PMR

Thanks for your response and information re reducing pred.

I did initially take my pred. on going to bed with yogurt but someone told me they would not work so well as with water?

The GP wanted me to take them at supper time and not as late as 10.30/11pm when going to bed. What do you think I wonder?

I think following the Vitamin D Cure/diet will help the body,s immune system to fight the inflammation or so the book says and if I lose a bit of weight along the way it will be good.

I am not very good at sticking to things but intend to give it a shot.

I will go to my physio who is excellent as maybe it is a back problem. Wont be playing tennis this week!

DJ

Hmmm - well, in that case there are a lot of us suffering unnecessarily because we take our pred at breakfast time with a bowl of cereal or fruit and a yog! The theory is that calcium affects the way you absorb your pred - but it doesn't seem to be too bad with dietary calcium in milk or yoghurt. You shouldn't take calcium tablets and pred together - pred for breakfast, calcium for lunch and dinner!

Why did your GP want you to take your pred at suppertime? The standard recommendations for PMR are to take it as early as possible in the day in one dose which achieves the maximum antiinflammatory effect which should last all day and the stiffness will then appear overnight when it shouldn't matter as much. It also gives your body a good 16 hours with no pred in your body and so should reduce the side effects.

A study in Germany showed that the best time to take ordinary pred tablets (the white ones) to avoid morning stiffness is about 2am (they did the study on patients who were in hospital for some reason who were quite likely to be being disturbed anyway). As a result a special form of prednisone has been developed which you DO take at 10pm and it is released to have its maximum effect at 4am, the time at which ordinary tablets taken at 2am peak in the blood. The idea is that the substances which cause the inflammation are released at about 4.30am and so the pred is there, ready and waiting to neutralise them immediately so to speak.

If you take ordinary white pred tablets at supper time (whatever time that is, if I ate supper it would be about 9pm I suppose) then the maximum blood level of your pred would be achieved at 11pm and would have fallen to very low levels by 4.30 and wouldn't really achieve much.

If you were taking enteric coated pred they take quite a bit longer to be absorbed (they travel further down the gut for a start and then the coating has to be dissolved) so taking them at 9pm would possibly work in the same way though it is less reliable than the special formulation. You did mention you were on enteric coated - so perhaps he had had the same idea I had about it some time ago.

However - if you are on enteric coated you don't need the yoghurt as the tablets pass through the stomach unaffected by the stomach acid and are absorbed much further down. The yog is to stop stomach irritation which some people are bothered with when on ordinary pred and you mentioned you had been given a new prescription to be able to take 9mg at a time instead of jumping from 10 to 7.5 - but I have given you a solution for that in the previous post.

Once my physio had helped the knotty spots in the back muscles I did Pilates and visited a Bowen practitioner both of which helped my back problems a lot. Neither is available to me where I live now (or at least a session would cost about £65!) and I really miss them.

Eileen

You are a mind of information EileenH. Thank you and I think I am now getting to grips with this nasty steroid!

Having been prescribed 2 months worth of the 1mg pred I will keep taking the mix making up to 9mgs until tabs finished.

As 1 .1/2mg is not very much in the non coated I hope my stomach will be OK. If not I will take with yogurt rather than water. Maybe I should try the 1.1/2 uncoated in the morning and enteric pm.

Just hope mixing the 2 will work. I suppose the GP thought taking with food at supper time would be better for stomach. Not sure of any other reason Anyway I shall stick to around 10pm.

Maybe at some stage I should try again taking all tabs at breakfast time, from what you say it is what the majority do.

Definitely fuller in the cheeks with people noticing the change, so depressing!

DJ

If it were me and it worked well (which is what matters after all) I would continue taking all the pred at the same time at whatever time in the evening suits you. If you split the dose you will get a couple of lower peak levels in your blood, one much lower, and that may not be effective. See what works best for you - and if it upsets your GP you could be a bit economical with the information you give him.

If you take it within up to 3 hours of your evening meal it should be OK in terms of there being something to cushion it (so to speak!). The Lodotra I take MUST be taken with or within 3 hours of food to create the correct conditions for the tablet coating to split after 4 hours - if it is more than that you need a slice of bread and ham or cheese or similar as a snack (that's a standard idea for a snack in Germany where it was developed but the emphasis is that a couple of biscuits isn't enough). Frankly - it isn't until you try you find out if it bothers you - I could manage up to 3 tablets at a time, it wasn't really DOSE related. Four tablets though gave me the odd twinge so maybe it something in the carrier substances rather than the pred. A yogurt was enough to combat that without taking the tablets in the middle of a meal (that surrounds the tablets with the food and protects the stomach in that way).

Eileen