Can I take prednisone at night instead of morning?

In this article:

• Preferred timing
• Taking prednisone at night
• Benefits
• Risks
• Managing side effects

In this article

• Preferred timing
• Taking prednisone at night
• Benefits
• Risks
• Managing side effects

Prednisone is a corticosteroid commonly prescribed to reduce inflammation and control immune system activity. It’s used to treat a wide range of conditions, including asthma, inflammatory arthritis, psoriasis, psoriatic arthritis, hormone imbalances, skin and soft tissue diseases, blood disorders, and certain cancers.

While some people may take prednisone at night for specific medical reasons, it’s generally recommended to take it in the morning with food to better align with the body’s natural hormone rhythm and to help minimize side effects.

Why morning dosing is often preferred

“Prednisone is an oral steroid (glucocorticoid) that suppresses inflammation and activity of the immune system,” Elizabeth Lumpkin, MD, a healthcare provider in Atlanta, explains. “It’s used as a treatment for many conditions such as asthma, COPD flares, allergic reactions, autoimmune arthritis, inflammatory bowel disease, certain cancers, and can be used as a replacement for hormones when natural steroids are low.”

For most conditions, prednisone is prescribed as a single daily dose, usually taken in the morning. Unlike some medications where the timing doesn’t matter as long as you’re consistent, prednisone’s effectiveness and side effects can vary based on when you take the medication. 

“Prednisone is typically recommended to be taken in the morning, ideally with breakfast,” Annie DePasquale, MD, a board-certified family medicine physician and the founder/CEO of Collaborating Docs says. “That’s because it closely aligns with your body’s natural cortisol production, which peaks early in the day.” Taking it with food also helps reduce stomach upset and sleep disturbances, two common issues when the medication is taken later.

There’s a biological reason for this timing. “Our bodies run on a circadian rhythm, a 24-hour internal clock that regulates various biological processes, including hormone release,” Dr. DePasquale explains. “Cortisol, which prednisone mimics, naturally peaks in the early morning and tapers off in the evening,” she says. “Taking prednisone in the morning aligns with this rhythm, helping the body ‘accept’ the medication more smoothly and reducing the chances of overstimulation at night.” Taking it too late can mean disrupting your body’s natural hormonal cycles and make side effects such as insomnia or restlessness more pronounced, she cautions.

Can I take prednisone at night?

While morning dosing is generally recommended, some people may benefit from taking prednisone at night. “People with conditions that flare overnight, such as severe nighttime asthma, rheumatoid arthritis with early-morning stiffness, or specific kidney diseases, might benefit from an evening dose,” Dr. DePasquale says. “In these cases, the timing is tailored to when inflammation or symptoms are most active, maximizing the medication’s effectiveness.”

“Evening dosing may be preferred by those taking a special delayed-release prednisone (Rayos) designed for bedtime use at around 10:00 p.m.,” Dr. Lumpkin explains. “This form of prednisone is designed for drug release about four hours after taking it, aiming to target the pre-dawn inflammatory surge.” 

This FDA-approved delayed-release formulation is often prescribed for rheumatoid arthritis and has been shown to significantly reduce morning stiffness compared to placebo (inactive treatment). “A similar chronotherapy strategy has supporting evidence in polymyalgia rheumatica trials,” Dr. Lumpkin explains. “This also allows specific shift-workers to time their dosing to their biologic morning, under clinician guidance,” she explains.

Conditions that may benefit from evening administration

Prednisone may work best when taken at night for the following:

• Rheumatoid arthritis with severe morning stiffness: Taking prednisone at night can help control inflammation before it peaks, reducing joint pain and stiffness upon waking. As Dr. Lumpkin mentions, the delayed-release formulation of prednisone has shown particular benefit for people with rheumatoid arthritis who experience intense morning stiffness.
• Asthma with nighttime symptoms: For individuals whose asthma worsens overnight, taking prednisone in the evening may help prevent nocturnal flare-ups. Dosing closer to bedtime allows the medication to take effect when symptoms are most likely to occur, improving nighttime comfort and sleep quality.

Potential downsides of taking prednisone at night

Both experts caution that taking prednisone too late in the day can increase the likelihood of side effects—particularly sleep disturbances. “The most notable downside is insomnia,” Dr. DePasquale says. “Because prednisone can boost energy and alertness, taking it too late in the day often leads to trouble falling asleep or staying asleep.”

While prednisone insomnia is the most common concern, it’s not the only one. Evening dosing “can also increase the risk of mood changes, agitation, and even elevated blood pressure overnight,” says Dr. DePasquale. “Over time, misaligned dosing may disrupt your circadian rhythm, which can have a ripple effect on your overall hormonal balance and metabolic health.”

“Taking prednisone at night is more likely to cause insomnia and can worsen nighttime reflux if not taken with food,” Dr. Lumpkin explains. “Generally, morning dosing is favored for once daily immediate release prednisone unless using a delayed response formulation specifically intended for bedtime use.”

If you’re unsure about the best time to take your medication, consult a healthcare professional before making any changes to the timing, form, or dosage of prednisone. 

Tips for managing side effects, regardless of dosing time

Prednisone side effects may happen no matter what time of day you take it. Possible side effects include: 

• Stomach pain
• Nausea and vomiting
• Weight gain
• Increased appetite
• Facial puffiness or redness
• Unwanted hair growth
• Skin problems such as acne or skin discoloration 
• Mood swings including agitation
• Fluid retention and swelling
• Sweating
• Sodium retention
• Potassium loss
• High blood pressure
• Elevated pressure in the eyes
• Increased blood glucose
• Headaches
• Slow wound healing
• Menstrual changes

Allergic reactions are not common, but you should get emergency medical help if you have symptoms of an allergic reaction such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. 

The risks of taking prednisone may increase when combined with certain medications including NSAIDs, diabetes medicines, immunosuppressants, blood thinners, or diuretics (water pills). Review your medication list with your healthcare provider before you start taking prednisone. be sure to mention all of the prescription drugs, OTC medicines, vitamins, and supplements you take.

Generally, prednisone is not intended for long-term use due to the risk of more severe side effects. However, there are ways to help manage side effects and protect your health.

• Take it with food. “To manage side effects at any time, take prednisone with food and ask about GI protection if you have or are at risk for ulcers,” says Dr. Lumpkin.
• Protect your bones. “For those using prednisone long term, support bone health with adequate calcium and vitamin D, strength training, and medical interventions if needed,” Dr. Lumpkin advises.
• Manage underlying conditions carefully. People with diabetes, hypertension (high blood pressure), or fluid retention should talk to their healthcare provider about using the lowest effective dose for the shortest time possible to reduce complications.
• Avoid live vaccines. “Do not receive live vaccines while taking immunosuppressive doses,” Dr. Lumpkin cautions. “Always review your vaccination plans with your doctor.” If you are getting a vaccine, make sure the immunizing healthcare provider knows you are taking prednisone.
• Never stop suddenly. Abruptly stopping prednisone after several weeks of use can cause adrenal insufficiency or withdrawal symptoms. “It’s important to taper off the medication under medical supervision,” Dr. Lumpkin says.
• Support your overall health. “Managing side effects starts with following your provider’s dosing instructions closely, including timing and tapering schedules,” says Dr. DePasquale. “Take prednisone with food, eat a balanced, low-sodium diet, exercise regularly, and monitor your mood and blood sugar levels.”

Finally, always consult your healthcare provider before changing your dose of prednisone, timing, or form.