Timing of Pred - mornings

[TheMoaningViolet]

I have just taken my first 0.5 mg today. In the last two weeks on 1 mg, I started feeling like myself again, with normal energy levels (for me relatively high), normal tiredness and a generally more cheerful outlook, so at the moment all is good.

I take my Prednisolone in the morning with breakfast, so usually, around 8 am. I would like to try to stretch periods when I don't eat to try to practise intermittent fasting, but missing dinners is unpopular with my family, and I can't drop breakfast as I need it to take my medication.

What do you think about taking Prednisolone a bit later, around 10 am or even 11 am? Any potential issues that come to mind? I don't have any PMR symptoms in the morning, and on an odd day when I took my medication a bit later (10 am), I didn't experience any problems.

[Koalajane]

I miss out on lunch and have my pred with breakfast at around 8 then eat my evening meal about 7. You will find t that your body will soon get used to missing a meal

[TheMoaningViolet in reply to Koalajane]

Thank you, that's another option, but skipping breakfast would be good as I am usually not very hungry until 11 am anyway.

[PMRpro Ambassador]

The only way is to try. I do intermittent fasting in that I don't eat breakfast and rarely eat before early to mid-afternoon but although it doesn't affect the pred which I take within 3 hours of dinner at night because I take the delayed release form I have a load of other stuff to take during that time, usually with a cup of tea.

I would think at 1/2mg you probably won't have any problems - whether taking it with just water or at a different time.

[TheMoaningViolet in reply to PMRpro]

Thanks, I will give it a try.

[PMRpro Ambassador in reply to TheMoaningViolet]

After all - if the PMR really is gone, you won't need it anyway!! And if you are that near the end the adrenal function must be doing SOMETHING.

[TheMoaningViolet in reply to PMRpro]

I was thinking whatever they happen to be doing, it would be at its peak in the morning anyway.

[PMRpro Ambassador in reply to TheMoaningViolet]

Should be - all that matters is that the blood level is as near zero as possible at midnight. And on 1/2mg, it will be.

[PMRCanada]

I split my dose and take 2/3 of it at 11pm (in an enteric capsule), and the other 1/3 at 11am (uncoated with food). This works well with my intermittent fasting schedule that entails an eating window from 11am-7pm.

All you can do is try and adjust the time you take your VERY small dose and see what happens. I agree that it is easier to skip breakfast and partake in early lunch and supper, especially with family joining in for meals.

Good luck in your efforts and it sounds like you are in the home stretch when it comes to your condition.

[TheMoaningViolet in reply to PMRCanada]

I hope so. I am not stressing about it, it has been quite a journey so far. Thank you.

[piglette]

I miss out breakfast and have brunch. I take my pred at 2am with a piece of hard cheese.

[TheMoaningViolet in reply to piglette]

I would find it super-hard to be up in the middle of the night. Thankfully, having Pred with breakfast worked fine for me.

[piglette in reply to TheMoaningViolet]

I am normally going to bed at that time!!

[TheMoaningViolet in reply to piglette]

🤣I thought I went to bed late (just after midnight).

[PMRpro Ambassador in reply to TheMoaningViolet]

If you don't go to bed until after midnight - that could be an ideal time to take pred. But you are so low it probably doesn't matter

[Louisa1840]

Congratulations M.V on what looks like the end of the PMR journey - fingers & toes all crossed! I often take my pred with a few spoonfuls of natural yoghurt which is good for the gut and good for you. Good luck with Journey's End..........

[TheMoaningViolet in reply to Louisa1840]

Thank you, I am cautiously optimistic. 🙂

[Lookingforideas]

hi there,

You sound like me - and I’ve been fine doing the ‘lunchtime pred’ almost the whole time - I intermittently fast by skipping breakfast (never liked breakfast !!!) and have been taking my pred with lunch for quite a long time now - probably since around the 10mg level, so about two years … but I am a late to bed (1am ish) and late up person (9ish) anyway so maybe my whole circadian system runs later than normal??!… if that’s possible??? But for whatever reason, I’ve been fine on that timescale - I have always ensured I have a decent ‘breakfast’ at lunchtime - usually raw oats, nuts, seeds, various fruit, always inc at least half a banana and some soy yoghurt - so a large bowlful! Or very occasionally smoked salmon and scrambled egg whites or beans on toast …

I’m stuck at 0.625mg at the moment … ha , I’ll bet you wonder why that strange amount 😂 it’s a quarter of the 2.5 mg tablets - I had a lot left over, so when I was stuck at 1mg for a few weeks and couldn’t get down to a half, I thought I’d edge down even more gradually by chopping those up into quarters - I’ve been on that .625 (average) level for a couple of months but every time I try a half, even using the Dsns gradual transition, after a few days I do get aches and stiffness creeping back in so I think this is my ‘correct’ dose for now therefore I’m sticking with it. I certainly don’t want a flare at this stage after a relatively smooth and fairly slow taper from January 2020 (2 years and 8 months so far and counting myself pretty lucky) but I don’t want to jinx it so I’ll shut up about that & stick on this level a bit longer 😊

[TheMoaningViolet]

Yes, we have been on a similar journey for a similar length of time, I started treatment in December 2019. I feel I need to bring my self-care up a notch to gain the confidence for the final stretch. Good luck.

[Yorksman]

I'm pleased for you, your doing well. I was diagnosed at the same time as you and down to 13mg. Can you give everyone a brief idea of how you reached 0.5mg please?

[TheMoaningViolet in reply to Yorksman]

Hi Yorksman, I am so sorry to have given you an impression of my phenomenal success when in fact I made a mistake in my reply above. Having examined it, I realised that I wrote 2020 instead of 2019 (I have corrected it now). I started experiencing symptoms in August 2019 and started the treatment in December 2019. If you still find this encouraging, I can send you my taper so far. I am tapering slowly, but I was reducing to 4.5 mg before the end of my first year, and I had no flares. Other than that I try to get enough rest, eat well, exercise and manage stress.

[Yorksman in reply to TheMoaningViolet]

Thanks for reply. Just wondered if you had found a winning formula to achieve your result. Did you just reduce so many milligrams a month?

[DorsetLady PMRGCAuk volunteer in reply to Yorksman]

There is no wonder formula -only what suits you and your illness - but most once into single figure (whether PMR or GCA) find that small steps -so 1mg monthly/6weekly from 10mg say to 7 or 8mg, and then 0.5mg each taper. ..provided no hiccups.

A slower tapering plan rather than “overnight” drop is also easier. .. see FAQs

[Yorksman in reply to DorsetLady]

Thanks DL, think he's done really well.

[DorsetLady PMRGCAuk volunteer in reply to Yorksman]

if you mean MV -he’s a she…😊

[TheMoaningViolet in reply to Yorksman]

Only at the beginning, but afterwards I did a combination of approaches and kept adjusting them as I went along, with one aim, which was not to ever increase the dose if possible. So if I took one of my slow steps and didn't feel right, I would repeat it until I was fine and ready to take another step. This would usually come up during DSNS method as I was hitting 1:3 ratios (i.e. 1 day lower dose, 3 days higher dose). I would move through these key changes slowly and then would not linger very long on the final dose.

I spent the longest on 5 mg, I wasn't sure I was ready to move down and I found the taper to 4.5 mg slow and more difficult that I expected.

The background to our lives is not constant and I felt that my tapers needed to reflect that.

[PMRpro Ambassador in reply to Yorksman]

There is no "winning formula" - just the one that works for YOU and everyone really is different. The only generally applicable formula is SLOWLY!