Has Prednisone Affected Your Eyesight?

Yes, I nearly ended up head first in the overgrown rose bushes today. My toes have become unsteady too, just  in the last couple of weeks. I live in earthquake territory in NZ, and several times a day now I have been checking to see if it is the earth moving or me. There is always something new cropping up.

I just get the cheapest glass possible.  Have ordered new reading/long distance and sun glasses at a very respectable optician  The cost €19 each - in the old frames.

I don't go a bundle on bottle bottoms! It is such a pleasure not to have sore patches on my ears and nose which I have had all my life because of the weight of the specs. The cheapest/thickest lenses for me need a pretty solid frame and the whole thing is heavy. I did have frames that had the tennis string stuff holding the lenses at one time but they are next to impossible to get now. 

Ah!  Same as my husband.  He always has to get special frames/glasses (usually cost €600)!!!  Luckily his eyesight hasn't changed in 13 years.

Quite - once every 8 years is quite often enough!

i have probably posted on here before about  this... I know this is not recommended, but  the blurred vision, definitely eased for me, when I split my dose of Pred....7mg with breakfast, 7 mg evening meal....although I think if I`m right, you, or someone on here said in the US they do sometimes split the dose......perhaps some people just can`t take the hit....like palpitations ect all eased for me when doing this...when dose is lower (I hope!)will take all at once....it works for me....

Yup - there is research that shows your adrenals are affected less when you take the dose in one go at 8am or so. But there isn't a lot of point if all that does is compromise the management of the symptoms - and a bit of experimentation can make a big difference. One argument is also that it will affect your sleep pattern if you take it late in the day - but that is by no means always true either.

I support what works for the individual patient - and it is something I shall be pointing out to the research group when the opportunity arises because there are increasing numbers splitting dose in various proportions. It is much the same as the assumption that the stiffness is in the mornings, no it isn't, it can happen any time of the day - or night. 

eileenh, can you post a link to the research about your adrenals being affected less when you take prednisone in one dose at 8am or so? I'd love to read it. Now that I'm ata 40mg and a split dose, I don't seem to be handling it well. i used to be on a one dose but doc suggested splitting it. I'm wondering if I shouldn't try a one dose again now that I'm at a lower dose. 

Ooooh - I'd have to find it, it's one of the facts that is stuck in your mind once you learn it! They found a 5mg dose at night suppressed cortisol production the next morning (6 hours later or so) but 15mg in the morning didn't have an effect the next morning which was 20 hours later.

However - at the dose you are still on it doesn't apply, it's for doses of 5-15mg that they did the work. At doses above that the adrenal glands won't be doing much on their own because the corticosteroid thermostat is set way above the level at which they'd need to switch on and produce any at all so you can't measure it.

thanks!

Hi Eileen,

Several of us on this forum take our Pred at bedtime....around 11 pm. For me, my aches are a little better when I do this.

However, from what you have said above, perhaps this is suppressing our cortisol production the next morning?

And even though they did the work for 5-15 mgs, I would suspect it would apply to doses a bit higher/lower than that.  I'm on 4 1/2 mgs for about a year now and I'm thinking if there is any chance my bedtime dose is adversely affecting my adrenals this may be contributing to my inability to reduce down to 4 mgs. 

Geez, another variable to think about!

It is a possibility I suppose though I do know people who have got off taking their pred even though taking it at night and one in particular is a very energetic over-80-year old! I've just had a few months at 4mg and now have a return of aches - back to 5mg for a while with the blessing of my GP. I effectively take mine at 2pm, peaking in blood at 4am. But I think my adrenals are working - I cope with stress fairly well I think and at 4/5mgs they have to do something, 7-8mg is supposedly the amount.

What about trying taking it very early in the morning? Not the 8am that doctors say but 5.30am and stay in bed for another couple of hours?

Hello Eileen

glad i'm not the only one who moves her glasses up and down our noses.   i use bifocals and have them tinted, so have a need to use sunglasses.

