What time of day

Hi Madge!

Most of us take our prednisolone as one dose in the morning. The main reason for this is that your body makes its own cortisol in the early morning (between 2am and 6am) and taking the tablets then mimics the action. One of the side effects of steroids is to make you feel \"high\" - they have the same sort of action as adrenaline - but they don't stay in the body very long so if you take the dose all together in the morning there is a better chance that, if you are one of the people they make very active, the blood level will have fallen enough by the time you go to bed for you to be able to sleep reasonably well. The big dollop of steroid dose will also have a better inflammatory effect on your body and that is what you are aiming for - a reduction in the inflammation which will help the symptoms reduce.

That said, some people find no effect on their sleeping and some find that spaced out doses work better for them. We all exhibit our PMR differently and all react differently to the steroids. So it's really a case of suck it and see - but the normal recommendation is one dose, all together in the morning with breakfast (best taken with or after food).

cheers,

EileenH

Hi Madge,

As Eileen said, Prednisone (Prednisolone) is usually taken once a day in the morning [i:61584d52b6][b:61584d52b6]with food[/b:61584d52b6][/i:61584d52b6]. I divide mine up per my Dr's direction (10mg at breakfast; 5mg at dinner). The Dr said this would help me fell better first thing in the morning. But... it does effect my sleep some where I usually up around 6 or 7 AM.

Below I pasted a good link that gives a lot of info on Prednisone or Prednisolone called, \"All about Prednisone\". This post will have to be approved with that link inserted, but I think it's worth waiting for. It als addressed your question about drinking some alcohol. In part this source states:

[quote:61584d52b6]Taking prednisone properly

* Unless instructed otherwise, prednisone should be taken all at once with breakfast. Prednisone is not to be taken randomly during the day. This minimizes the risk of adrenal gland suppression and atrophy. (When high doses are required, the dose may have to be split between morning and evening doses for short periods of time.) In some patients prednisone can be given at twice the dose every other morning. This doesn't work for everyone, but when possible, allows your system a brief, yet helpful, reprieve from the drug. [/quote:61584d52b6]

[b:61584d52b6]All about Prednisone:[/b:61584d52b6]

http://www.gihealth.com/html/education/drugs/prednisone.html

Hope this helps.

Hallo, Madge I'm very interested in the question of the best time to take steroids. I take mine (12.5 at present ) daily with yoghurt and muesli at breakfast around 7.30 ish. From the pain point of view this is working fine and always has but, as I have posted ( under PMR taking no medication ), I would dearly like an answer to the \"high\" problem. This kicks in about 90 minutes after taking the tablets. My heartbeat feels accelerated, I feel aprehensive and agitated and I have found that the best way to at least partly control this is to be very active and energetic. Most of the time this is ok and certainly a lot gets done before lunch by which time it all gradually calms down so that by tea-time I feel normal (well, \"ish\", anyway ) But the hyper activity does sometimes take its toll and I feel weak especially my legs. What I wonder, as you can see from my other post, is whether, depite taking steroids, I am still making my own cortisol. Don't dare reduce too soon to see if that would solve the problem as I've made that mistake before and then the pain returns. As Eileen says it really is a case of trial and error and it is never a case

of one size fits all with PMR.

It gas been said that 2.00AM would be the optimum time to take the Pred. but that this is not practical. If I thought it would solve the \"high\" problem I'd take a pot of yoghurt to bed and give it a go. Has anyone?

Best wishes and good luck. Betty

:D Thank you everyone on this forum for answering all my questions. You are all great! So far, I haven't felt any detriment to taking the meds at seven o'clock in the evening and I am sleeping very well. I would be a bit worried about changing it to breakfast time because when I start doing that, there would have been only twelve hours between the time I stop doing it that night and start morning doses. Also I have to have a dental operation in mid June, will that affect anything to do with the prednisone dosage.?

Hello again

I was told to take my steroids with my breakfast so I always have but some people seem to have been told other things but I think the majority of us take them then You could speak to your Dr or Pharmacist and see what they think I was told by a chemist not to take my Calcium tablets within 3 hours of taking the steroids

You should be prescribed Calcium and a weekly bone drug to stop any bone loss while on the sreoids I have also had no problem with either of these I just feel you need to eat sensibly while you are doing all of this

Best wishes Mrs G

Hi Madge. Pleased to hear that you're not having any problems sleeping, although this may happen at some point and you might find taking the Prednisolone in the morning helps. I wouldn't think changing from evening to morning would be a problem just the once as Prednisolone is often prescribed in big doses just for a few days, but obviously you would need to check with your Doctor or Chemist. As regards to your dental operation, are you having a general anaesthetic? If so, you must tell the hospital during your pre-op consultation. I had a knee operation in October under general anaesthetic and as I was 'nil by mouth' I couldn't take my steroids before the operation. The anaesthetist gave me a steroid injection just before the op. In any case you should always tell a dentist that you are on steroids. Good luck and keep well.

