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Prednisone stops working at night????

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Posted 7/12/2009 8:28 PM (GMT 0)
 

Hi all,


I mentioned this in another post, but I think it was a little off topic there. I began severely flaring around 6/25 and have been on 60mg prednisone for 6 days now. I guess overall I am much better, during the day I feel reasonably good. The problem is, the pred stops working around midnite and then the frequent, painful and bloody trips begin--up to 15 over a few hours. Things seem settle down again around 7 am. Its such a drastic change in how I feel, I am wondering if this has something to do with the half life of the drug or something. I am also wondering if any of you split the dose up over the day--could it just be a matter of timing that will help maintain the continued relief?  I am soo exhausted from these horrible nites. I know that you have to take the drug as directed, so I didnt want to start experimenting on my own, but was wondering if any of you had experienced this and had found breaking the dose over the course of the day useful.

Thanks!!!

Post Edited (gonnaworkthruthis) : 7/12/2009 6:13:32 PM (GMT-6)

Posted 7/12/2009 8:31 PM (GMT 0)
It's certainly okay to split the dosage. Generally we take pred in the morning because this mimics when the body releases natural cortisol, and it also helps with the insomnia some get from pred. But it's perfectly okay to take 30/30.
Posted 7/12/2009 9:16 PM (GMT 0)
I split mine because that's how my GI wanted me to do it because I was always worst at night/early mornings. The energy/staying awake at night is just about the only side effect I don't get from the Pred, so it never bothered me to do it that way. I do get bad night sweats from it, though.
Posted 7/13/2009 4:30 AM (GMT 0)
Thanks, ladies. Ill give my doc a call tomorrow. Pam, congratulations on your baby boy!
Posted 7/13/2009 5:53 AM (GMT 0)
I've had nowhere near the amount of issues you've had in the night; you're very brave. But I have noticed that while I'm on prednisone I am fine during the day and then I have more diarrhea during the night.
Posted 7/13/2009 1:05 PM (GMT 0)
I've gone so far as to split my dose to 4x a day. My doctor thought I was crazy but I really felt like it worked best for me when I kept it even in my system. You should definitely try it, I bet you'll start feeling better at night.
Posted 7/13/2009 1:44 PM (GMT 0)

gonnaworkthruthis said...
Thanks, ladies. Ill give my doc a call tomorrow. Pam, congratulations on your baby boy!


thanks :)
Posted 7/13/2009 3:51 PM (GMT 0)
My doc had me split my dose. When I was on 40 mg, I took 10 mg 4 times during the day (so breakfast, lunch, dinner, bedtime). When I dropped to 30 mg, I took 10 mg 3 times during the day, and dropped the bedtime dose, and so on and so forth. It seemed to work really well, as I was able to taper off without any problems. However, some people on here thought it was a nutso plan, but whatever!
Posted 7/13/2009 4:35 PM (GMT 0)
My pred usually is prescribed to be split when it is at the 60 dose, 30 7am, 30 5 pm. But I often would still be very bad at night, like you are describing. I have often sat in the bathroom watching the clock, counting the minutes until 7 am so I can take my next dose! It just takes time I guess to heal up. best of luck.
Posted 7/13/2009 4:45 PM (GMT 0)
Thanks, ladies. Yes, I have had two theories-- 1) that the prednisone wears off at nite, hence the question of this post and splitting the dose or 2) the prednisone itself is working on my stomach at nite and causing me problems.

Last nite I decided to keep food in my stomach as much as possible. I kept eating (small amounts) like every two hours. It seemed to be workiing kinda well, and I hadnt made a lot of trips as the nite wore on. I fell asleep, however, around 3:30 am. (after having eaten at 2:15) and then , the fun began again. It was probably 11 trips before 9 am, each one increasingly more nausea, pain, blood. When I got up, my mother gave me a Prilosec (which is what she was told to take with her pred--but he hadnt mentioned it to me). This caused me lots of dry heaves.
Again, things cleared up again around 11 am. Thank God. So its really confusing. My doc told me to take the Prilosec in the a.m. and Zantac before bed. Will try that tonite. If it doesnt work, Im gonna be admitted tomorrow, cause its been a week on pred with these probs.
Unfortunately I took all 60 mg pred at once this a.m., I wish I had read your responses sooner!!!!
Still appreciate your input, though. ;)

Post Edited (gonnaworkthruthis) : 7/13/2009 10:41:29 PM (GMT-6)

Posted 7/13/2009 7:36 PM (GMT 0)
As far as the body's natural cycle of cortisol production goes, my understanding is that it is lowest around bedtime and it then builds up gradually to a peak at around wakeup time, and then reduces again to the low at bedtime- so it seems to me that many GI's oversimplify this with their advice that  'wakeup is when you need all the cortisone' when in fact you need to start getting it again during the night.  I also suffer badly if I don't split my dose.  If one is wired up to cortisol infusions in a hospital, they do have it coming pretty evenly all day long, in fact.  Prednisone can take a few hours to metabolize fully into cortisone, to boot, further strengthening the idea of a split dose- ideally a booster at bedtime if one were to do twice a day- just my two cents.
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