Recently diagnosed, symptom question

This is a typical pattern although I woke up at 3 a.m. with pain. Waking up with pain is a bad omen for the beginning of any day. If the pain wakes you up at 6 a.m. then that is the time you should take your Prednisone dose. Why wait until 8 a.m.?

Prednisone does take an hour or two to be absorbed in the stomach. Prednisone is then converted to prednisolone, its active form, in the liver before it gets into the blood stream.

Taking a small prednisone dose in the evening may help with the morning pain and stiffness. No need to take an additional dose than what is prescribed. I took about 1/3 of my total Prednisone dose in the evening before going to bed and 2/3 of my total dose in the morning. I didn't wake up with any pain in the morning when I split my dose that way.

There are some valid reasons why doctors say to take the entire dose in the morning. My doctor had the opinion that whatever worked best for me was what I should do. As long as I didn't randomly increase my total dose, my rheumatologist was okay with splitting my dose.

You should read up on cortisol circadian rhythm. After about 2 weeks prednisone is making your cortisol. Your body has stopped producing it. Thats why it takes a taper to get off prednisone. Your body does not produce cortisol just in the morning. It produces it to a circadian rhythm or when needed for stress response and other daily requirements. Your morning requirements are the highest. You feel the most pain during that time. It takes the prednisone several hours to start working. Plus the fact your requirements start decreasing by mid day. You could try a split dose or taking your prednisone early in the morning. The only drawback is it can affect your sleep. I think everything sounds perfectly normal.

Hello @sjf1024, I would like to add my welcome along with @dadcue @tuckerp and others. If you aren't already doing it, I would suggest keeping a daily log with your level of pain when you wake up along with your dose of prednisone for the day. It helped me while I was tapering off of prednisone. I usually woke up with something in the level of 0 to 2 for aches/pain while tapering until I was up and moving around which helped with the symptoms. Everyone is different when it comes to acceptable level of pain so I'm sure other members will share their experience.

Do you mind sharing what your starting dose of prednisone was and what was suggested for a tapering schedule?

Thank you for your reply. I don't think the pain wakes me at 6. Thats just my wake time. I take the pills at 8 because I wait till after I eat. I can try taking them sooner.

Thank you

I think I am really at the trying it out stage. At 20 mg for the first while. Not effective but I did not know what to expect so didn't get back to the doc promptly. Now I have been at at 30mg for 6 days and have just dropped to 20mg for the next 8 till I have my next appointment.

Welcome sjf1024 to the PMR journey that no one knew about and no one wanted to get their ticket punched.
You at in a great chat room for quality answers and emotional support while on this journey.
Understanding the way steroids work and your adrenal glands stopping their function while on long term steroids will help now and definitely come in as valuable knowledge when you start your taper.
Starting on the an hour earlier might make a big difference. I take thyroid when I get up, then when I was taking steroids, I took those an hour later. On an empty stomach. More gets into your blood stream when taken before eating. That too is a consideration.
Cortisol does dimmish in your blood stream as the day progresses, that's it natural pattern.
Stay plugged in we are glad you found us.

Prednisone should always be taken after food to avoid gastric problems and possible damage. I see there are prednisone tablets marked "enteric coated" or "gastro resistant" which can be taken without food, but they are the only exception.

It doesn't need to be a big meal. I take my morning dose after a full milk coffee.

I always took my prednisone dose before eating breakfast although I did sometimes have part of a banana. I did read that it can cause gastric issues but I never really had any problems taking it without food for both of my occurrences of PMR. Probably comes from eating all that junk food in my younger days working at McDonald's. 🙃

That was lucky. I've read so many warnings about making sure to take it with or after food or milk that it's not something I'd risk. The Mayo prednisone info says "Take this medicine with food or milk to avoid stomach irritation" and my prescription bottles say "Take as directed with food."