Hi,
Thank you to all who replied to my first post!
If I am taking the correct dosage of prednisone for my PMR, should I feel any discomfort?
I can feel mild soreness/discomfort late evening. It doesn’t seem to affect my ability to sleep. Always feel mild symptoms in the morning. Symptoms ease about two hours after taking my 10mg prednisone in the morning and are barely noticeable throughout the day until late evening.
The reason you feel symptoms in the morning is [as explain in my intro post] the inflammatory substances -cytokines - are release around 4am.. so are causing issues until you take your Pred, which may take an hour or so to get to work.
If you are getting similar in the evening, then that may indicate the effect of the Pred is wearing off, so you are feeling the effects of the inflammation again.
Ideally, your Pred dose should last around 24 hours - but it doesn’t for everyone. You may need to consider a few things
a. Is it actually enough on a daily basis to control the inflammation caused by your PMR,
b. As it’s not lasting all day would it be sensible to split dose - usual advice is 2/3rd and 1/3rd later in day, or
c. Are you doing too much during the afternoon/early evening and therefore you are poking your PMR?
Thank you. I will try am pm split dosage.
Worth a try - give it a couple of weeks to see if it works.
What time do the pains return in evening - if you take Pred about a hour or so before then it should help, and it may also help the morning as well.
CAreful with a pm dosage - too close to bedtime it may disturb your sleep but more important as you taper further, taking the pred in the evening may mean there is enough at midnight to inhibit the return of adrenal function. The trick is to take a morning dose and the rest late enough to carry the effect over the full 24 hours. Even taking the second dose at lunchtime may be enough - and prolong the symptom relief.
Thank you. I will try 7.5 mg in am and 2.5 mg at 12:00-1:00 pm and monitor.
I've been taking my dose around 2am. You would think, taking it at that time would inhibit the return of adrenal function? No?
No, that is an optimal time. It is the level in the blood at midnight that matters. You could take the tablets any time after midnight without it being a problem as it takes time to get into the blood. The signal to the body to produce cortisol depends on the level of cortisol in the body at midnight, then it is supposed to be at its lowest, what is called the nadir.
Ok. Thanks for that. I often wondered about pred being an interference with the recovery of the adrenals.
As long as there is more pred present than the body requires to function, they won't produce any more steroid. Once you get down to about 5mg they should start to produce a bit to top up the lower dose of pred but it varies a lot from person to person. As long as the level at midnight is low, the trigger is there to switch them on again but it doesn't always function reliably!
As per PMRpro’s reply - more info from FAQs on adrenals -
Not necessarily - some people are totally symptom free, others still have some discomfort. DL has covered the options that can result in residual symptoms. Probably the most significant question is "Do they remain stable?" If they are stable over a month or so then they probably aren't much to worry about - but if they worsen, it suggests you may need more pred, possibly only a mg but a bit more.
And I almost forgot - sometimes keeping a diary of diet, activities and symptoms can illuminate why problems have arisen! A binge on carbs or more activity can often be followed by a bad or worse day ...
PMR treatment without prednisone 
Prednisone Taper
Time of day dosage 
Possible PMR Diagnoses: Phoenix,Az
New to PMR
