I have been taking Prednisolone for several months now. I take it in the morning between about 8am and 9am. I vary a bit from day to day but from the beginning I have found that I am at my best from around late afternoon onwards. My symptoms are not bad earlier in the day but I seem to be better (less stiff) quite a few hours after taking my dose. Is this a matter of the Prednisolone just taking a while to have its full effect or is it just that after being active for a few hours I have loosened up?
I am wondering whether I should take my dose of Prednisolone at night instead of in the morning.
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Siena62
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I take mine at 2am with some hard cheese, which works well so the steroids have time to work before I get up. I take the coated version which takes longer to absorb.
You have tapered pretty quickly & there’s two options you could have got too low for the Pred to be doing it’s job & you are also close to what is called the Physiological Dose which is around the dose we need anyway, so it might suggest your dose is too low……
If you take it at night you may feel OK when you wake in the morning but not so much later in the day?
Are your tablets gastric coated? Mine take several hours so I take them at bedtime. I have changed my optimal times as the disease progresses. A balance between allowing sleep and maximum symptom relief.
I keep experimenting. Taking them at night before going to bed between 12 and 2 didn't work, made insomnia worse. If I wake up or am still awake about 3 or 4 am it works well. Taking them at 9 am means I'm stiff on waking and they kick in around 1pm and affect my sleep. Splitting the dose doesn't work at all. Who did you say uses enteric gel capsules?
I purchase my acid resistant clear, empty vegetarian capsules from a manufacturer called Capsuline (they are shipped from the US to me here in Canada). I get size "0" which allows me to stuff up to nine uncoated 1mg pred tablets, and this size also accommodates 5mg pred tablets. It is important to order the "acid resistant" ones as the plain vegetarian gel capsules will not delay the absorption of the medication. $65.00 for 1000 capsules.
It seems to me that there is a big variation between individuals as to how long it takes for pred take effect. I take coated tablets and they take about 10 hours to be effective - much longer than most people. Have now settled on taking them about 6pm so by the time I get up I am in (quite) good form. Getting on the move does also seem to help with stiffness. Maybe over time you can experiment and find the best way for you. Good luck!
Yes you're right it seems to be different for everybody, some take them at night, some earlymorning, some before going to bed, some in the middle of the night Some even find splitting the dose works, even though it's not officially recommended. In theory the best option would be if you can get the Pred to kick in around 4am but I've found it impossible in practice. Some people on here put the Pred inside an entric gel capsule fr delayed release - I need to research that
Yep, bioavailablity seems different for everyone. I just wasn't getting a full 24hours of relief from taking just one dose in the a.m. I would be still until later in the afternoon. I started trying to get up at 2am every night but that only lasted a few months before I discovered empty acid resistant capsules (see my earlier response).
It takes about a hour usually for pred to get into the system - possibly longer if you are taking them with food. The inflammatory substances are produced and shed in the body about 4am - by 9am they have had lots of time to wreak their havoc and there is more for the pred to do,
The ideal time to take plain pred is 2-3am and then it is at its peak in the bloodstream when the inflammation starts and it never gets a hold and that makes mornings better. It also depends a bit on how long it remains effective for you - can be 12-36 hours depending on the person so some have symptoms returning before the nect daily dose is due.
Thanks for this. I don't think that I'd want to stay up until or wake up at 2am. What is the best way of moving the time of my dose? Should I take a second dose the same day, say at around midnight, and go from there or should I take my dose an hour later each day until I get to midnight? I don't fancy going for over 36 hours without a dose (by taking a dose at, say, 10am one day and my next dose at midnight the following day) and risking a flare.
Just take the next dose early - you are likely to have a better day and then be back to normal. Take the day's dose as early as you usually aim for and the next before bed.
I take mine at 6am and feel they are working by the time i get up about 8 or 9am. Not prepared to break my sleep at 2am when my sleeping is not great as it is. Hope this helps
Yes - when i first started taking it about 2 and half years ago i was taking it about 9am and it also didn't seem to work until early afternoon - hence why i took it earlier
hi...I have to take a pain med at midnight and pretty quickly you can teach yourself to wake up to take a pill. I have my midnight dose in a little dish with a glass of water so all I have to do is reach over without getting up. I sometimes don't remember taking it at this point. I also have sleep issues so I didn't want to try taking.the dose but I also didn't want pain waking me up every five minutes. But quickly it became easy to do and not disruptive. You might want to try for a bit to see how things go. Good luck.
oh...I agree 100%. I was just wanting to say I had and easier time adding a night med to my life than I thought I would. That's all. Not pushing you in the direction just wanting to try to be supportive. All of this is hard...this disease takes so much.work!!! Ugh. Be well.