 

Hi Mrs CJ,

I have talked to a specialist in far Eastern health practises who is also a medical doctor and have been told that our adrenals make their most corticol steroids during the hours of sleep at night.  It was suggested to me that we shouldn't take Pred before bed as it would suppress our cortical steroid production when in actuality we want to increase its production so we can gradually replace the Pred.  Taking it at night may relieve morning symptoms but the opinion given me here is that it prolongs our returning to balanced health.  I would imagine it's a 'catch 22', taking it at night allows a reduction in morning pain which may help our bodies feel more balanced sooner, but it is potentially at the expense of creating weaker adrenals!  It will interesting to hear any reactions to my post here.

Think he may need to revise his physiology lectures:

"Shortly after awakening, a sharp 38–75% (average 50%) increase occurs in the blood level of cortisol in about 77% of healthy adults, and it occurs in people of all ages. The average level of salivary cortisol upon waking is roughly 15 nmol/l; 30 minutes later it may be 23 nmol/l, though there are wide variations. The cortisol awakening response reaches a maximum approximately 30 minutes after awakening though it may still be heightened by 34% an hour after waking. The pattern of this response to waking is relatively stable for any individual. Twin studies show its pattern is largely genetically determined since there is a heritability of 0.40 for the mean cortisol increase after awakening and 0.48 for the area under the cortisol rise curve.

Normally, the highest cortisol secretion happens in the second half of the night with peak cortisol production occurring in the early morning. Following this, cortisol levels decline throughout the day with lowest levels during the first half of the night. Cortisol awakening response is independent of this circadian variation in HPA axis activity; it is superimposed upon the daily rhythm of HPA axis activity; and it seems to be linked specifically to the event of awakening."

As I understand it - the most is made just before and just after wakening, and that is because the lowest level is reached in the first half of the night's sleep. The production is governed by a feedback system - low levels stimulates production and once the level in the blood rises production slows. So yes, taking it at night may reduce the amount your body makes in the morning but that is because of the feedback system. The adrenals glands aren't "weakened" - the thermostat is being fooled. Reducing the pred you take isn't going to make your body produce more cortisol to deal with the PMR pain and stiffness. If it were as simple as that, why didn't I feel very much better in the mornings during the 5+ years I had PMR but wasn't taking pred? 

 

just for clarification ... not trying to put you on the spot ...

is the rise on wakening around 50% of whatever it was, or is it an increase to what the thermostat is trying to control it at? In other words, is the result relative or absolute?

If the increase occurs regardless then it doesn't matter whether the pred is taken before wakening (yes, I know that's hard) or after. If the increase occurs to a different control level then, at least in theory, it would be best to take the pred after the increase has occurred on the basis its probably better to let the body do as much as it can naturally and that hopefully leads to less pred.

Asking another way, would taking the pred too soon after wakening suppress the natural "shortly after wakening" cortisol production?

I'm writing this at 7am as I lie in bed waiting for my kidneys to do their thing - I reckon I can stay here at least another two hours if I really try .... though I don't think I need another excuse. Just tired usually suffices.

During this time I'll contemplate the effect of the half life of pred being 2-4 hours and assume it takes longer for inflammation to return than for pred/cortisol to suppress it.

My brain's functioning isn't quite as advanced as yours when I'm trying to convince my kidneys that I don't really need to get up! My focus is elsewhere at that moment. Good questions though--I'd ike to know the answers too.

I'm following this discussion with great interest. It sounds like if you think you are a person with adrenal thermostat issues, you may not want to take your Pred at bedtime or at 2:30 am, but rather try taking it closer to when you get up.....like maybe 7 am or so. 

I will wait and see your response to Julian's comments before I make a decision about what I want to try!

Overnight some cortisol is being produced, just it is at a lower rate, and probably forms about a straight line on a graph (I say about a straight line, it probably wavers up and down a bit but the trend is stable). After wakening it increases - say from something like 4 to more like 7 to form a peak, depending on the person, so yes, it is relative. Everyone is different, not only in the amount they are producing all the time but also in the amount it jumps when they wake. But the thermostat in this case isn't keeping things totally constant - you produce cortisol in spurts during the day in response to need, to do things and in response to stress. If you work in a very stressful environment your production of cortisol is consistently higher and that is what contributes to the weight gain around the middle you often see in stressed individuals, raised BP, raised cholesterol and so on. It should bumble along at a lower level with occasional spurts but it doesn't, it runs along at a persistently raised level.

