Having recently been diagnosed with PMR and prescribed 3 x 5mg tablets / day. When is the best time to take the tablets because if i take them in the morning the effects are minimised by the next morning and the pain returns before the next tablets have taken effect. My GP wants me to reduce dosage but hasn't stated to what and when the initial prescription ran out i was almost bed bound with the pain in all my muscles.
Any and all comments welcomed!!
I believe the general consensus is take full dose in the morning.
That doesn't always work for folks. I had a return of stiffness/pain in the mornings before I took my next dose, therefore was not getting a full 24 hours of relief each dose I took. It would take until afternoon before I would get relief from symptoms again.
Taking your pred dose around 2am ensures the medication is on board before the body sheds inflammatory substances (cytokines) into the body daily at 4am.
I tried getting up at 2am and it helped, but sometimes I would sleep through, or have trouble getting back to sleep because I had to take food with my uncoated pred tablets.
Eventually I split my dose 11am, uncoated pred with food and 11pm, pred tablets stuffed into enteric empty capsules) that delays the dose being released and absorbed. There are no enteric coated pred tablets (Lodotra) available in Canada. This has worked well for me for years.
Sometimes it’s a matter of experimenting to find the best way for you to take your medication so it is most effective. I consulted with my GP along the way.
Hope you find an effective solution and with it some relief.
the best advice I got on this forum was to take the full dose around 2 a.m. because the immune cells that cause PMR are released at 4 a.m. This means you don't wake in pain. By the way you should be taking enough to eliminate the pain.
2 a.m. isn't very convenient and I haven't found it makes nay difference taking it at midnight. The reason for shifting it after midnight is not to dampen the funciton ofthe adrenals (sorry details escape me) but I think that is most relevant when on low doses.
Many of us take it with a spoonful of yogurt rather than on an empty stomach..but this will depend on whether you have any gastric problems.
I am sure DL or PMR pro will explain better.
Hi and welcome. DorsetLady will be along shortly with her introductory post.
The antiinflammatory effect of pred lasts anything from 12 to 36 hours depending on the person. For anyone where it lasts longer than 24 hours, the new batch of inflammatory substances shed in the body next morning will be unable to cause much inflammation so the symptoms won't be too bad. However, when it lasts less than 24 hours, there is nothing to stop the effect and you get symptoms again until the next dose starts to work. These inflammatory substances are shed in the body about 4-4.30 am and the sooner you take the pred after that, the sooner it works and has a lot less to do. If you can take the pred at 2am, it stops it happening at all. But it doesn't alter how long the effect will last - so that MAY mean the symptoms return overnight, but not necessarily. You have to try to find out.
Taking all the dose at once in the early morning is the best approach for most. If the antiinflammatory effect doesn't last the full 24 hours, then splitting it, taking about 2/3 in the early morning and the rest a short time later often extends the duration of the symptom relief - taking the bulk with breakfast and the rest mid to late morning or with lunch keeps you going until next morning.
I would say your GP is wrong to be pushing you to reduce the dose at the moment - I think you probably need a bit MORE pred for a short time to really clear out any accumulated inflammation that is still there. Once that is dealt with, you are less likely to experience the return of pain in the morning.
On your profile page you say you took the pred at lunchtime the first time - you have changed that to earlier now I assume? When did you start the pred? You had obviously had PMR for some months, there is likely to be a fair bit of deep-seated inflammation to clear out as there was for me and it took 3 or 4 months to get rid of all that sort of pain but once it did, it hasn't come back except briefly if I try to go to too low a dose. How is your GP telling you to reduce the dose? How big steps and how often? It should be a slow process - but I would say that first he needs to make sure you have a lot less pain.
Hi and welcome,
Usual advice certainly at the beginning is to take with/after breakfast - and no it doesn’t always last the full 24 hours. Sometimes that’s because 15mg is not enough - it just happens to be the usual starting dose that doctors prescribe. But it sounds as if you may require a slightly higher dose to get things under control especially as your name indicates your work…
The inflammatory substances associated with your disease shed around 4am - so you will feel the affect if those until the tablets get into your system - maybe have a look at this - it does contain info on that and how to manage your illness -
healthunlocked.com/pmrgcauk...
..and certainly no tapering until you have got your PMR under control
Hi,
I was about your age when first diagnosed. My GP started me on 20mg, but, for me, that didn’t last all day, and she (the GP) increased me to 30mg. That was to clear out all the accumulated inflammation going back almost six months.
After three weeks, the pain was under much better control, and I was able to start reducing - albeit very slowly.
You will have lots of good advice, especially from DL’s introductory post. Whatever else you do, don’t try to reduce the prednisolone too quickly, or by too big an amount. Those of us, who have been through the mill, would say not to reduce by more than 10% of your currant dose! PMR has a nasty habit of biting back if it doesn’t like what you are doing!
Good luck.
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