Timing of taking prednisone

Hi @pst, That's a good question. When my PMR was active, I always took my prednisone dose in the morning and it generally kept me pain free until the next morning's dose. Here's some information I found on your question:

"Can I take prednisone at night instead of morning?
The morning is best as it mimics the timing of your body's own production of cortisone. Taking your dose of prednisone too late in the evening may cause difficulty sleeping. Nov 14, 2022"
-- Is prednisolone best taken in the morning and why?: https://www.drugs.com/medical-answers/prednisolone-morning-696499/.

My own non-medical opinion is that if it works for you and doesn't cause sleeping issues it's probably OK. Several members have mentioned splitting their dose between morning and late afternoon/evening in another discussion here:
-- Taking prednisone dose, morning and evening: https://connect.mayoclinic.org/discussion/taking-prednisone-dose-morning-and-evening/

@christopherc shared a post here discussing the same question and may have some suggestions to share with you - https://connect.mayoclinic.org/comment/733943/

Thanks, John. As I explained in my original post, taking it in the evening really worked much better for me. I never had trouble sleeping because of prednisone.

Hi,
I am wanting to taper off my prednisone. I will do it under a Drs care as it can be dangerous to do it on my own.
Just wondering what dose others have used to taper and the time frame to taper. I can be patient and taper in small doses. I’m on 15 mg daily, now I take 10 mg with breakfast and 5 mg around lunch time. That seemed to help with breakthrough pain the next morning.

My question is- what dose have others used to taper off of prednisone? I see my Rheumatologist in March so I would like some info for our discussion. My pain is much better, have been on prednisone since July and I am sick of the side effects.

Thanks for any help!

I was on prednisone for 3 and half years the first time my PMR was diagnosed. There is another discussion you might find helpful:
--- PMR Dosages and Managing Symptoms:
https://connect.mayoclinic.org/discussion/pmr-dosages/.
I think the key to tapering off of prednisone is to manage the pain levels and listen to your body. My rheumatologist had me keep a daily log of pain level when I got up in the morning and the prednisone dose for the day. It helped me decided when and how to taper off. Each of us are different but my last six months of my first round with PMR I went back and forth between 1 mg and 1/2 mg prednisone (hate pill splitting!) until I was finally able to stop taking prednisone without a lot of pain.

Yes I keep a journal of wt, heart rate (I seem to have a little tachycardia now and then), BP, blood sugar and pain.

Prednisone for 3 years???!! Oh my! I don’t know if I can do that. I didn’t like the PMR pain but these side effects from prednisone are not very fun either.

I’m more worried about the long term use of the prednisone. I have a new diagnosis of MGUS so I need to watch for symptoms of any progression. The prednisone may mask those sx and I need to know where I’m at with all that encompasses.

Found the MGUS with blood work for the PMR.

I keep asking why me? Try to live a clean life, I don’t drink it use illegal drugs, try to be healthy and live a positive life.

Thanks for the response.

On a different tack, I am wondering about the timing of prednisone for minimizing morning pain and stiffness. I am thinking of splitting my dose in a different way: taking part at 2 AM (if, as I often do, I wake up then) and part after breakfast.
A post I found on a British forum explains why I might want to try this:

"A study found that the optimum time to take prednisone for minimal morning symptoms is 2am, Prednisone is absorbed in about an hour and then processed by the liver to make prednisolone which also takes about an hour, getting the level in the blood to its peak by about 4am which is when the inflammatory substances are shed in the body. By having the antiinflammatory effect present in advance, the inflammation never gets a hold and there are fewer morning symptoms. In the case of prednisolone, you can take it about an hour later as it doesn't need the time to be processed by the liver but is active as soon as it is absorbed.

The trigger for return of adrenal function is a low level at midnight or thereabouts. By taking the pred at 2-3am you allow the maximum possible time for the pred to be washed out of the body by midnight. (It takes 5.5 half lives to get there and that is up to 22 hours)."

Source: https://healthunlocked.com/pmrgcauk/posts/149131000/purpose-of-taking-prednisone-at-2-am

I have looked for the study alluded to but haven't found it. Has anyone tried this?

