Purpose of taking prednisone at 2 am

[PBfs]

I have read where it mentions taking prednisone in the early hours like 2am. Can someone explain the purpose of this? I am currently tapering down at 1 mg per month from 7 mg, split at 5mg in the morning and 2 mg in the evening. Thank you!

[DorsetLady PMRGCAuk volunteer]

If you take at 2am or thereabouts your Pred can then combat the inflammatory substance, a cytokine called IL-6, which is shed in the body at about 4-4.30am and causes your early morning pain.

But as you already split your dose, your 2mg in the evening may already be doing that for you.

[Bridge31 in reply to DorsetLady]

how does it work with the time difference if you are flying to say San Fransisco ?

[Bridge31 in reply to Bridge31]

Just boarded a plane for Philadelphia so although I take my Pred after breakfast I was just curious

[DorsetLady PMRGCAuk volunteer in reply to Bridge31]

As I’ve said before , when you get on aircraft -set your watch on time of arrival city -and then take your tablets at the usual time -so if that’s 8am GMT, then make it 8am US time. One way it will be less than 24 hrs -no problem .If it’s going to be more than 24 hrs then slip in an extra half dose to tide you over.

longer answer- was out before -

Long haul advice and timings of meds– based on my trip to NZ.

Long before GCA, my son always said put your watch (and mind) on local time in country of arrival -and work to that.

Depending on which way you are going… forwards in time or back you need to think about medication times. Sometimes it would be good to travel with Dr Who in the Tardis!

On my first trip to NZ when still on Pred, I took usual morning dose in UK (taking an early evening flight) with stopover in Singapore.

Took another dose with last meal on plane before landing at Singapore-local time 17.30 next day (UK time 7hrs behind).

Left Singapore evening around 3-4 hrs later -arrived Christchurch mid-morning following day (another few hours ahead) so again took dose with breakfast on plane.

Back to morning (local time) next day.

So, I actually took 3 doses over 27hours rather than 2 -but no issues, and probably helped with travelling hassle…

On return flight -left NZ their noon -so usual dose in morning -either take half a dose in Singapore airport or on UK flight plane with supper (flight left evening local time) and then usual dose with breakfast on plane just before landing 6am UK time.

Just sit down with times of flights and work it out -always better to take an extra dose or half dose than not enough .

Most of all enjoy…and make sure all meds in original boxes and copy of prescription in your hand luggage -and book assistance-always a long walk at airport.

If you need, ask for special assistance at airports, the cabin crew will also be aware so will be a bit more attentive - makes life so much easier, and take your medication, copy of prescription and anything else relevant in your hand luggage.

Don't do too much for a couple of days after flight, but most of all enjoy yourself!

Worked for me.

[Bridge31 in reply to DorsetLady]

Thank you Dorset Lady .Sunny and 65 here in Philadelphia . Very unusual and it’s not going to last !

[christi48 in reply to DorsetLady]

Thank you so much.

[PBfs in reply to DorsetLady]

DorsetLady, Thank you for your comments. Very helpful.

[Zebedee44]

hello PBfs, I see you have had no replies as yet so I’m just replying to say that I do exactly as you do and take my 7mg in a split dose which works very well for me.

Others will doubtless give you a more scientific reply but I know from this forum that the inflammation is released into your body between 3 and 4am so if you take your dose of pred at 2-3 am it is in your system ready to tackle the inflammation.

Personally I didn’t fancy waking at 2am to take the pills and eat something so I have stuck with the split dose but I know that I should change this practice to encourage my adrenal glands to spark back into life as I taper down. That’s a whole other world of managing PMR that I have yet to deal with, and you too I’m afraid. It’s good to know there are others here in the same boat, best wishes Chrissie

[PMRpro Ambassador]

A study found that the optimum time to take prednisone for minimal morning symptoms is 2am, Prednisone is absorbed in about an hour and then processed by the liver to make prednisolone which also takes about an hour, getting the level in the blood to its peak by about 4am which is when the inflammatory substances are shed in the body. By having the antiinflammatory effect present in advance, the inflammation never gets a hold and there are fewer morning symptoms. In the case of prednisolone, you can take it about an hour later as it doesn't need the time to be processed by the liver but is active as soon as it is absorbed.

The trigger for return of adrenal function is a low level at midnight or thereabouts. By taking the pred at 2-3am you allow the maximum possible time for the pred to be washed out of the body by midnight. (It takes 5.5 half lives to get there and that is up to 22 hours).

[Bluey-1 in reply to PMRpro]

Would the recommended timings for enteric coated pred be different Pro?

[PMRpro Ambassador in reply to Bluey-1]

Yes - you can take that shortly before midnight as it takes at least 4 hours to get through the stomach and be absorbed. There is a form of prednisone that has a different sort of coating that breaks down after 4 hours in the right conditions but if you have e/c you can use it in the same way.

[PBfs in reply to PMRpro]

Hi PMRpro, Thank you for the clear understanding of the time to dose and explanation. VERY helpful! I always love to read your posts. Thanks.