Forgot pred!

Hi angelcake - where have you been hiding?? 

Just above the yellow box with Groups in Bones, joints and muscles on the right hand side you will see a black box with "Start a new discussion" on white typescript. Click on that.

Thank Eileen

I manage to stumble across it but I don't know how.

Sorry for not being around, my husband has been really poorly for the last year, had some scary time with, urosepis and pneumonia and sepsis, with hiccups that last for 7 days 24hous a day, respite for 2 days then com e back again.

Nice to be back 😀

Sorry to hear that - hope things are improving xxxxx

Hi Margaret 89358, Prednisone is taken just once a day, it is usually best to take it in the morning.

Taking it too late in the evening may cause difficulty sleeping. It should be taken at the same time(s) each day to maintain even levels of medicine in your blood. Yes, most people gain weight, it helps to change to low carb diet. Now with that said I had a bad time during the night so I split my dosage 3/4 morning with breakfast, with food, easier on stomach, lite snack 1/4 bedtime. Every individual and case is different so I think you have to figure out what suits you best.

Common wisdom, one dose, breakfast in the morning, same time every day.

Hope that helps, good luck, keep smiling. 🙂

Hi, I gather it's because it's mimicking what the body does naturally in terms of producing steroid, plus it can make it difficult for you to fall asleep if you take it at night. I don't think it's a major issue. Steroids can make you feel hungry you're right - the only way I've been able to control my weight is avoiding carbs like potatoes and bread, and sweet stuff like cakes and biscuits. I do lapse occasionally! 

Sounds like a fairly sensible doctor who doesn't take all that is received wisdom as gospel. 

A study showed that there is more adrenal suppression by taking 5mg at night than 15mg in the morning - so it was assumed by many doctors that this should be applied to everyone. It IS significant for patients on a short course of steroids, up to a few weeks perhaps, there will be little adrenal suppression so they will find it easier to stop taking it. It ISN'T as important for people like us who require pred for months and months, or more likely years. There will be some adrenal suppression on any dose above about 5mg, above 10mg there will be almost total adrenal suppression. So then you look at the situation - and in PMR the new lot of inflammation is created in the body every morning about 4.30am. So the sooner after that you take the pred, the less inflammation has been created and the less work the pred must do. It also helps to take pred with food - ergo, take it about breakfast time. Lots of people take it even earlier with a yoghurt. That is also the time the body would produce cortisol naturally. And for some people it keeps them awake - but sometimes taking it just before bed allows them to get to sleep better. Everyone is different.

However - pred can make the body process carbs differently and increase appetite. I won't go into the details here but it helps a lot to cut carbs drastically. It helps avoid weight gain and helps avoid the development of steroid-induced diabetes. Many of us have either avoided weight gain or lost weight despite being on pred by doing so. I lost 35lb - the Cushingoid look and the hamster face went. It took 18 months - but it happened even though I was still taking a moderate dose of pred.

When do you take Lodotra?

10pm - exactly the way it says on the pack, within 3 hours of dinner. 

Which is what I do, but got concerned with the other posts.  Lodotra is obviously different.

It is, yes. The coating on it is designed to break open after 4 hours in specific stomach conditions - hence taking it within 3 hours of your evening meal or with a substantial snack. It is based on a study that showed that taking pred at 2am meant it was absorbed and ready to work at its maximum between 4  and 4.30am which is when the cytokines that cause the inflammation are shed in the body and so morning stiffness was minimal. But who wants to get up at 2am? So they invented Lodotra.

I have always split my dose at higher levels. Now that I am down to  4mg I take most of it late at night (1AM or so). When I tried to reduce below 5 first time, I tried to cut dose at night.  It did not work. Second time I tappered only morning dose and dropped from 5 to 4.5 to 4 without any problems.  When I take dose late at night, besides targeting cytokines release at 4am, it just occured to me while reading this thread that maybe by taking pred at night  I have avoided food craving and weight gain... Any thoughts?

I don't think that would work, EVERYONE would take the pred willingly at night if it meant they wouldn't put on weight.

I was also one of the lucky ones who LOST weight on high doses.  I eat carbs, chocolate, ice cream, etc (not overly much) but I enjoy food too much to go on a strict diet.  I also cannot excercise more than 1/2 hour per day (PMR and Poly arthritis), so that is not the answer either.  I think it is pure 'luck' whether people put on weight or not.

EileenH, when first on Pred I gained about 20 lbs, changed diet lost 14, had a flare large increase in Pred, weight stable. I hoping as Pred get lower I will lose more weight. Tapering to 17.5 now and feeling good, with a smile. 🙂

I realize that it is a speculation on my part, and there is no way that I can re-live the same experience with taking pred only in one morining dose. I bring it up, to see what others think of it, and what their experience is.

It is possible - but my usual mantra applies: everyone is different!

I have a suspicion that it might do far more people good to try taking their pred at night - but some seem to be very sensitive in terms of it interfering with sleep - but to be honest, if they weren't told and took it as they got into bed, I bet they'd be fine ;-)

The role of diet in various aspects of PMR is becoming a topic amongst doctors - especially after I told some about weight loss while on pred. They are taught that steroids means weight gain - but the experiences on all the forums I haunt suggests that weight gain can be managed. Cutting carbs reduces at least 3 of the side effect they are most concerned about: steroid induced diabetes, raised cholesterol and weight gain. All are closely linked to carbohydrate metabolism. Osteoporosis is also greatly over-emphasised if they thought about its incidence in the general population versus in steroid-taking populations. And both salt and refined sugar in the diet add to the risk of osteoporosis. Salt and pred also combine to cause fluid retention - which causes weight gain.

Cutting carbs and salt - removing all processed foods at the very least - must make a big difference.

I agree that there are many factors involved.  My activity level lets me eat pretty much anything without weight gain.  I use it all up. I was more referring to steroids induced "hunger" that may be avoided if pills are taken at night.

You mention something interesting about carbs and cholesterol. Can you expand on that or give me some reading links, pls? I always had cholesterol on a high side, but now it is high. I was always told that because of ratio LDL/HDL I have very little to worry. 

With pred my LDL has gone up to 155, but HDL is also ridiculously high (105). Would not mind knocking a few points off...