I was Recently (3 dys ago) diagnosed with PMR and started a 15mg dose of pred. it immediately helped but on 2nd day I was a bit achy - still much better than before. My GP suggested taking the 3x5mg tablets in the morning to avoid insomnia but as the aches are worse in the morning I thought later in the day would be better ?
Any advice/views
Hi and welcome
Usual advice is to take first thing in morning with/after breakfast -and really initially you should do that. If you’re on plain white tablets they take about an hour to get into system - so the earlier you can take them the better.
To be honest 3 days is not long for the Pred to take full effect (some get almost immediate relief-but not everyone)… so give it a bit longer.
Maybe have a look at this -
healthunlocked.com/pmrgcauk...
..and a plea, when you feel up to it some info on your bio would be good.
Thanks - will follow up
Hi and welcome!
The pred dose for PMR should be taken all at once and as early in the morning as possible. The new daily dose of inflammatory substances is shed in the body in the early morning, about 4-4.30am. The sooner after that you take the pred, the less inflammation has been created and the less the pred has to do. The ideal time to take it is 2-3am so the pred is at its peak in the body before the new inflammatory substances are shed - but that is a bit of a committment! It will take a while for the existing stored up inflammation to be cleared out and that will mean the stiffness may last some time still - it isn't always an instant 100% result.
And a warning: DON'T go rushing around catching up on what you haven't been able to do - that isn't the idea! Just taking pred isn't the whole story, you have to do your part too with pacing and resting appropriately. This is a chronic condition and you have to achieve a balance of medication and lifestyle adjustments so you manage with the lowest effective dose of pred to minimise the adverse effects.
DorsetLady has posted her introductory post - read it and take note of the links in it.
Interested to hear best time to take pred. Am certainly awake by then, but should I have something to eat before taking them? I am on 30 mg atm. Would a few spoons of yoghurt be sufficient? Don't think I could manage anything else at that sort of time!
I take mine at 2am with a hard cheese
Others have suggested early in the morning and I agree. But the problem I have with that is that I don’t like to eat until at least 10:00 in the morning (preferably a bit later). I also try not to eat or drink anything after 8:00 pm which gives me a good 14 hours fasting every night. I found this a good way to lose and maintain weight loss.
Initially with PMR I had my pred with some yogurt early but I struggled with weight gain. So I switched and started the omeprazole to help my stomach. It seems to work for me.
Be careful with taking a PPI longterm. It can interfere with nutrient absorption and over time can be implicated in bone thinning.
Thanks. I must re-read everything I’ve forgotten about from when I first had the PMR diagnosis
Thanks for the advice.
Like the others said, for the time being stick with doctor's instructions for early day (breakfast time). If you are taking a calcium supplement do not take it when you take your pred. Pred for breakfast, and calcium for lunch and supper, or, even better, lunch and a little while before bedtime with a bit of yoghurt. Calcium and pred interfere with each other. Pred does something to the metabolism of calcium, and calcium prevents full absorption of pred!
I am at the same stage.I started on 15 mg one morning and woke pain free next day.Wow!Great relief.My GP suggested take them at night - with a little effort I changed.I don't sleep well anyway and I do think it may be better for my routine .I take a number of other drugs.Next week I start the reduced dose of 12.5 mg.I am a little cautious -we shall see.I am also starting on calcium and Vit D.It is a lot to take in.Presently I am angry because of the essential change in my life style.I am a very busy person stopped in my tracks.Help! How do I cope?
If you really want a reply and it wasn't a rhetorical question, you need to ask it as a new thread. Few people see questions asked in the middle of an existing thread.
How do you cope? You may well need some counselling in much the same way as in a bereavement - which it is as you have been bereaved of your former way of life. We all have - and most of us were busy, at the centre of our family life, often the go-to person in the family or in demanding professional positions. Acceptance is a really important step because being angry and fighting it all is a waste of energy that can be far better employed adjusting to the changes and reassessing our priorities - because all too often it is a warning shot across our bows suggesting we have been burning the candle not only at both ends but also in the middle! PMR is a relatively minor hiccup - if you go on to develop GCA then the earthquake can be even bigger because of the potential risk of sight loss and the high doses of pred involved to reduce that risk which in an of themselves are pretty life-changing.
Thank you for your reply.I grieved badly when I lost my hearing with Acoustic Neuroma but like everything else you learn to cope. I will get over the PMR but it is just another problem I don't need.I am learning quickly about drug regimes and fitting them in to my already existing regime.
Apart from being very tired and a little dazed by the speed of change in my life I know I shall settle.
It is very early days but being without pain is an enormous relief.
My biggest confusion is regarding the best time to take the steroids.I shall live and learn.At present it is working- we shall see and adjust if and when required.
I forgot to ask - why did the GP suggest taking it at night? That is something that works well if you can have the enteric coated variety - you take them before bed but they aren't absorbed until the early morning, the same sort of time as the inflammatory substances are shed in the body and that makes the morning a lot better because it reduces the symptoms and lets you get going better, It also means you stand a chance of getting to sleep before the pred gets into the system and keeps you awake. Once you are settled, you can experiment with splitting the dose so the antiinflammatory effect lasts a good 24 hours and the mornings are therefore better - and you can choose the times to fit well with your routine and meals.
Thank you for your reply.I have no idea why my Dr changed the time to take Prednisolone. -as a result of your information and his change I have indulged in more research.I now take the Pred. between 2 .30 am and 3 30am.(I have always been able to wake as required without an alarm).I altered times gradually and the new regime seems to be working for me at present.
I am beginning to see PMR more clearly as a triangle that needs to match effort/result(pain) and Pred dosage.
There is a small problem with this - the human body doesn't always obey the rules of the game!
As someone approaching 89 years old my lifelong repution has not changed.I like things to be right. ie accurate.Thankfully in spite of many ailments I still have a flexible mind.The challenge to safely fit all my essential drugs into a safe daily regime and to modify my activities is the just latest lifestyle change.
However,in view of my age,I would rather pass away in 'active' mode than any other.
Thr new year will still see me teaching but on line for a little while -hopefully.
I see my Dr in early January ?further reduction of Pred.I have CKD and have more questions for him regarding the wisdom of his Presc for Calcium etc .Perhaps look at my bone scan result from last year -has he?
I must be a nightmare.It isn't a question of doubting his knowledge but one of applying it appropriately to each individual.Self preservation.
Enough for Christmas Eve I hope you enjoyed a happy break.
Hi, yes, it is very frustrating to have to change your lifestyle to cope with PMR but it is probably your busyrobyn lifestyle that has brought this pesky condition into your life.
I managed to maintain a reasonably active lifestyle by taking part of my daily dose of pred at bedtime. I recommend that you wait for a while until you start doing that and see what daily dose you need and maybe discuss with your doctor. And of course you MUST be kind to yourself and pace yourself, otherwise PMR will bite you on the bum!
As an aside, if I was starting the PMR journey, as you are, I’d ask for a DEXA scan before accepting your Dr’s wish for you to take AA (ie Bisphosphonate).
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