prednisolone and fatigue

[Excelsior80]

Down to 8mg pred earlier this week. I take thyroxine in the morning on empty stomach, wait an hour and then take prednisolone with breakfast. Since diagnosis Ive felt fine but just this week cant get up and go, no energy for a few hours. two questions .... is it likely adrenal recovering effect, and should i not be taking it with coffee or is thst fine ?

[DorsetLady PMRGCAuk volunteer]

May be adrenals being to realise they need to wake up, and not quite ready to… some patients/papers suggest limiting caffeine intake, have a look at this [quite old and regarding another a/i disease but still relevant I think].

healthunlocked.com/pmrgcauk...

My personal opinion and experience is to taper much more slowly to gently nudge adrenals into action - I didn’t give up caffeine altogether- but did limit it a little.

But do make sure that fatigue isn’t related to your illness as you have just reduced … you might be a little bit too low.. sometimes it’s difficult to know what is causing what…

PS - you have reduced your 8mg quite quickly…

[Excelsior80 in reply to DorsetLady]

thank you 🙂 .... GPs plan was drop 1mg every six weeks unless I got problems, and this is the first time I noticed any change after a drop. But I may also have been overdoing things ... gentle walking holiday, feeling great from 6 days in the open air .... but the minute we were back on Wednesday daughters babysitting fell through and we rushed off to help .... home yesterday so now resting .... I plan to suggest dropping by 1/2 mg when I next see GP as it becomes proportionally more at lower doses, as recommended here

[DorsetLady PMRGCAuk volunteer in reply to Excelsior80]

Overdoing things probably contributed to it-but sensible to slow down anyway. Good luck

[Excelsior80 in reply to DorsetLady]

and thank you for adrenal glands link, really interesting....amazing the human body normally just works! So complex and flexible.

[ChrisBeeLoop]

I suffer badly from fatigue. We normally take the dogs out for a walk at 10.30am, well after the Pred dose,, driving to one of our favourite walks and I regularly find my eyes closing and drifting, not while I'm driving! Then after a few days it seems to wear off. I think that's when my body has adjusted and I can drop down. I felt on the weekend I was ready for another reduction but I have a busy week coming up and will stay put for now. I really recommend buying a pill cutter and going for ¼ mg reductions,

[Excelsior80 in reply to ChrisBeeLoop]

thank you! very interesting and helpful ... I mostly stayed in bed with a book yesterday and today much better, and its exactly a week at lower dose. if i did 1/4mg reductions, is that for shorter times? so stepping down bit by bit over 6 weeks rather than in one jump? Looking for a pill cutter today 🙂

[ChrisBeeLoop in reply to Excelsior80]

Absolutely, creep down rather than doing it in one fell swoop. I find fatigue kicks in about five or so days after the reduction and then gradually fades away and you can drop down again. Pill cutters on Amazon. best to cut the 5mg tablets into 2 ½ and 1 ¼, then do the maths. I have to write it down. 🤔

[AtopicGuy]

This NHS link says you are doing things correctly:

"Take levothyroxine once a day in the morning, ideally at least 30 minutes before having breakfast or a drink containing caffeine, like tea or coffee. Food and caffeinated drinks can both stop your body taking in levothyroxine properly so it does not work as well."

nhs.uk/medicines/levothyrox...

That leaves open the question as to whether you need a higher dose of thyroxine and/or prednisolone to keep the symptoms at bay, or whether your adrenal glands are sluggish.

[BladesLover]

Hi there. I haven't got any experience of thyroxine. My regime is generally to take my Omeprazole first thing, then wait at least half an hour before breakfast and coffee, then take Prednisolone (currently 5mg) pretty much straight afterwards. This generally seems to work for me, but having said that, I can still get my fatigued days apparently out of the blue. Also, I seem to always get a drop in energy every time my Prednisolone is reduced (currently every two weeks) but, generally, this seems to last just for the first day of the reduction.

Are you able to get advice also from pharmacist / rheumatology / GP etc.?