! I thought it was me.....

Many many thanks for your replies. I am delighted to be able to try this method of dosing and know that it's safe to do so.

Even better is your pointing out that the pred shouldn't interfere with sleep (difficult enough at the best of times but the least of my current problems!).

I'm really excited as this could give me four fours freedom of eating/not eating/pill taking. Well, I know what I mean!

Thank you very much for your help.

What would this forum do without a few knowledgeable bods such as yourself? Regards

PS

Please don't go falling off an Italian peak...!

[PMRpro Ambassador in reply to Rostom]

Oh I know just what you mean - I have to separate tablets too but at least only 5x daily! But that is only because I refuse to take some of what they'd want to give me! Thank goodness for dosette boxes and phone alarms!

[piglette]

I take my pred at 2am, my going to bed time! I normally take a piece of hard cheese with the pills. It works very well for me. Changing to 1.30pm should be fine, just see how it goes.

[Rostom]

Hello Piglette

I remembered that it was you who eats cheese at 2.00 am - perhaps we are related!

I am really looking forward to trying this method of taking pred - I feel it could really help my overall lifestyle. I can eat at more normal times... so exciting!

Thank you very much for your help and advice. As I wrote to PROpro, please look after yourself - we can't afford to lose the knowledge of some contributors in this forum and you are one of them!

Regards

[SheffieldJane]

When I made the switch I would have taken the 9 am dose then the 1.30 am dose resulting in more Pred in my system during that 24 hour period with no ill effects, possibly, good effects. It seemed to take at least 4 hours for coated Pred to get into my system. My sleep wasn’t unduly disturbed.I just took it when I went to bed. My Endocrinologist said early morning dosing was optimism for adrenal recovery. Not sure whether he took the absorption rate into consideration when he told me to take it in the morning though.