Down to 5mg! - wondering about changing timing of dose?

[Hopingsail]

Hi Everyone, I haven't posted lately as I have been steadily reducing using Dorset Lady's 5-week plan - at a .5mg rate since 7 - with a few pauses along the way to manage stress points (such as my BP meds that I had been on since 1990 suddenly ceasing manufacture!). Generally feeling much better, much more like my former self - busy with my many activities and just got a new boat (though no name change on here yet contemplated!).

Currently I take the Pred dose, plain, with milk at bedtime, usually about 10pm. I'm aware that this is not an ideal time, but tried and dropped 2am as it completely wrecked my sleep pattern. So I'm wondering if this is a good moment to change to a split dose, taking a coated 2.5mg at 10pm and the remainder uncoated in the morning - I am often but not always awake for a loo visit about 4am. I am thinking I might make the split, pause on the split dose for a couple of weeks, and then begin to taper the morning dose.

Questions: Is my thinking sound on this? What happens when I'm down to the 2.5 coated bedtime dose only - which won't of course split? Maybe bite the bullet and go to the 2am regime with standard Pred split as necessary?

(Other issues for which I take meds in the morning after a cup of tea: BP - Ramipril 10mg + Lercanidipine10mg; Rosuvastatin 10mg; Osteopaenic - Risedronate 35 mg once weekly and Adcal daily. My prostate is also being monitored.)

BTW I've joined the local PMR Group - which is a supportive experience with a lot of laughs along the way!

Good wishes to you all!

[PMRpro Ambassador]

If you take an enteric coated dose of pred at 10pm, it will not be into your system until well after midnigt and so won't influence the low midnight blood steroid level that is what triggers the body to produce its own corticosteroid in the form of cortisol.

After 2.5mg e/c, the next level is using 1mg e/c tablets. then you get to 1mg via a very extended slowed taper or using 1/2mg plain pred. But what you suggest seems a fair approach.

[Hopingsail in reply to PMRpro]

Thanks for your insights. In your penultimate sentence you mention ‘or using 1.2mg plain Pred’ - is the 1.2 a half mg? I’m just a bit confused…

[DorsetLady PMRGCAuk volunteer in reply to Hopingsail]

Typo I think -guessing should be 1/2mg… 😊 that’s how I read it.

[PMRpro Ambassador in reply to Hopingsail]

Indeed - I use an Italian keyboard and not all keys match what they do!!!! And when I forget to check ...

[DorsetLady PMRGCAuk volunteer]

Won't know until you try…..and good luck..

[Hopingsail in reply to DorsetLady]

Thanks - I’m sure I’ll need it!

[PMRCanada]

I already do split my pred dose, 3.5mg stuffed in enteric capsules (no e/c pred here in Canada) at 11pm, and 2mg plain pred at 11am. No problems.

If/when I get down to 5mg I’m also wondering about attempting to take my pred all in one dose (early morning) as I believe it is preferred and helps with adrenal function (although I don’t recall the exact science behind it).

Hope the transition goes smoothly for you. Enjoy your new boat!

[PMRpro Ambassador in reply to PMRCanada]

As long as your pred is not into your system until well after midnight, that is all that is required - so it has the maximum time to get out of your system by midnight, A low as possible level at midnight is the trigger to the HPA set-up to tell the adrenal glands to make cortisol in the early morning.