Best time to take Pred

Hi Andy I have always taken my pred first thing in the morning and that worked for me .I think Eileen mentioned that the adrenals prefer morning but everyone is different .

I am sure Eileen will advise but I think 2am is around the optimum time. Some people do that but I never did as I thought I wouldn't manage to get back to sleep. I always take mine in the morning and I must admit to being a bit lax with the timing now that I have reached 3mgs. Sometimes I am a bit late in taking the Pred but don't seem to suffer as I would at the beginning when it was so painful on waking. 

I believe the peak time for the inflammatory release is around 4am. Some people take it around this time and go back to sleep. I take mine as soon as I wake around 7am with some yoghurt. Works for me. Some people also split their dose morning and evening. I think taking it on waking mimics the body’s normal release of cortisone, also taking it at night can cause insomnia for some. It’s finding what works for you but I think most take it first thing. Good luck.

I have to take thyroxine first thing and nothing else for an hour afterwards. I get up at 8.30, take my thyroxine and then at 9.30 take my pred with some yogurt followed by breakfast. I am fine with this at the moment.

I did read a report somewhere by a doctor (who also had PMR) who believed it was better for the adrenals to take the pred later in the morning as it would be less of  a problem when you get to the low doses. Typically, I cannot find this again no matter how I word the search!! Has anyone else heard of this?

Hi Andy, welcome aboard this "crazy" pmr/prednisone rollercoaster ride! I obviously can't speak as a medical expert, all I can tell you of is my own experience. I'm relatively new to this thing as well, apprx. 3mo. in. When I first started on prednisone, I took it around noon time. I was having Lots of trouble sleeping and was told to take it much earlier in the am, which I continue to do. For the most part that seems to work ok. It Does get a little tricky around 4-6 in the am, but if I take it too early, then it doesn't quite get me through to my next dosage! I try 2 just power through. Over time, it has gotten easier, I guess as the prednisone has built up in my system! I hope some of this info helps! Good luck 2 you, and put your seatbelt on!😏

You are correct, cytokines are released at 4 -4:30AM, so the best time for pred would be about 2-3 hours before for regular ( non-coated) version. Since it is not practical for most people, doctors recommend  to take it as early as possible in AM.  Some people(including me) compromise and split dose, half in the evening before going to bed and the other half in the morning. I take mine very late (~1AM) and second dose when I wake up.

As ever, it is a case of what works for you. I think that when we are first diagnosed we  are all told to take Pred. in the morning with some food. When I complained to my doctor that I couldn't live with the hyped upness that came from Pred. he said try taking it at night and for me this worked. My sleep was not affected. This does seem bizarre, I know, but the only explanation is that we are all different or, rather, we are not all the same.

Listen to and be kind to yourself.

The recommended time to take pred in PMR is in the morning as a single dose. The inflammatory substances that cause the inflammation leading to pain and stiffness are shed in the body at about 4am - the sooner you can take the pred after that, the sooner it will work and the less it has to do. As Silver says, 2am was found in a study to be the optimum time to avoid morning stiffness - except it isn't very practical! Many people wake early and take their pred and settle down for another couple of hours to allow the pred to work before getting up.

As has been mentioned, sometimes the antiinflammatory effect doesn't last the full 24 hours - it ranges from 12-36 hours. Then splitting the dose may help extend the pain-relief, taking about 2/3 in the morning and the rest later, about 2 hours before you expect the symptoms to return.

The comments about adrenal function refer to a study that was done some years ago showing that taking 5mg of pred at night suppressed adrenal function more than 15mg taken in the morning. This has led to doctors saying pred should always be taken in the morning. This really only applies to short courses of pred - for chest infections  or asthma for example, so that when the patient stops taking pred their adrenal function takes up their job again easily. When you take pred at above 10mg for more than a few weeks the adrenal glands shut down their production of cortisol, the body's natural corticosteroid which is essential for life, because the body knows that there is plenty of corticosteroid present and no more is required. It is an excess that leads to the side effects.

Since the natural production of cortisol is suppressed it really makes little difference what time pred is taken until you get below about 10mg and so it makes most sense to take it at the time that works best for you in suppressing the symptoms. Pred doesn't cure anything - it just allows a decent quality of life in the meantime until the underlying cause of PMR symptoms burns out and goes into remission. That can be anything from 2 years upwards, the median (average) is just under 6 years. You start at a dose that is usually plenty to manage the symptoms and then reduce slowly to find the lowest dose that manages the symptoms as well as the starting dose did. It is usually under 10mg when you go about it slowly and sensibly. Rushing doesn't help - the symptoms will just flare up. Doctors have been heard to say "I get all my patients off pred in a year..." - it is rubbish. There isnothing they can do to speed up the process, PMR calls the shots and you will get to a low dose or get off pred when PMR says you can. Not before. No exceptions.

I was told that it could cause you NOT to sleep so I take mine with breakfast

Hi Andy

I am 3 months in to my PMR journey and initially I found that I woke with pain at 2am so took my dose then, and tried to get back to sleep (mostly failing). Following comments on this forum (so helpful) about splitting the dose, i started to take 1/3 of dose at night before bed, then 2/3 on waking at 6 or 7 with a couple of spoons of yogurt. This works for me as I don't wake early with pain/stiffness and am reducing slowly.