I've been taking 5mg and 2.5mg gastro-resistant prednisolone tablets because the ordinary ones give me heartburn. As part of stepping down, I've been prescribed 1mg tablets.
I've checked on the eMC ddatabase and find that 1mg gr prednisolone is manufactured by a UK firm, Alliance Pharmaceuticals, under the trade name Deltacortril.
However, after taking the script to 2 different pharmacies ( Boots and Lloyds) both have told me they can't issue it as their suppliers don't supply it.
Has anyone else been able to get hold of it? Or found a way round a similar problem?
Thanks
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whisperit
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Certainly when I was on it it only came in the 5 and 2.5mg doses and we were told by the company that it was not cost-effective to produce it in a 1mg version (they would cost the same as 5mg). I wouldn't be surprised if the chemists may not be aware of its existence - but I am SO pleased you have posted about this! We in the PMRGCA community have complained about this for years!!!!
That Boots claims they can't supply it doesn't surprise me - but I bet if you pointed out that Alliance is part of their group they might possibly be more helpful! Other patients on the forums have been told by Boots they can't have Drug x because their supplies can only be obtained from Alliance Healthcare and they don't stock it. Also doubtful.
Other than Boots/Lloyds, do you have an independent chemist anywhere? They usually have total freedom to obtain supplies.
And on the PMR/GCA forum I suggest this way of reducing - whatever size tablets you are forced to use. You don't have to take the same dose every day and by alternating 2 doses 2.5mg different you have a difference of not much above 1mg/day. Spread the mix over more days and the dose reduction becomes less obvious to the body. Using this approach
you only have 1 day of the new lower dose at a time and then go back to the old dose to recover for a few days, how many is up to you. I find I feel "different" for the first 3 or 4 times but then my body stops protesting and settles down again. You can slow it down as much as you like.
The pharmacists at both took the scripts and said that the information on their ordering screen was ambiguous. Each held onto the script for a couple of days and then rang to say that they had spoken to the suppliers. Neither were able to offer more information than , "The suppliers just say that they can't supply it".
I will try the local independent. Failing that, I may not need the 1mgs after all, thanks to your tapering regime.
Do tell me what happens. The lack of an enteric coated version was a pain (literally!). However, a lot of people manage the 1mg tablet when they can't manage a higher dose - and normal practice is to give a PPI to "protect the stomach". You know, add yet another drug to the mix - but don't get me started on that!
It is possible that they don't have stocks - but it does seem strange that the company that makes the stuff can't supply it to the distributor!
We should send Paul off in his "contact the suppliers" suit!
A few years ago they decided that there was no evidence that enteric coated was any better than plain pred and in some illnesses it is actually less good (gut ones, interferes with the absorption which is lower down the gut than the stomach. It was also considerably more expensive - they claimed 17x, not sure I believe them but no doubt they used the retail not the negotiated price. So enteric coated was to be stopped and a PPI given together with the plain white variety. If people couldn't cope with the plain white then enteric coated was to be approved. Apart from the fact that introduces another layer of tablets (poorer compliance) and side effects they didn't actually understand the arithmetic. Nor the pharmaceutical manufacturers - who immediately increased the price of plain white pred considerably!
The arithmetic (figures supplied by a pharmacist 2 years ago):
30 tabs 5mg enteric coated cost £1.86 plus a single dispensing fee which is IRO £1 (it can be more) Total £2.86
30 tabs 5mg plain white cost £1.31
30 tabs PPI (omeprazole) cost £1.86
plus TWO dispensing fees IRO £2 Total £5+
Your average 7 year old would manage to see that plain white now cost heading for double the enteric coated. No savings!
The GPs had agreed to it - but within weeks patients were appearing with stomach problems - despite (and in some cases because of) the omeprazole. Many said they regretted having agreed now they realised what problems their long term pred patients were having.
And of course - one of the side effects of omeprazole is to reduce the absorption of calcium - leading to osteoporosis when used long term (which it isn't meant to be).
Thanks for that info I am going to make an appointment with my gp next week to discuss everything I am on omeprazole have been for years and I have osteoporosis and the diarrhoea and stomach problems drive me mad .
You might find using ranitidine/Zantac instead relieves the diarrhoea at least - does the same thing by a different mechanism so different side effects. PPIs are slightly more effective (in the sledgehammer way) but don't work at all for about a third of patients. Zantac plus lots of yoghurt would be as good! And lots of us have managed fine with just yoghurt...
Probably not one that allows complete absorption of calcium as it requires some acid to be present. Ranitidine/Zantac is felt to pose fewer risks and has different side effects.
Lots of us have never used either - yoghurt worked well for many of us. Or we have cast iron stomachs!
