Pred timing

[Ann1A]

Hello again lovely people, I'm seeking clarification.... in my ( sometimes questionable) memory, it is best to take pred, with food, at around 6.00 am, to be in system before the natural adrenal hormones are released. However, as I am now reducing to the point where it us hoped my adrenal glands will kick back in ( for me at high end of range, 10mg with strong symptoms of adrenal insufficiency, and symptomatically diagnosed by rhemy, not tested) ... should I ease my 6.00 timing till slightly later in the morning, in order to give my pituitary gland / adrenals time to register that they should kick in ?

Many thanks in advance

[PMRpro Ambassador]

No - the critical time for pred to be low to trigger natural production of cortisol is midnight or thereabouts. The morning relationships you quote are not what actually happens.

Natural production of cortisol is at its peak about an hour before you normally get up - and that settles itself as a circadian rhythm that is related to your mormal routine. That is why shift work is so hard on the body. The peak is therefore generally about 8am - and that IS the reason doctors tell you to take pred with breakfast at 8-9am. But they misunderstand the reality - taking prednisolone requires another hour for it to be absorbed before it can do much, in the case of prednisone it requires another TWO hours. So taking it at the sort of time natural cortisol peaks or even later doesn't help anything, The sooner you take the pred in the morning, the longer it has to be washed out of the body before midnight to achieve the desired nadir to flick the switch to set the production of cortisol in motion.

[Ann1A in reply to PMRpro]

Right, thank you so much, very helpful and couldnt be clearer . I'll carry on with 6.00 dose.

[PMRpro Ambassador in reply to Ann1A]

If it works for you, that is the most important factor - and it isn't compromising your adrenal recovery.

[Ann1A in reply to PMRpro]

My adrenal recovery seems pretty patchy anyway.

[artfingers in reply to PMRpro]

So wait a minute. I am taking a split dose: 2 prednisone at around 10pm (my bedtime) and then 3 1/2 pred at 8am when I wake up & eat breakfast, and my thyroid at 3 or 4 a.m. when I wake up in the middle of the night (per gp's orders re the Levothryoxine timing). I am extremely worried about my adrenals beginning to work again. So maybe I should adjust my schedule! But if I forget my night dose or don't take it, I can barely sleep or move (pain). So what about taking the night pred at 6 or 7pm then or something??? I learn so much on this forum!

[PMRpro Ambassador in reply to artfingers]

If you continue with the morning dose - how late can you take the other bit and still sleep OK? The earlier you can take it in the day, the more time it has to get out of your system. Taking it at 6pm will get it pretty low by midnight, but not all gone. SOme find that taking the extra dose in the early afternoon is enough to extend the effect overnight. But actually, with a really low dose, the effect on the adrenals is negligible anyway.

[artfingers in reply to PMRpro]

Thank you! I'll try the evening dose at 6pm even if it is only 2 mg. Good to find this out!

[SnazzyD]

This puzzled me for ages and my doctor wasn’t able to tell me that you’re trying to avoid having Pred in the system in the early hours when the brain needs to detect a low level of cortisol in order to work for the morning. For this reason I had to stop taking Pred in the evenings as my brain was getting a cortisol peak at the wrong time for the adrenal axis to know when to turn on.

[Ann1A in reply to SnazzyD]

I'm glad I wasn't the only one puzzling over this.