I heard PMRPro write that there is a best time to take the prednisone to help the adrenals wake up. I am at 4.5 mg now and taking it at 4 am has made all the difference --- no more headaches during tapering.
But I am very interested in helping my adrenals wake up.
Thank you all in advance.
chiqui1950
Early morning is best. I take mine at 2am with some hard cheese. I am glad 4am is working for you.
Glad things are going well, like Piglette I take mine around 02:00 with some yogurt.
4am should be fine because the cortisol level needs to be low around midnight to trigger the body’s feedback system into producing more cortisol. This is quoted from the link below.
“In 33 normal individuals who had 20-minute cortisol profiling over 24 h we have shown that cortisol levels reach lowest levels at around midnight, levels start to rise at around 02:00 to 03:00 and reach a peak at around 08:30”
ncbi.nlm.nih.gov/pmc/articl...
Thank you!!
Other than taking it at 2am which is the optimal time to manage morning symptoms, you can't do much more. The aim is to get the lowest possible level in the blood at midnight. The half life of pred is 2-3 hours, it takes 4 to 5 half lives for the body to eliminate effectively all the pred - so up to 20 hours Taking at 4am allows that time,
I take a 1mg coated prednisolone tablet before bed around 11pm then the balance of 1.5 around 8am with breakfast. I’ve split my dose for some years and it’s now become habit. I’m thinking of changing to take the whole dose in the morning but 8am sounds like it’s too late. Will the 1mg at bedtime be worth keeping if it takes a few hours to get into my system?
Thank you so much Piglette, Bcol, SnazzyD and PMRPro! I really appreciate your answers and encouragement! It means a lot to me!
It turns out that I often wake up between 2am and 3am and I take the prednisone then with 1/2 banana. How important is it to take it a the exact same time every day?
Within an hour or so it probably makes little difference - bigger swings may cause problems if the time to the next due dose is too much more than 24 hours. Depends on the person to some extent.
Thank you PMRPro!!
I usually take mine around 5.30 if working or around 10 am if not. I also do some night shifts so when on nights switch to 17.00. Is this ok or is it messing with the Pred to much?
It is probably confusing your body rather. When you do nights is it a long set of shifts or just 2 or 3 and back to days? But every 24 hours is fairly important
so usually 3 nights or sometimes 2 then back to days. They are both 12 hour shifts (Probation service)
Like the NHS! Crackers - what happened to the old idea of just nights for x weeks, much healthier"! When it is such a short time there will be no adjustment of the circadian rhythm so you can probably get away with taking it at the usual time - have you tried that?
😂😂 yes I worked in the NHS for 10 years and used do 2 weeks of night and 2 weeks of days!… I haven’t tried taking at usual time as scared the Pred would keep me awak…what you think?
They don't appear to do anything so sensible these days - my daughter in the ED gets the daftest rota patterns!
Only one way to find out - it doesn't keep everyone awake and a few people take it before bed to avoid unpleasant side effects by sleeping through them!
Probably not a recommended format - but it’s keeping your PMR under control and suits you then go with it. Might be more difficult on lower doses -but cross that bridge when you come to it.
Hopefully keeping it at bay…… I’ve just dropped from 6.5 to 6 as been taking 6.5 for a while now.
I've heard Sarah Mackie recommend 9 am as the optimum time, which is when cortisol levels are at their peak naturally.
Except it isn't. The peak of cortisol is in the first hour after wakening to prepare you for the day ahead. For most people in the UK that is between 8 and 8.30am. However, if you don't take your pred until then, there is a further delay before it appears in the blood - something over an hour for prednisolone and over 2 hours for prednisone which must be processed in the liver to form prednisolone. If you want to replicate the normal circadian rhythm, you must take the tablets early enough to account for that, Not taking your pred until 9am with food means the peak will be reached sometime after 10am, 2 hours later than cortisol would have achieved its peak.
But that is of no relevance if the pred is being taken to deal with the early morning shedding of the inflammatory substances at 4-4.30am. The ideal time to take pred to deal with that is at 2-3am - established in a study which led to the development if the prednisone formulation Lodotra which can be take late evening after/with foodso its delayed release coating breaks down about 2am. Otherwise, the earlier you take it in the morning, the less inflammation has been created and the less the pred must achieve to get symptom relief.
That's interesting. I wonder why she said 9 am?
No idea - it is certainly what most doctors seem to think as it has been the received wisdom. Don't know why.
So 2 - 3am is the ideal time to take Prednisilone to cover the body’s natural low levels at 4am? How do people manage with sleep patterns?
No - that isn't the link, the link is that the inflammatory substances are shed about then and that is when the antiinflammatory effect of the pred is most effective in combatting the symptoms. The absolute nadir of naturally produced corticosteroid is midnight and soon after - and that is what triggers the production of cortisol for the early morning. It will vary if you consistently have a slightly different sleep/wake pattern and shift work really messes it up.
This has nice graphs to illustrate it
zrtlab.com/landing-pages/di...
Thank you. So in the past while racing to the bottom and before I joined this site, the melting joints (best description) at 4am were the result of inflammation rather than low cortisol? However they were relieved if I took ibuprofen or paracetamol which is a sign of adrenal/cortisol? Isn’t it?
Not necessarily - I get achy joints about then at times and it varies, It also fades after an hour or two. Don't really know what it is but my PMR is very well managed with Actemra and pred AND my pred is a delayed release that is taken before bed so present at the time I feel the discomfort, I think it is most likely inflammation though,
This is the most confusing condition!
I can tell you - it doesn't help when the weather is wet!!!! Everything aches this morning - a reminder of why I don't want to return to the UK!!!
It is particularly grey and cold here today. Yesterday was more like November than April.
I have taken my pred with a small banana at 4am for 5 years. It has worked fine for me. If I need the loo earlier I take it then. Occasionally I wake, eat the banana, drop back to sleep and find the pred sitting there when I get up. 😊
At 3.5 mg pred for GCA , what is THE best time to take that dose ? 
PMR - unable to lower Pred
Best time to take Preds
Night time prednisone
About to drop to 7.5