Best wishes

Lizzie Ellen

Lizzie Ellen

You should always carry a Blue steroid card - preferably one in every handbag.

Some of us have 'splashed out' on medi-tags (bracelets or necklaces).

Also, if you have a mobile phone, put under the heading ICE (In Case of Emergency) the number(s) you want them to call ie home, next of kin and/or GP. Emergency services know about it and check mobiles.

Not that you will have an accident, but 'belts and braces'.

:D From where does one get the blue steroid cards? No one has mentioned them to me. I really feel that I ought to have them.

Hi Madge

No need to worry about the dental surgery if it is being carried out under local anaesthetic. I had a root removed from the gum which involved cutting and stitching. I was on 4mgs but going through a flare-up of the inflammation at the time so did have to increase the dose the following week. One bit of advice would be not to decrease your dose (should that be on the cards) until after the surgery.

With regard to your steroid card, you can obtain this from either your GP or pharmacist. Three years into my journey with PMR and GCA, I have now built up a little library of these cards! :lol:

As to switching your dose from evening to morning, you could try switching it to your midday meal time on one day and then to breakfast on the following day. I started my first 'emergency' dose of 40mgs during an afternoon and I slowly switched it to breakfast time following my stomach protection 'live' yoghurt which I can't recommend enough although I'm sure everyone on here is fed up with seeing my ravings about it but, being unable to tolerate the stomach protection meds, I feel it's my little bit of magic:magic:

Very best wishes,

MrsO

Hi Mrs K. I carry a Blue Steroid Card but your post did make me think. I wonder if they carry them in Spain as I spend a considerable amount of time in my home there and with the standard of Spanish driving would be far more likely to have an accident there than here :yikes: I'm going to check next time I'm out there, if not I think I'll attach a short translation to my English card (that'll the tax the brain cell)! Although if my experience with my Mum when she was taken ill in Spain is anything to go by, my insurance details will be uppermost in their mind!! (Maybe EileenH in Italy might have some info of this one). Just putting ICE in my mobile phone - did know about it but didn't do anything about it, so thanks for jogging my memory!

Kind Regards

Lizzie Ellen

I wonder if the 'Blue Steroid Card' is an international program? I can't find any pictures or info here in the USA.

I recently added a medical alert ID card to my wallet. I also purchased one of those Med ID USB key-chains so I could have additional information handy in case of emergency. My med-ID card states, \"see key-chain for more info\". This USB key-chain has a self-contained program (MSWord template) where you enter any important information that emergency personnel would need. For instance: Name, Address, DOB, medical condition(s) you suffer from, medications you're taking, allergies, list of doctors with phone numbers, ICE (in case of emergency) contact list. I also listed my surgeries... and of course my health insurance information. All a doctor or nurse has to do is plug this USB device into a computer and a screen pops up and offers the user to view or print the medical information. With my information, it prints out 3 pages. If you need to change anything or update some information, it's easy to plug it into your computer and make those changes.

If interested, there are a couple of links below that offer these.

[b:57898debf9][i:57898debf9]Please note:[/i:57898debf9][/b:57898debf9] I have no affiliation with this company, just sharing some information.

[b:57898debf9]Metal Medical Alert wallet card[/b:57898debf9] (free engraving)

http://www.my-medical-id.com/product/Wallet%20Card

[i:57898debf9]...gives examples what to have on card[/i:57898debf9]

[b:57898debf9]Medical ID USB Keychain[/b:57898debf9]

http://www.my-medical-id.com/product/My%20Medical%20ID%20USB%20Keychain

Went to see my usual GP today armed with the diary I have been keeping since returning to steroids a month ago.

Started on 15 for 2 weeks, then reduced to12.5 and today to 10 and the pain relief has been 100% but the side effects kicked in after a week or so. Thundering pulse, mini ( or perhaps not so mini, panic attacks I don't know ) only relieved by vigorous activity, desperate muscle weakness, a feeling of missed heartbeats followed by a \" catch-up\" beat. Also noted that there did seem to be a food component. More than two and a half hours without something to eat exacerbated all the aforementioned symptoms. What COULD my poor body be trying to do? Duly recorded this and presented it with some trepidation as my last three BPs had been uncomfortably high. When not on Pred. I register 110/74 or thereabouts but have recently been 174/97!! Much lower today, thank goodness.

Diary was read and considered and I was relieved to hear that all my symptoms were likely to be attibutable to the Prednisolone. Having today Googled Panic Attacks/Prednisolone it seem only too likely.

I am now to try taking my steroids at night, starting tomorrow; 10 for 2 weeks then 9 for 2 weeks then return for further consideration. That means that tomorrow I shall have almost a whole day without Pred. having taken today's at the usual 7.30AM ish time which will be interesting, almost mimicking the Alternate Day method that Eileen recommends. Feeling slightly apprehensive but hopeful. Will post again when I can report on the outcome.