I get up at 3 a.m. so I can take my prednisone for the reason you outlined it takes a couple hours before I am Mobil enough to be able to go to work I take with yogurt sharp cheese and crackers
just reading about prednisolone here. I've and off these tablets for months now but finding as soon as ive tapered to one a day "5mg. That my breathing gets worse again does anyone else have this problem.
Yes I have that problem on low doses and before I was diagnosed with PMR and put on Pred, Ive been throroughly investigated heart lungs etc and still no answer as to why, I don't have asthma. Just feels everything is tight.
Sorry I'm piping in so late. Hard to get to my emails of late. Just thought I'd share a device I just received and why I ordered it. I too was short of breath and so doc ordered an angiogram (clean test, great for an 80 year old), chest x-ray (also clear), and then a pulmonary function test. It was determined that I breath IN just fine but don't exhale sufficiently. They didn't say I had asthma, but hinted at it. At the end of the test they gave me a breathing treatment, then one last test. All the heavy exhaling started bringing up mucous I didn't know I had.
I was concerned about using the inhaler that was prescribed because I have been unable to stabilize my eye pressure (glaucoma) since starting Prednisone over 2 years ago. I did some research into natural ways to help my breathing and found info on a device called Air Physio. It exercises the lungs and helps to bring up mucous. I got it today, used it twice for just a couple minutes (they recommend 5 to 10 minutes a couple times a day) and I can tell the difference. Do the research and see what you think.
No, I haven't. I do get the emails each day or so but don't get on the computer till late evening and sometimes go down a rabbit hole researching something and never check them.
Hi Siena62, I used to take my pred in the morning, but like you I found it took too long for it to work. I then tried splitting the dose and it kind of worked. 1st upon getting up and then 2nd around 9 or so but found that it ran out before the 9pm dose. I tried a bit earlier as well without much luck. I also tried the 2-3am dose but found that if I was sleeping, I didn't want to wake up to take it because inevitably I couldn't get back to sleep. It only worked if I was already up til then. I currently am taking my dose anywhere from 10:45pm - 12am. At first I did what I could to force myself to stay awake as late as possible, take the dose with yogurt and stay upright til it settled. Then I could go right to sleep and get from 5 to 7 hours of sleep. I mostly have a hard time now staying awake after 11:30pm and I am usually up by 7-8am. Yes, I still have the trip or 2 to the bathroom but I go right back to sleep. Yes I still have the occasional insomnia &/or late sleep in but I also find that I have more energy and less pain throughout the day since it has kicked in while I am sleeping and during the inflammation production time. I still have to watch that I don't over do it though. I also feel ready to sleep by the time I take my dose at night. I think that you just have to try different things and see what works best for you. Maybe you could split the dose and take it at night and in the morning? I do agree with Mrs. Nails however, that you may be tapering too quickly. April til September is rather quick. Might want to stay at the 8 mg or go back to where you were last comfortable for a bit. Try the suggestions and then when you settle on something that works better, continue the taper. Of course, I'm no Dr nor an expert, just saying what did and didn't work for me. Good luck and I hope you can find that happy medium!
Thanks everyone for their contributions. I’d like to ask a related question. If you take slightly too low a dose of Prednisolone does the body produce the same amount of inflammation each day or does the body produce increasing amounts of inflammation each day as the days go on.
I’ve never been entirely symptom-free since I started on the Pred but, thus far, my symptoms haven’t noticeably worsened since I started to taper. The improvement in my health has been massive and I have been content to put up with some stiffness and soreness because I am, broadly, able to lead a normal life, although I have not gone back to the gym or the swimming pool (not that I was a very energetic exerciser). I am terrified of becoming unwell again by flaring but, equally, I am concerned about staying on steroids for a long time. My rheumatologist was wanting to put me on Methotrexate but has backed off since I indicated my reluctance. I saw the rheumatology nurse who proposed a taper of 1mg a fortnight down to 5mg when I need to see her again. The rheumatologists are just desperate to get you off the steroids and if you can’t taper down as quickly as they want start pushing Methotrexate. My questions about how many people actually get off the Pred whilst taking Methotrexate / how much more quickly they are able to taper the Pred whilst they are on the Methotrexate were not answered and that’s why I refused the Methotrexate and decided to see how I got on with tapering below the 10mg that I was on for some three months.
I think it probably produces a similar amount of inflammation but the amount that isn't combatted by the pred builds up over time.