No - taking the pred immediately after waking won't affect the production at wakening: just because you swallow your tablet at 6am doesn't mean that it appears in the blood then - it takes another couple of hours for the tablet to be broken down and absorbed and reach its peak in the blood. Which is why the morning dose has less effect on the morning peak than a nighttime dose.

But as I said before - the adrenal function part is a bit of a distraction. There is no point taking ANY pred if it isn't achieving its end: relief of pain at the most efficient way. The difficult part of getting the adrenals back into production is less to do with the adrenals themselves than the entire set-up of the hypothalamus, pituitary, thyroid and hormone production which is fiendishly difficult to explain and understand and it isn't entirely clear how the whole thing works (or doesn't work) in any of these illnesses. And all work a little less efficiently as we age. There is some thought that there could be an element of adrenal malfunction involved in PMR - but it is just one of the many theories that have been propounded but there is no backing for. 

Basically - if you find a best time to take your pred that works particularly well for you you will probably need a slightly lower dose overall. The problem with adrenals not working won't be an issue until below 7mg or so and anyway, during the day they are going to have to work to produce the spurts of cortisol needed for other things - especially in response to stressful activities. That's when you notice it, fatigue when trying to be active, finding phone calls, dealing with difficult situations more of a challenge. but reducing in tiny steps gets the body used to that.

And to throw another spanner into the mix: some endocrinologists think that a good way to deal with it is to change from prednisolone, which is a medium-acting drug you take once a day, to hydrocortisone which is a short-acting drug that does the same thing but you would normally need in 3 times a day doses. But that is beyond most rheumatologists so let's leave that lie for now!

ta,

I should have looked - similar control loops to thyroid. Hypothalmus -> Pituitary -> Adrenals vs Hypothalmus -> Pituitary -> Thyroid.

With my Hashimoto's the thyroid gland isn't producing sufficient so I'm interested in maintaining a stable, normal level or thyroxine.

With PMR I'm interested in providing just sufficient excess cortisol to suppress the inflammation.

Which can lead to underactive adrenals. So, applying my limited engineering closed loop control knowledge to my more limited knowledge of the endocrine system, its probably useful that the adrenals are exercised on wakening so they can pretend, at least for a short time, that things are "normal". So that when the PMR disappears things really are normal.

I guess that's why we are advised to take the pred first thing in the morning.

I managed to stay in bed until 10am but nothing really changed. Until Ali made me a cup of coffee, which had the usual flow on effects.

Not just similar - fairly interlinked too. So mess up one bit and the others have to cast about for a new position. I don't think the bit of knees bend they get at wake-up time makes that much difference - you could look at it as being a bit confusing for the other bits. Although there are a lot of similarities between medicine and engineering there is a limit - medicine is far more flexible than an engineering closed loop system...

yes, it gets so much more complex when multiple controls have to interact. Part of why thinking holistically is so difficult and its so easy to be seduced into considering them independently. And part of why there are so many pred side effects methinks. I suspect we are a very long way from understanding how all the bits fit together to allow living things to function in their preferred eco-system.

I am trying this tomorrow Linda. My eyesight is so inconsistent. Fingers crossed

 

Will we fall into the "77% of healthy adults"  catagory Eileen ?

?

 

Depends what you classify as "healthy" doesn't it! Does PMR itself make us unhealthy otherwise? And there are some PMR patients who have reduced adrenal function anyway - it has been postulated to be involved in the development of PMR but they never check...

I was 91 last Thursday. Have had PMR for about 4 months. Weaned myself off Pred after a month, and just tolerated the leg/back/shoulder pain - painful but bearable. Had to take about 5mg at 2a.m. last night. Think inflammation was brought on by all the birthday cake well wishers brought me and I indulged. To-day, due to medicine feel much better, but will not stay on it. Will try to go back to Tylenol. I do not want the side effects of racing heart and blurred vision.