I have taken prednisone at 2-3 am and it did make a difference for me. I would like to see what that study says.

I took prednisone at 2-3 am out of necessity. My job demanded that I call in sick early so they could replace me if I wasn't able to function well enough to work at 7 am. I couldn't wait until later to decide I was too sick to work.

I would routinely wake up in pain at 2-3 am . When I woke up in pain at 2-3 am, I would take my prednisone dose. Most of the time I was good to go to work by 7 am no matter how badly I felt at 3 am.

I never thought it had much to do with inflammatory substances being released only at 3 am. In my opinion, it had more to do with the circadian rhythm of cortisol levels in the body.

Autoimmune disorders are associated with "chronic inflammation" meaning it is happening all the time. The inflammation isn't caused by sudden spurt of inflammatory substances released only at 3 am in the morning. When you think about it, your immune system is on constant alert and can respond instantly when there is a threat. The perceived threat in autoimmune conditions is always present so the inflammation never completely stops.

My PMR pain was always present which makes me think the inflammation was always present. My inflammation markers could be done at anytime of day and were generally elevated. PMR pain was only partially relieved with prednisone. The greatest pain relief happened within a few hours after taking my prednisone dose.

Cortisol is what regulates inflammation. Normally, your cortisol level is at the lowest at midnight and gradually increases during the night and peaks between 6-8 am. The cortisol your body naturally produces is insufficient or not being produced when we take prednisone.

When the cortisol we take in the form of prednisone starts to decrease at 3 am we need more cortisol. This would happen when my last dose was sometime around 8 am the previous morning. The prednisone dose I took at that time was starting to wear off at 3 am. In essence, I would wake up with pain and think it was time to take some exogenous cortisol in the the form of prednisone.

When I took prednisone in the evening, I usually didn't have pain during the night. However, my higher than normal cortisol level would keep me awake and it was hard to sleep well.

I previously taken Prednisone at night for my Ankylosing Spondylitis and now for PMR (recently dx).
I have not had sleep disturbances and I track my sleep pretty religiously, including quality. Basically as someone said if it works for you.

I based my decision to do it on a study. I can’t post link here but try searching “nighttime-prednisone-could-address-morning-stiffness-ra”

Thanks, @saltyg. This article does explain why nighttime dosage works. Last night I woke up at 2 and took 5 mg of my 15mg dose. This is the first morning in a long time that I have been able to lift my dumbbells without pain. I plan to try various combinations and will report my results.
https://www.rheumatologynetwork.com/view/nighttime-prednisone-could-address-morning-stiffness-ra

I think the split dose worked the best for me. Approximately 2/3 of my dose in the morning when I woke up and 1/3 of my dose in the evening before going the bed was really good. My overall pain relief and being able to sleep during the night was best when I did it that way. The pain was always there but it was better depending on the way I took prednisone. When things improved, I took my whole prednisone dose in the morning when I woke up.

Much of what I learned about prednisone dosing was because of having uveitis. I told my ophthalmologist that I could "see inflammation" inside my eye. My ophthalmologist would verify the presence of inflammation inside my eye during his exam.

My ophthalmologist would quiz me about how much inflammation there was and whether it was getting worse, better or staying the same. No lab work was done to determine how much inflammation was present. In any case, my ophthalmologist and I were always in agreement and terms of the presence of inflammation inside my eye (uveitis), how much inflammation there was, and whether or not the inflammation was getting better.

I described the inflammation inside my eye as being like fog. Prednisone worked like the sun in the morning causing the fog to dissipate as the day progressed. I would adjust my prednisone dose based on how the fog was clearing. My vision was foggy all day long sometimes depending on my prednisone dose. It really helped me decide how much prednisone was needed to achieve the desired result-remission of uveitis.

When I first started having uveitis, I needed frequent ophthalmology visits about every 3 days until the uveitis improved and eventually stopped. I got so good at starting prednisone and tapering off to achieve remission that my ophthalmology visits were reduced to 2 visits. The first visit was to verify that I had uveitis and the second visit was to confirm remission. Remission of the inflammation inside my eye was described by my ophthalmologist as "clear and quiet."

PMR was a different challenge because I had no way of knowing how much inflammation there was.