Adrenal response to cytokine release, I’m confused

[Zebedee44]

So the subject has been discussed here recently about when is best to take the daily dose of pred when tapering down through the adrenal gland recovery period and it seems I should stop splitting the dose so that they are urged back to life, but does that mean it is better to take the dose before or after the release of the inflammatory cytokines?

I know there are clever people out there who can help me understand the physiological process. Thank you in anticipation, Chrissie

[PMRpro Ambassador]

You kill both birds with one stone by taking the pred at 2-3am. Adrenal function is triggered by a low/no level of pred in the blood at midnight. If you take the pred after midnight it has the longest possible time to be removed out of the system (5.5 half lives is said to get to near enough zero, pred half life is 3-4 hours, 5.5. half lives 16-22 hours) but it will be at its peak just before the cytokines are shed at 4 - 4.30am.

[Zebedee44 in reply to PMRpro]

Thankyou PMRPro, I knew you would have the answer, as always. Chrissie

[HelenDaisy in reply to PMRpro]

I find this very interesting, and new to me after 4 years of PMR, but isn’t one of the side effects of prednisone that it keeps you awake?

[Zebedee44 in reply to HelenDaisy]

Hi HelenDaisy, I don’t think it keeps me awake, although I do wake during the night to pee. Splitting the dose has always been successful for me in managing my pain and energy.

[PMRpro Ambassador in reply to HelenDaisy]

Depends on the person - doesn't keep me awake!!! I was struggling to sleep at doses over 15mg but it wasn't the pred, it was my husband who was ill! After he died, I slept well despite the dose. I'm still at 10mg for other reasons recently but can sleep like a log.