Hello Eileen

It's good to read that you have managed to reduce from 15 to 10 in just 4 weeks and have remained completely pain-free. However, I can understand how alarming it is to be suffering from the racing pulse and irregular heartbeat.

I suffer from a heart murmer caused by a slightly leaking heart valve together with arrhythmia where my heart misses a beat and then does 'catch-up' and when first put on Prednisolone (40mgs)I ended up in A&E with extremely racing pulse. It was found that the steroids had suddenly caused the arrhythmia to kick in. This gradually improved as the dose was reduced but recurred each time I had to increase the dose due to a flare-up.

Hopefully, you may now find that at your reduced dose this problem will subside especially as you say that your latest BP reading has normalised.

Don't quite know what your GP is hoping to achieve with switching your dose from morning to evening but I hope for your sake your present side effects reduce or even disappear completely either by his suggestion or the reduction in dose.

Very best wishes.

MrsO

Hi all!

Just a note about the timing of taking prednisolone:

The recommended time for taking steroids is normally as a single dose first thing in the morning as this is the closest mimic of the body's normal production of cortisol. By taking it like this there is the least suppression of the HPA axis which is the posh name for the hypothalamus, pituitary and adrenal glands which produce a whole range of chemicals which together make a lot of the rest of our body operate normally (thyroid etc). It has been shown in studies that taking a dose of less than 20mg in the morning has no suppressive effect whilst 5mg in the evening does suppress the early morning activation of the HPA axis.

The anti-inflammatory effect of prednisolone lasts for between 12 and 36 hours and that is the underlying idea of alternate day therapy (ADT)where you take double the dose one day and nothing the next. If you are amongst the lucky people for whom the antiinflammatory effect lasts longer you can change to ADT with no problems on the second day and this allows your body to have a day without the suppressive effect. On the other hand, if you start to get stiff and sore again after the 12 hours, you might feel that taking an evening dose is helpful and this is often used for rheumatoid arthritis patients as steroids are sometimes used together with other medications for them. Whilst many people are terrified of taking steroids, in fact there are a lot of drugs out there for rheumatic disease/arthritis with even worse potential side-effects and which require far closer monitoring than steroids do.

And while I'm at this: someone asked recently in one of the threads how the dose is decided as we are all different sizes. In fact, the relation is not to weight but to the area of your skin, which doesn't vary as much with weight as you would think! The dose you need is decided relatively empirically: it's the dose that gets rid of the symptoms! Basically, the lower the steroid dose the less likely you are to suffer the side-effects which is the reason for wanting to get the dose down as low as possible as quickly as possible. So you find a dose that sorts the problem (maybe starting low and going up until you find the right level) and then work back down slowly until the symptoms start to appear when you go back to the dose with no problems. In my case a change of half a mg over 2 days is the difference between being near enough pain-free and able to do a lot of things or being in constant pain and able to do almost nothing. After a stabilisation period - it seems best to be several weeks - it's worth trying again to reduce. It seems to me that there is little point reducing the dose for the sake of reducing it: if such a small difference in dose makes such a big difference in physical status, stick with the dose that works for a bit longer.

And yet again, let us emphasise that you must always bear in mind that steroids ARE NOT A CURE for PMR, they make the symptoms manageable by reducing the amount of inflammation. However - an interesting fact I found this morning is that there is not necessarily a relationship between your symptoms improving and the inflammatory markers changing (the ESR and CRP) so if you feel OK at a lower dose there is absolutely no need to stay on a higher dose just because the ESR stays high. Your ESR is only a very non-specific indication that there is something wrong - it may be high if you have a cold - and may never have been increased in some patients. It is a guide, no more than that, and may be misleading.

PMR should be suspected on the basis of the CLINICAL HISTORY and presence of at least 3 of a group of about 8 or 9 certain quite specific symptoms (amongst them shoulder pain/stiffness, hip girdle pain/stiffness, more than 1 hour early morning stiffness, stiffness after not moving for a short time, night sweats, joint/tendon pain) and exclusion of other possible things such as hypothyroidism. A rapid respons

[b:7eda926940]Betty[/b:7eda926940] - I replied to your post last night but apologise that I addressed it to Eileen instead of you - put it down to the lateness of the hour but I'm sure it's more likely to have been a senior moment or CRAFTs disease as Mrs K likes to call it!

[b:7eda926940]Eileen[/b:7eda926940] - you obviously realised that my reply wasn't meant for you last night - think I was living up to your name of an \"old-timer\" in more ways than one!

That's another very informative post from you today Eileen - I was particularly fascinated by the bit about the dose being decided by the area of our skin rather than our weight. You'd think the taller and bigger our bodies the more skin covering there would be but perhaps that's more a case of the skin stretching - the incredible hulk comes to mind!

MrsO[/b]