Time it takes to kick in - prednisone vs prednisilone?

[LarMarge6]

Hello everyone, I'm having trouble finding an answer to this and I was hoping someone here might know.

From what I understand, prednisone is a pro drug, so it has to be converted in your liver first and takes around 2 hours to fully kick in. Whereas prednisolone is already the active version, so it might only take 1 hour. Does that sound correct?

I've been taking my prednisone at 2 a.m. so it will be fully kicked in by 4 a.m. based on the Rayos delayed release prednisone study and article I read. I found from experimenting that it does seem to be more effective for me when taken like this versus taking it later in the morning.

Tomorrow is going to be my first day trying prednisolone and I was wondering if I should switch my alarm to 3 a.m. if it kicks in an hour sooner?

My doctor is having me try a couple different forms of steroids because in the past oral prednisone hasn't been as effective for me personally.

For example whenever I get poison oak (which I'm very allergic to and is everywhere here in the woods of northern California), taking a steroid shot gives me immediate relief, but taking prednisone tablets would take a week or longer, plus I would get a lot more side effects.

So we are going to trial prednisolone and then methyl-prednisolone to see if they may work better. And we might try some other versions too if that doesn't make a difference (maybe dexamethasone or even a steroid shot).

My new doctor told me that he personally doesn't get much help from prednisone, but does do well with the methyl-prednisolone form.

I'm wondering if this could possibly be one reason why I still haven't been able to drop below 35 mg without flaring badly Or maybe it's just related to how relatively extreme my PMR has been? I'm not sure, but it seems worth exploring at least.

I've also asked to try Kevzara so I can reduce my steroid dose and hopefully be able to taper down more, but this was just my first appointment with him and he wants me to get new labs done before he prescribes me a biologic.

*** Oh and one more question - are prednisone and prednisolone equivalent in dosage? Does 40 mg of prednisolone equal 40 mg of prednisone? Thank you!

[PMRpro Ambassador]

Yes - you are right, prednisone must be processed by the liver to form prednisolone to be active. In theory, yes, you could take prednisolone later and still get the same result, We often talk about the concept of taking the steroid at 2-3am for optimum control of morning symptoms and those who have tried it probably haven't bothered to adjust the time, I don't think it is that critical for most patients. And yes, the dose equivalents are the same for prednisone and prednisolone. Methyl pred is stronger, 4mg is the same as 5mg pred/

I understand your doctor's theories - there are differences between the preds and methyl pred but they aren't always positive. I have had next to no adverse effects from either prednisone or prednisolone, the 6 months I spent on methyl pred were horrendous. I gained a lot of weight, developed severe myopathy and muscle wasting, it didn't work as effectively as pred (I switched from 20mg Medrol which wasn't effective until mid-afternoon and poorly even then to 15mg prednisone and had the same miracle effect as on the first day of pred) and as cherry on the top I had a wonderful black beard!

The fact that 40mg is working so poorly suggests to me that you may have something else, not the PMR we talk about here. PMR isn't the disease, it is the name given to a set of signs and symptoms which are being caused by an underlying disorder. There are quite a few, including cancers, inflammatory arthritides with a polymyalgic presentation, and several other things. First these should be ruled out and only then can you say this is probably PMR as we mean it. There is no test to "confirm" PMR or rule it out - although if a patient has a positive ACCP, the likelihood of PMR is probably very low. When it takes a lot of pred and tapering isn't working, then the first thing you do is investigate other things.

Something I don't understand is why they don't test for IL-6 levels in the blood as that makes a diagnosis of PMR more likely. It isn't the only inflammatory substance involved, but it is predominant.

[LarMarge6 in reply to PMRpro]

Thank you so much for this incredibly thorough answer! Sorry it took me a while to reply, I've been completely overwhelmed lately.

I didn't like the methly prednisone either. It felt much weaker despite the fact it's supposed to be 20% stronger and after hearing your experience with it, I don't think I need to do any more experimenting with that one!

The prednisolone and the prednisone seem so similar I can't really tell the difference. I guess prednisolone is not commonly used here in the US and I noticed without insurance the cost was over $2,000 for my refill! So I think I'll just be going back to regular Prednisone for now or they may come after me 😬 lol

That's disheartening to hear that as knowledgeable as you are on the subject, I may in fact not have PMR and that my diagnosis could still be a mystery. But I absolutely want to rule out everything and get to the bottom of this correctly.

Thank you for all of your wise suggestions for other conditions to ask my rheumatologist and doctor about. Today I wrote another post and went into more detail about my symptoms in case that further clarifies anything.

I have a PET scan coming up in 6 weeks so if I do have any cancer hopefully it can detect it? So far none of my lab tests have shown any signs of it at least.

I'm also scheduled for a chest x-ray, shoulder and hip x-rays, and I was thinking of asking for an additional one to detect ankylosing spondylitis?

I did just get back the results of the CCP antibody test from last week and it was negative, I'm also negative for rheumatoid factor. Yes too bad an IL-6 test isn't available, hopefully someday soon.

I hope you're having a wonderful weekend, take care and thanks again! 😊

[PMRpro Ambassador in reply to LarMarge6]

The IL-6 test is available, has been for some years, just they rarely seem to use it. I think MRI is best for ankylosing spondylitis and unfortunately PET-CT is less useful as it is characterised by bone formation rather than inflammation.

[Grants148]

PMR pro’s very informative reply to your post means that l am unable to add to it . I have only ever been prescribed Prednisolone which works well for me .