Does excessive fluid intake reduce the effectiveness of Prednisone ?

Without a doubt, caffeine affects the adrenal glands.

I have often wondered how caffeine might affect production of "steroid sparing" cortisol by the adrenals, knowing that caffeine stresses the adrenals.

The halflife of pred in the body is 4 hours, yes, but the antiinflammatory effect perists for 12-36 hours, depending on the person. If you are a 12 hours person - which is what is sounds like - then you will have returning stiffness/pain in the late afternoon. I, on the other hand, am obviously nearer a 36 hour person and for quite a time was able to take a double dose of pred on alternate days - a recognised way of reducing pred side-effects but one that doesn't always work in PMR and it is agreed is far too risky for GCA.

The longer you can have in a day without any pred present in the body, the more your own adrenal glands have to do and the less likely it is they will go into hibernation. The side effects, especially the Cushingoid ones, are due to the prescence of excess pred in the body - so 4 hours of exces balanced by 44 hours of none is better is the theory.

However - since the point of pred is to manage the symptoms there isn't a lot of point not managing them as well as it is possible to do is it?

Hi Mariane - Toronto ?

Yes - I'm Dave the moderator for the "PMR in the USA" group.

It is appreciated that you are very active providing us all in the new PMR Group with your PMR life findings. 

Like you, my rheumatologist has suggested that due to continuous misery that I try dose splitting and I did - but after many attempts, single dose still works best for me.

I originaly thought that the increase in pain may be due to my absorption rate not being quite normal and the distribution effect of the corticosteroid needed to be modified. 

My rheumatologist and I thought that the Rayos (Lodotra in Europe) may be appropriate due to the time-release factor of the pill and taking it at night instead of in the morning. Knowing that the normal maximum activity of the adrenal cortex is between 2 am and 8 am and is minimal between 4 pm and midnight, corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity.But the Rayos didn't work for me and I went back to normal prednisone. So my thoughts are that the closer the maximum dose activity can be between 2am and 8am, the more control the prednisone will have. I usully get up at around 6am, somedays at 4:30am to play racquetball, and I find the days of most relief are those when I take the pred early.

Following this with 4-5 cups of strong black coffee during the morning - I seem to be doing fine - 4.5mg with 0.5mg tapers over 2-3 month increments.

No Booze - I'm also on methotrexate.

That's my story - Dave

Dave what was your problem with Rayos? I found it was easier to reduce and alse seemed to reduce the side effects.

Hi dave

Nice to see we are both monitoring both sites. Great info, and for me it's comforting we're not alone.

Sorry splitting didn't work for you but don't you think racketball maybe to hard on your jounts and muscles. From what Eileen and everyone says this is a no no.

If not you give me hope.

Mariane

Well, it just didn't make any change to my daily 'feelings' and my first reduction dose for my taper program actually seemed worse than when I was tapering with regular pred taken early in the morning - Oh yes - I forgot to mrention, until the insurance deductible is met it is $228 per month !!!

Anyway, I'm sticking with those little "cheap" white tablets that can be cut into tiny pieces to let me continue with my very slow taper.

Dave

Well, I really love raquetball - have played for 40 years and despite my present "hobbling" around, I still play well enough to whip some of the younger non-PMR players !

I go to the club at 4:30am and sit in the hot tub and exercise in the tub for about 15 minutes - do a bit of stretching in the gym before I play and it doesn't seem to have had any bad effects on me for the last two years - so I'm going to keep at it - mentally it is very good.

Dave

No - we didn't say that, if you are used to an activity already you will be able to do more than someone starting out. You may initially be able to do less than usual but you can build up to doing much more in time as long as you listen to your body and go about it slowly.

Good for you Dave,  I'm envious you can be so active although if I got off my butt a bit more could likely work up to some good hikes this spring. I've started doing a few exercises in the pool and have found I'm getting stronger and feel better with no increased pain so will keep at it. 

I'm at 8mg reducing to 7.5 very slowly because the little darlings at the orphanage I volunteer at gave me their colds😷.

hugs, Diana🌸

That was quick:

"The interactions of diuretics with other drugs is mainly due to the Na-K dynamics which are altered, not only in the nephron, but also in the body. So, hypokalemia (decreased potassium in the body) due to diuretics causes enhanced toxicity of drugs like digitalis. Or for example, aminoglycoside anibiotics(streptomycin, amikacin) should not be used with diuretics because they potentiate their toxic effects on the kidney.

What it basically means is that diuretics have no effect on drugs being excreted by the kidney, unless that excretion is dependant on Na-K dynamics in the kidney (which is very very rare). Or in other words, the half life of the drug is not affected. The half life of the drug reflects the dosage to be given so that a therapuetic concentration is acheived in the body. And the half life changes only if there is some problem with the kidneys in ulrafiltration - say renal failure, where half life changes and so drug dosages change. Even doses of diuretics change."

I've sent you the link - will keep reading though.

Diuresis is getting rid of WATER - the kidney is quite clever at not getting rid of substances too fast but obviously if you drinks LOADS of water in any form you will then get rid of sodium and potassium and that isn't good. Hence the need for electrolyte supplementation if you sweat/pee a lot. 

And it is a fallacy that you can become dehydrated from drinking coffee - you pee the excess fluid out faster but not to excess. Yes, preferably drink water because it has no stimulants or calories but you CAN include the fluids you drink that are in the form of tea and coffee in your daily fluid count.

Hi Eileen,

Thanks for the reference.

What I don’t get is what it is that is acting as the diuretic ? From what I understand a diuretic is any medicine causing increased urination.

So any medicine identified as a diuretic causes the kidney to secrete excess fluid by blocking the re-absorption of either water or electrolytes ?

Does this mean that diuresis is a common side effect of Prednisone ? Not that it is a true diuretic, but many PMR patients do seem to have an increase in urination. I do !

But from what you reference, intake of excess fluids does not seem to have any effect on the half-life of the drug (pred) unless there is a problem with the kidneys in ultrafiltration.

Based on this information, do think that there is any issue taking other drugs such as Valsartan (hydrochlorothiazide) for treating high blood pressure – this is a diuretic.

The ‘world of pills’ is so complicated and it seems that medical professionals don’t go into enough to find out what might be happening or going to happen with this long term pred medication intake.

SO - based on all this - it seems like it doesn't matter how much fluid intake one has, providing the kidneys are functioning correctly, and there shouldn't be any influence on the half-life of the prednisone intake dose - RIGHT !

Dave

Yes, exactly! There are conditions where you shouldn't drink a lot but you'd have been pretty ill and a doctor might have noticed so you would have been told. It isn't good for us to drink TOO much but that is also fairly difficult to do. We're talking LARGE amounts there. 

All diuretic means is "a substance that encourages removal of water from the body" - and in that sense even water causes diuresis! It even says that on bottles of mineral water here in central Europe!

If you drink a lot then your system notices that you are getting "diluted" so to speak and the amount of urine produced increases - simply because the amount you need in the body is carefully regulated by the kidneys. The rest is discarded.