Methylprednisolone Prescription Question — Why 2 Tabs at Bedtime If Insomnia Is a Side Effect?

[mattryp]

So I broke down and went to urgent care today, got myself some steroids. Today is day 5 of my recent acoustic trauma, so I'm a little late, but am hoping it will help anyway. Does anyone know why the 4mg 6 day 21 tab methylprednisolone schedule has '2 tablets at bedtime' as an instruction? The nurse practitioner (couldn't get in touch with ENT) who prescribed me said that methylprednisolone is tolerated much better than prednisone, after I expressed my concerns, and suggested I try that. Also better absorption, (less strain on liver) since the methyl is what prednisone converts to anyway, and less sleep trouble than standard prednisone.

But still, I can't help but wonder why 2 at bedtime, if insomnia is one of the side effects? Something to do with dosing being more effective while the body is repairing itself during the sleep cycle? Why not 2 for dinner instead, and 1 at bedtime? I think that makes more sense...

 

[David Dubros]

It might be that your metabolic rate slows in your sleep.
Just a guess.

 

[mattryp]

That's a pretty good guess actually, thanks.

 

[1MW]

Methylprednisolone must be taken in morning because if taken at bedtime it causes insomnia and axis suppression.

4mg is a very low dose.

 

[PaulBe]

I thought you were supposed to take steroids with food anyway. All the regimes I've seen involve dosing in the mornings.

 

[mattryp]

@1MW I think 21 tabs 4mg of methylprednisolone is the standard 6 day dose pack. Prednisone converts into prednisolone, so taking methylprednisolone skips a processing step within your body, giving the liver a break. Because of that, much less mgs are needed with prednisolone. It's very strange though, that the instructions say 2 at night. I've been spreading them out throughout the day instead, and taking 1 at night, because as you mentioned, trying to avoid insomnia.

 

[mattryp]

@PaulBe I've been trying to find a concrete answer, and it seems very mixed. Some say steroids can even be taken when fasting, and that the breakfast / lunch / dinner instructions are for people who have stomach sensitivities, and just use the meal as a reminder of when to take it. In the past, there were reports of steroids causing ulcers if taken on an empty stomach (probably long term use), but that has apparently been disproved. I don't know, it's murky waters, and after this post acoustic trauma experimentation of mine, I think I'm done with them. I don't like how your body systems get messed with, and will just stick to the holistic healing path that I know.

 

[Originatalie]

Why 2 at bedtime?

Because inflammation is worse at night...guess they figure the patient will take a sleep aide for the insomnia . I have heard that benadryl helps with the insomnia; it dries me out too bad so i will not try it to see. My inflammation is worse at night so i wasnt getting much sleep anyway. At least with this I know the possible insomnia is from treatment and not in vain.