In all my years of dispensing meds I have never seen an enteric coated 1mg prednisolone tablet. I had to go onto a PPI (omeprazole) when I had to use them when I started my reduction.
Retired nurse here, never saw enteric coated 1 mg prednisone In 30 years as far as I know, it is usually supplied with a ppi if needed, but many patient used to ask, not because of heartburn, but because the little devil's are so hard to swallow! They stick to your throat and taste vile for hours.
There definitely weren't a few years ago because the charity asked. They aren't mentioned in the prescribing info put out in July this year - but there is this separate one issued in August. Obviously new. You don't get enteric coated at all anywhere else that I know of.
Thank you so much for posting this question as the forward plan is for me to go on 1 mg alternate day with 2mg but I like you need hasten resistant - good luck hope you get lots of answers xx
I had no idea what a hornets' nest I was stirring up! Thank you all for your thoughts.
I rang the independent pharmacy, Shackleton's, this morning and they rang their supplier. Their supplier also said they won't supply it but Shackleton's appear a bit more helpful and persistent than the multiples. The pharmacist said that the brand name "Deltacortril" is the same as the 2.5mg gastro-resistant tablets, and that she had never seen 1mg Deltacortril. However, she could see the 1mg version listed on the eMC database, and was intrigued.
So she has promised to speak to the manufacturers direct on Monday and she'll will update me (and you!) then
I take 1 mg prednisolone tablets but not sure if there the Gastro- resistant ones your after. On the patient leaflet they have other ingredients with them and doesn't say if they are of not. If you want to know more just let me know. Hope you get your POTS referral soon. X
I think the gastro ones are coloured 5mg red 2.5mg are brown and they are more rounded the white prednisolone are flat , are yours white ?
I get these with no problems at all, but on a private prescription (I don't use the NHS at all for anything). I'd hazard a guess that it's NHS bureaucracy that's stopping you getting them, as they are much more expensive. I usually get them online from Lloyds Pharmacy, but have never tried with a NHS prescription, though may be worth a look. Their delivery is usually quite cheap and quick.
Wishing you all the best in finding what you need!
That's very interesting. I've just looked at the Lloyd's online pharmacy site. It lists 5mg gastro-resistant pred, and 1mg pred, but no 1mg gastro-resistant option? How do you get to order that?
mike
Hi Mike,
I have their repeat prescription service, so it's possible they don't list it online for standard orders, especially if it's an NHS prescription, as private prescription only meds often aren't advertised. My prescription goes from my GP (also private) to them electronically and then they take payment from my card and the meds are sent to me, every 3 months.
I had a similar problem with getting Ferrous Sulphate rather than Ferrous Fumarate from pharmacies when I still had NHS prescriptions. As soon as I had private prescriptions and hence were paying for my own, I could get it no problem.
You can order from Lloyds on the telephone as well (I do this for one off prescriptions) so it may be worth speaking to them to see if they can advise the situation.
Where are you based? I'm in Liverpool and have also managed to get them in one or two local pharmacies before today (albeit on a private prescription). I'd be more than happy to ask them about it for you.
The independent pharmacist (Shackleton's) came up with the goods!
And I now have a packet of thirty, 1mg Prednisolone gastro-resistant tablets, as promised!
My gofer asked the pharmacist how she had managed it, but she wouldn't say, beyond "I waved my magic wand". But she did look very pleased with herself, apparently.
More power to the elbow of the independent chemist! I will NOT even go into Boots if I have the choice - even OH now understands when he saw the prices of things he wanted in Boots and then we went to Superdrug next door!
The independents need all the support we can give them.
I was prescribed this and successfully had two prescriptions dispensed by Lloyd's but they now say it's unavailable. It's annoying because the plain ones give me heartburn.
It seems that there isn't enough profit for the manufacturers. I see one contributor managed to get them on a private script. I'll try that but I think stocks are running out.
The company that makes them, Alliance, says they have no problem with stocks. A member of PMRGCAuk community actually called them. I wouldn't believe all the pharmacy says, they often just don't want the bother os finding a supplier.
Why do you need 1mg tablets? We managed with 5 and 2.5 in the past. If your problem is in reducing your dose and 2.5mg being too big a step for you, try this approach with 2.5mg but repeating each step 2 or even 3 times:
That is really helpful. Currently I'm on 8mg daily, having reduced over 6 months. I came down from 9mg three weeks ago having taken that dosage for 6 weeks. I did call Alliance myself who are the distributors as well as the manufacturers but they refused to talk to me as I don't have a contract with them. Both Cohens and Lloyds have told me that Alliance are saying they are unavailable, and Boots say they can't get them. I'm currently taking 5mg gastro-resistant and 3mg plain, with some heartburn, so I have started omeprazole.
I will try and get the 2.5mg, as they do seem to be more available.
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