Hello.
Could you pls offer me some advice?
I have been on preds for about 2.5 years reducing from 20 mg with a few flare ups due to reducing too quickly.
I'm now on 8.5mg daily but have been taking the tablets before bedtime so that I can get a good night's sleep and be relatively pain free in the mornings however as I reduce Im feeling pain in the evenings so wondering if it would be better to take the preds in the morning when I get up.
Any thoughts please.
Thank you
I split my dose in 1/2 @ bed time(1AM) and the other half when I get up ( 8AM or so). The logic behind that is that there are two peaks for cytokines 4:30AM and 9AM. I try to target both. Currently at 5mg of uncoated prednisone tablets.
There are several lines of thought - one dose or split dose - but it does matter that you take at around the same time each day. Pain as the evening goes on is not that uncommon but if it's unbearable - yes split your dose - but it may give you two slightly lesser periods in some level of pain but normally discomfort which most put up with this particularly during reduction times. We are all different!!
Hi I have been taking Prednisolone for 4 months to treat GCA. I was advised to take them in the morning after breakfast (food). When I started it was 8x5mg tablets and when I questioned taking them all in one batch the GP said if you take them later you probably will not sleep. This seemed to be borne out by the fact that when I was on 40mg I needed little sleep awake at 530am and loads of energy. Now I am on 15mg I am slower and less likely to spring out of bed early!
The recommended time to take your preds is all as one dose in the morning and some of the others have mentioned some of the reasoning. However, one of the resons is tha taking them in the morning has been shown to suppress normal adrenal function less than taking them at night. At higher doses that is less important - adrenal function is going to be suppressed anyway with that much pred floating around in your body - but below 10mg there is a fair bit of logic to taking the pred in the morning.
What some people with morning stiffness problems do is take their pred early in the morning, a couple of hours before they want to get up. Pred takes between 40mins and 2 hours to get to a peak in the blood and start to work. A study showed that the optimum time to take ordinary white pred to avoid morning pain pretty much altogether is 2 am - it is at its peak in the blood and tissue in time for the morning shedding of inflammatory cytokines, the substances that cause the trouble, at about 4.30am. I do actually know a few people who set an alarm and do that and I am on a special form of pred that was developed to take at 10pm which then releases at 2am so you don't have to wake up! But taking it as soon as you can after 4.30am seems to work well for a lot of people - and the effect will then last another 4 or 5 hours into the evening than it is for you at present.
hi Julian
i thought i was the only turtle in reducing among us. it's been over a year for me and I've gone from 20mg to 16mg.
Everyone says take your prednisone in the morning which i do between 5:00am-6:30am however i also split my dose and take 5mg at 3pm to control the afternoon pain.
prednisone is known to screw up your sleep how has yours been over the years?
if you do change your timing tou will have to change slowly.
You CAN just have a single day where you take the extra bit - i.e. you take the old morning dose as usual. Then in the evening you take your new evening dose followed by the new morning dose the next morning - doing that you still have the dose high enough at all times. A few mg extra on one day won't hurt at all.
My experience has been that early AM is the most helpful for my morning exercise which is several games of pickleball. It has also proved best for morning stiffness in general. I used to have an alarm set for 2AM. I am now trying a different approach. Since I normally wake up sometime in the early hours to urinate (82 yrold male) I just take my pred whenever that occurs. I am taking medrol, 7.5mg.
Julian, we really are all different! In my experience I find very little difference in how I feel all day, so must be one of the ones who metabolizes pred slowly. I take mine at breakfast. There was a day fairly early on in my journey when I forgot to take my pills until I was out of the house, so there was a four hour delay, and I did feel it slightly. But more recently I forgot completely, now at a really low dose, and didn't feel any difference, but took a half dose in the evening, when I remembered. So to make a long story short: how you take your own dose will depend very much on how your body metabolizes pred.
I think if I were you I'd try first of all to alter the time of day taking pred, and see if that works for you, before trying a split dose. Just easier if the single dose works.
Absolutely - I'm one of the people who can manage fine on a higher dose but on alternate days, i.e. stopalternate days nothing! It would help of course if doctors understood that everyone really can be that different!
"However, one of the resons is that taking them in the morning has been shown to suppress normal adrenal function less than taking them at night." I seem to remember that you added at one time that the study which found that taking pred in the evening supresses normal adrenal function was contraversial. Am I immagining that, or you have changed your position on this subject?
just few days ago I had a "project" that took me 6+ hours of hard labour. That night I was so exhosted that I forgot my late nihgt dose ( 2.5mg). In the morning it felt stiffness and muscle pain. I took 5mg ( 2.5 that I missed + 2.5 for morning) and by late afternoon I was back to normal. Everyone is different.
No - I stated the fact of the study. 15mg of pred taken at 8.30am suppressed adrenal function less than 5mg taken at 10 pm. What I also said was it probably doesn't matter too much for us.
If you are on a short course of pred at, say, 10-15mg for a week or two (which is how most pred is used in general practice) then it is far better to take it in the morning than at night and the doctors should advise that. At the end of the short course of pred the patient usually simply stops taking it or spends a week on 5mg less - that is all the tapering they usually require and that is because the moderate dose taken in the morning didn't suppress adrenal function much and production of cortisone continued, albeit at a lower level.
The reason it is not so important for us is that we are on doses of 10-15mg and above for months - long enough for adrenal suppression to occur anyway, what time you take your pred is less significant in that situation and you might as well take it at the time that works best for you. That may even result in you being able to manage on a lower dose and the "total steroid load" over the course of the treatment will be lower - which is a holy grail for many doctors.
I presumably am a 36-hour reduced inflammation person and you are a 12-hour one!
The other factor is that I may absorb 90% of my dose - and you only absorb 50%. This is a pharmaceutical measure, the "bioavailabilty" and applies for various medications including warfarin and pred amongst a lot of others. That is why there is no real fixed dose to recommend, you either take plenty (as in short courses of pred) or you start with an average sort of dose that works and then "titrate" the dose to get the desired result.
Thanks for clearing that up... I am wondering, as we lower the dose ( currently at 5mg) would the time I take pred influence in any way how quickly adrenal function would restore? Would the same logic apply as in the study you quoted?
I nearly added that - I would think so yes. If you were taking 5mg at night there would be more effect than if you took it in the morning. However - you are only on 2.5mg at night aren't you so there should be some adrenal production in the morning, the rest of the dose is in the morning and at that level shouldn't be doing much.
I don't know, but I would think that you are possibly doing it optimally in every sense in that you are probably encouraging adrenal function to recover but still achieving optimal symptom management for you. The only improvement might be if you can reduce the night time dose rather than the morning one.
I find pred acts as a sleeping pill for me! Take 10mg at 4amish after which I go straight back to sleep and 3.5 at 7pm. Sleep like a log which wasn't the case when I was diagnosed. Back 10 months ago took it at breakfast as instructed but then had to split the dose to cope with bad night pain. Worked like a dream. Night pain went and so did sleeplessness. Sorted.
I just switched to taking 15mg at 2am and like it much better than splitting -10mg at 8am and 0.5 at 8pm. Its early in the game for me so Im not sure if the improvement is due to the 2am dose or that the pred is finally kicking in.
thank you again. I might try 2mg at night +3 in the morning as an experiment and see how it feels. I feel that my body likes split dose and it seems that it is more efficient for me. I started splitting dose while I was at 12.5 and literally I could drop immediately to 10, because of the split dose without any increase in symptoms whatsoever.