[annie123 (OP)]

I was told to take a steroid in the morning (just before breakfast - to reduce pain) when cortisol production in the body was lowest, but I see from web info that the production is highest in he morning,.  so why would doctors and pharmacists say the opposite? And why, if steroids reduce the body's production by slowing down the adrenal gland would one take the steroid to produce the cortisol and not leave the gland to do it?Also, if one has low body production of cortisol - a low cortisol reading on a blood test - and a weakening adrenal gland , and one tries to increase cortisol production after stopping[steroids would one be encouraged not to do anything which raises cortisol levels?
Puzzled in Victoria BC

[chris]

Exogenous steroids (like prednisolone and dexamethasone) are best taken in the morning because this mirrors the natural steroid surge that accompanies waking. Regular use of an exogenous steroid will cause a reduction in the body's own steroid production, so topping up the morning surge is least disruptive to your circadian cycle. If you take the steroid later in the day then it provokes wakefulness and this can lead to disturbed sleep or insomnia.

[annie123 (OP)]

Thanks for your reply, but I'm still not clear as to why one would add to the body's morning production because this causes the body to decrease its amount and eventually give low cortisol results in a blood test thus suggesting the adrenal gland is 'shutting down'. So stopping the dexamethosone (as instructed by a different doctor) to allow the body's production to resume brings back the status quo and the pain resumes.Why would one  begin using the steroid in the first place? Is it different in terms of pain reduction to the body's version?

[chris]

Hmm, but not all steroid molecules are made equal. Relative to cortisol some steroid preps are much more bioactive, meaning that they access and stimulate their targets much more powerfully. So although they suppress endogenous steroid production, what you replace it with is much more potent.

[annie123 (OP)]

Possible.How would i find out? I could try a pharmacist. After a recent blood test - and after stopping dexamethosone - the natural cortisone level is normal again. But the pain has come back. So if i took the Dex. later in the day when the natural cortisol was low wouldn't that work?Seems more logical.
And why would i see this on a site . . .when previously when I was taking the drug the cortisol levels were low (Prednisone is the same kind of thing as Dx.)

There are certain drugs that affect cortisol levels. Your doctor may request that you not take these drugs before the test is done. Cortisol levels are sometimes INCREASED  by:
    drugs containing estrogen
    synthetic glucocorticoids, such as prednisone

(I also take Estrogel - ie estrogen)