timing of pred when on a low dose , slow taper

[Devoid]

Now down to 2 mg / 3 mg taper , and weekly Toc. Just wondering if the timing is still important or if I could take it later in the day. I’m not sleeping particularly well and find my best sleep is from about 6 a.m but I’m getting up for breakfast and pred between 8 and 9 am . I don’t particularly like breakfast and could have beneficial sleep if I didn’t have it .

[PMRpro Ambassador]

Can't see why not - just don't take it too late in the day. You need to blood level down as low as possible by midnight for return of adrenal function. On Actemra your only problem should be adrenal function.

[Devoid in reply to PMRpro]

Adrenal function seems to be the main problem at the moment but try telling the endocrinologist that!! I’ve had a very low base cortisol result but for some reason he won’t do further tests

[PMRpro Ambassador in reply to Devoid]

To my knowledge there isn't much in the way of tests. There is the synacthen test but that only really shows that your adrenal glands are CAPABLE of producing cortisol, not that that is happening reliably day to day without a chemical kick. And in a study by Imperial, London, 2 to 3mg pred has been identified as enough to function day to day and presumably also enough to suppress production of cortisol. SnazzyD has said just today I think that at 4mg her synacthen was poor, bit better but not wonderful at 1.5mg. You do have to be at a pretty low level of pred for adrenal function to get anywhere near normal and even off it it takes a year to sort itself out.