Taking Pred during the night

[Sibelius5]

I’m considering switching to taking Pred in the night and have two questions:

1. Is taking it around 2.00 am likely to alleviate the niggles I have noticed while reducing when I get up in the morning? I’m on 5 mg having reduced by 1 mg every 5 weeks (each time by 0.5 for two and a half weeks - my profile is up to date) - I’ve stayed on 5 mg for two months now to make sure it’s bedded in before thinking about reducing any more. - I was concerned I might be reducing too fast or too much. The niggles aren’t pain, more soreness or achiness but I’m mobile and can do my mix of exercises, stretches and tai chi, although with more tightness or soreness at back of legs or in shoulders. Once the pred kicks in after taking it around 8.00 a.m. I’m generally ok during the rest of the day without any serious soreness or aches. I was hoping switching the time I take the pred might bring that feeling ok earlier to benefit me first thing when getting up - hence my question. (I do have lower back disc damage so the aches could be that reemerging from the masking by higher pred doses. Or could they be adrenal related? I’ve had really erratic mood swings which I’ve partly put down to adrenal effects - I found the post last week on the depression issue very helpful so thanks to everyone who contributed to that.)

2. If I do switch to taking pred during the night with yoghurt as many people recommend, should I also switch the time of taking the Omeprazole I’m on? (I know there’s a debate about whether to take it at all but my GP would prefer me to stay on it and he is otherwise extremely good at listening and accepting how I want to handle reducing. I trust him so I’ve stayed with it.)

[DorsetLady PMRGCAuk volunteer]

The idea of taking it at 2pm is so that it is in system ready to work on the substances [the inflammatory cytokines] which occur around 4am.

But just aware that an increase in niggles could be sign that 5mg is only just borderline enough. So do monitor that closely.

Do you need Omeprazole for other meds?

[Sibelius5 in reply to DorsetLady]

Thanks for the quick response. I will keep a close eye on it. I don’t need Omeprazole for anything else.

[DorsetLady PMRGCAuk volunteer in reply to Sibelius5]

So when/how do you take them now - with breakfast or before?

I took a PPI long time ago when had GCA, but never took Pred at 2am..

[Sibelius5 in reply to DorsetLady]

I take the Omeprazole about 45-60 mins before breakfast then take the pred after breakfast. I know i probably don’t need the Omeprazole doing it like that and I think I should push to drop it

[DorsetLady PMRGCAuk volunteer in reply to Sibelius5]

That's a bit of a naus if you have to do that at 1am.. maybe try it before bed.

If you do decide you don't need it, then don't just stop cold turkey - ease off more slowly ..

[Sibelius5 in reply to DorsetLady]

Thanks

[AtopicGuy in reply to Sibelius5]

DL is right. The link below - and others - confirm:

"Omeprazole takes around 1 hour to block the production of stomach acid, and its maximal effect occurs around 2 hours after taking the pill. The action of omeprazole can continue for about 3 days."

medicalnewstoday.com/articl...

That suggests you should take your omeprazole before bedtime and it will take effect while you sleep. You can then have your breakfast as soon as you wake up, taking your steroids with the food. This should ensure that you get the benefit of prednisolone as early as possible, while minimising side effects on the stomach.

[PMRpro Ambassador]

I agree with all DL has said - the idea of taking it then that was studied was it would improve morning symptoms but it won't change much if the dose you take is too low.

Nothing to stop you taking the omeprazole before bed - no need to take it a fixed time before the pred and evening dosing is what is recommended if you have nighttime reflux.

[Lickle]

I have a similar musing. I'm now just this week down to 6mg Pred. I have been taking the odd 1mg tabs at around 9pm to 10pm, so am now just taking 1 mg then. I tend to wake up anytime between 02.30am to 04.00am for a sprinkle so take the 5mg and an Omeprazole then and I've been fine. I'm wondering for my next taper in a few weeks time whether to just take a 5mg tab in the early hours or whether to continue with a 1mg in the evening and 4 x 1mg in the early hours?

Have anyone got any suggestions/wisdom from experience?

I note that yoghurt was mentioned but I've just taken with water.

Thanks in advance,

[PMRpro Ambassador in reply to Lickle]

If you are getting up for the middle of the night dose, I'd just stick with that. The less you have in your body at mid-night the better for adrenal recovery. At this stage 1mg is now 20% of the current dose, way above the recommended 10%. Maybe think about moving to 1/2mg changes - or a very elongated slowed taper.

[Lickle in reply to PMRpro]

Thanks PMR Pro, I'll try that.

[Meggsy]

I always took it at 3 or 4 am, (depending on when I woke for the loo visit), with a banana.

[PMRpro Ambassador in reply to Meggsy]

Just a note to say that a banana isn't ideal for anyone trying to watch their carbs!!! Lots of carbs in a banana ...

[Meggsy in reply to PMRpro]

Fortunately, I didn’t/don’t have a weight problem as I lost my sweet tooth long ago and I stopped eating pasta, rice, potatoes and bread with the exception of a very occasional slice of toast so my daily banana was fine. If it was a large one (and some are enormous), I would give half to OH.

[PMRpro Ambassador in reply to Meggsy]

I don't have a sweet tooth either - but pred moves all of the goalposts ...

[ImC_]

for what it's worth: I found 2am difficult with interrupting sleep but 4am works for me. A little container of natural yoghurt by my bed and another with the pills. (just arrived at 2.5mg now! go, me!) It's done in 60 seconds then I'm back to sleep. Never liked Omeprazole.

[Sibelius5 in reply to ImC_]

Thanks for this - I’m going to try it tonight so it’s helpful getting some reassurance

[Whippetygirl]

I take my Pred 8mgs at about 11pm using vegetarian capsules size 00 from Amazon, easily solves the problem.

[Bcol]

I took mine at around 02:00 ish for many years, with yogurt and usually a banana, which worked fine for me. Would also suggest that at 5.0mg and getting some niggles that you contemplate extending your 0.5mg reductions over four or five weeks. At these lower levels slower is undoubtedly better and possibly/probably quicker in the long term.

[Sibelius5 in reply to Bcol]

Thank you - the advice to go slow is very wise. I don’t think I could manage a banana at that time. I tried yoghurt last might but it made me feel a bit sick and repeated. So I’m wondering about milk given I’m taking Omeprazole at 9,00 pm . Would that work do you think ?

[Bcol in reply to Sibelius5]

Not sure about milk, I think others here go with hard cheese, but guess even a couple of rich tea type biscuits would work. Agree a banana can be hard work at that time of the day.

[PMRpro Ambassador in reply to Sibelius5]

Pharmacists recommend taking pred with milk if it can't be taken with a meal.

[Sibelius5 in reply to PMRpro]

Great thanks - very helpful