Top experts say that a taper of more than 1mg per month below 10mg is predictive of flare. I wouldn't want to do 1mg every 2 weeks at this stage - it isn't long enough to know the dose is still enough either. And there really is no guarantee MTX will help - though you do have to try it to find out, It works brilliantly for a small cohort of patients.
1mg a fortnight sounds far too fast a taper to me and not one I've seen in any guidelines. The best method of tapering seems to be the Dead Slow Nearly Stop (DSNS0 method which you will find in the FAQs, totoise not hare. Remember as Pro constantly reminds us, you are not relentlessly tapering to zero as the disease is still ative underneath, but trying to find the minimum dose that still controls inflammation, so you need to listen to your body and find your happy
My rheumy told me to speed up rate of tapering to 1mg a fortnight, but I had the backup of TCZ. Even so, it worked ok down to 4mg, and then became untenable. Now doing roughly 1mg every 6 weeks - with TCZ.
They seem to forget it still has an effect on your body - and then the adrenals have to wake up. And that takes time. My rheumy said 1mg per month -and I'm not at adrenal territory yet!
Yes, when I've mentioned adrenal glands, he acts as though he's never heard of them! I always get an unrealistic reduction schedule, which means that I have to brazen it out at the next appointment when I'm still taking 'too much'.
Maybe he slept through that lecture!!! There seem to be a lot who don't understand that exogenous corticosteroids (pred) suppress production of the endogenous (cortisol) variety!
My rheumatology nurse has instructed me to taper one mg a fortnight down to 5mg when I have to see her again. I'm not going to do that, not least because I have various things planned which I don't want to miss if I'm unwell. No doubt I'll again be put under pressure to go onto Methotrexate if I don't taper quickly enough but I haven't been convinced that taking Methotrexate will enable me to come off the Pred more quickly. You have the problem with your Adrenal Glands whether you are taking Methotrexate or not.
I will say that being on Methotrexate has not enabled me to “come off pred more quickly”, but it has enabled me to lower my pred dose (which I couldn’t do for almost two years while on pred alone, stuck at 9mg). I agree, doesn’t matter how you lower your pred dose, once you get to a low enough dose you will encounter adrenal insufficiency.
I take uncoated (white) pred at 5am with a yoghurt drink. I'm not sure if the Actimel is complementary to the pills but it saves fiddling with a teaspoon and yoghurt carton in the middle of the night. Mostly I get back to sleep and when I awake for work at 7am I have no stiffness or pain. This has worked for the last month for me, but I guess it's trial and error for us all. I read tonight that you can get empty capsules to put the pills in. I might investigate that. It would be much less hassle to take the tablets before turning in for the night.
I also got up around 3am to take my uncoated pred dose for about 8 months before discovering acid resistant clear capsules that delay absorption for about 3 hours. Now I stuff my uncoated pred into the capsule and take it around 11pm. Works a charm! No more getting up, turning on the light waking hubby, fumbling around to eat some sort of food, not to mention dropped tablets that I would find later after I would be mysteriously sore (due to missing a mg of my dose).
I have always taken Pred (un-coated) between 1.30 am and 4am ish. The precise time depends on when I wake for a pee. After five years I wake naturally at the appointed time, take the tablets with half a glass of water (they are already counted out and in an egg cup beside the bed) and I go back to sleep. Some mornings I can't remember having taken them but if the cup is empty I have done! At higher doses (8mg and over) I would prop myself up on pillows just to stop any acid reflux and still fall asleep. One tip I learned is to sleep on your left side not your right after taking the tablets. This reduces reflux. It's all to do with the shape of the stomach and anatomy and works for me. I have never had any gastritis or heartburn so am lucky.
There is evidence that taking the Pred at bedtime or late evening, can have a greater effect on depression of the HPA axis and cause more adrenal suppression. Because we are long term users that probably doesn't make a lot of difference to us in the long run. Taking Pred between 2am and 4am is also said to enable a slightly lower dose to be effective at controlling symptoms but again we are all different so it's more a question of understanding the theory and adapting it to suit your own circumstances in the knowledge that there will be no quick fix for PMR
To comment on you last question too. Even if the MTX controls the PMR you still have a suppressed HPA axis and adrenal cortex, so tapering to accomodate that is still vital and cannot be rushed. Rheumatologists forget this fact and have to be reminded.
Personally, I think my PMR has gone following Covid !! However, I am on 3.5mg Pred and tapering very slowly because I have a history of issues at 2.5mg.
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