LUPUS UK

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prednisolone - Gastro-resistant Tablets. Does anyone get them from their GP on the NHS?

Hi everyone,

I was prescribed Prednisolone - Gastro- Resistant tablets by my Rheumatologist at the hospital. I have irritable bowel syndrome as a result of lupus and the none- coated ones play havoc on my stomach and bowel. I asked on of the GPs at my surgery if I can have those ones and she told me they do not prescribe them because payment for it will be rejected by the NHS. She also said research has shown there is no difference between the Gastro-resistant ones and the normal ones. I told her this was not so in my case there is a clear difference when I take the two. I have been prescribed anti acids in the past but they cause insomnia, which makes me feel like I am loosing my mind, so I cannot take them.

The thing is the pharmacy attached to the surgery stock it and I thought because they did I might be able to get them however, the pharmacist said he can only issue them if its specified on the prescription.

What I would like to know is does anyone else have this problem? Is there anyone who actually have them prescribed by their GP. Is there anyway of applying to the powers that be in the NHS to have them prescribed?

I would really appreciate any help or information as my stomach is taking a battering at the moment I am on three different immune suppressants medication currently.

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Hi Field, I did get them twice or three times but it was very RELUCTANTLY!! So now just take the ordinary ones with a drink of milk which seems to help. 😊 Bronagh

I am pressing to get the gastro resistant ones because the burning in my stomach with the normal ones are intolerable however, lining the stomach with milk is always a good idea if it helps.

thanks for that.

Yes a family member gets them, doctor writes enteric coated on prescription.

i get those too

thank you

thanks

Hi there, yes I get prescribed 2.5mg tablets of gastro-resistant pred and have done for 2 years. However when I am tapering down I need the 1mg tablets depending on what dose I slowly reduce to and I can't seem to get hold of them in a gastro-resistant form.

I completely agree with you that there is a big difference with gastro resistant and non gastro resistant tablets as I always get gastritis when I have to take the non resistant 1mg tablets. This is despite being on 60mg of omeprazole!!

I guess it depends on what area you live in but surely a GP should realise that it would be cheaper to prescribe gastro-resistant meds to a patient with IBS to prevent further complications such as gastritis, ulcers and potential further tests, referrals and treatment of an IBS/ GI flare?

Good luck, let us know how you get on.

Hi Happytulip

My GP, who is an absolute star and prescribes coated Pred for me says 1mg don't come coated. Pharmacist confirmed this.

Joy

I was prescribed gastro resistant Prednisolone, however on many occasions the pharmacy would give me the normal ones. I get them on prescription and they are more expensive, so if you get them prescribed and the pharmacy gives you the ordinary ones the NHS will reimburse them at a higher rate. Sometimes pharmacies are very keen to say that they are out of stock, Prednisolone is a very popular drug. Insist on the gastro resistant ones if you can on the prescription.

Hi MEW53,

This has happened to me on the odd occasion. I now always check my meds before I leave the chemist to make sure I have got the right ones. I'd be in big trouble 'gut wise' on the un-coated ones.

Certainly as far as "payment will be rejected by the NHS" is concerned she's talking b*££"&^$!!!!!!!!!

They were discouraged using it some years ago because there was a big price difference - but the manufacturers immediately put the price of ordinary up so there is far less difference (30 tabs ordinary cost £1.31, 30 tabs enteric coated cost £1.86). The PPI that is to go with the ordinary costs £1.86 for 30 tabs. And there will be TWO dispensing fees to be paid to the pharmacist by the NHS. A bit of simple arithmetic shows ordinary plus a PPI costs significantly MORE than just a pack of enteric coated, no PPI required (figures from a pharmacist 2 1/2 years ago).

As soon as it was implemented, many patients were having severe gut problems and GPs regretted agreeing - and it had been decided anyway that it was fine for anyone who had problems to go back to enteric coated. Many of my group are on them.

And you can get them in 1mg happytulip:

healthunlocked.com/lupusuk/...

Thank you sooo much for this information. now that I am armed with this information I can press for them. I have rang the gp again today and am waiting for a call back. I will insist on having them.

Hi there, pharmacist told me 1mg does ‘not’ come enteric coated.

He's wrong unless it changed very recently.

medicines.org.uk/emc/produc...

Tell him to look it up. Plenty of people on the PMR forum use it.

Thank you PMRpro! Very interesting!!

Hi PMRpro

Well this has got me stumped. My wonderful GP who prescribes me with the enteric coated Pred showed me her book of meds and coated 1mg Pred was not listed. She said she would for sure prescribe them if she could.

Are you in the UK? Take her this link:

medicines.org.uk/emc/medici...

It has only been around since last August so if her book was issued before that - it won't be in it. Which is why when I found it I put the link in the original thread.

Yes I am in the UK.

Many thanks PMRpro - much appreciated!

2012 was when I was first prescribed Pred. so perhaps that was the status.

Yes Joy, my pharmacist told me only yesterday that 1mg does not come enteric coated.

Yes!

Due to my chronic upper GI conditions (paroxysmal haematomas + sjogrens + prebarretts oesophagitis + gastritis + gastroparesis) I insist Gastro resistant 2.5mg prednisolone is specified by my GP on my repeats list on the GP dispensary system. Like the others, I have to take normal 1mg tabs. But I have no doubt the Gastro-res tabs definitely spare me upper GI flares. My GP wouldn't dare argue. If rheumatology has specified Gatro-res, then you GP surgery cannot change this spec.

I always take photos of the boxes & labels of anything my hospital clinic prescribes so I can use them as evidence if my GP surgery tries to pull a fast one...this has been known to happen: I win my case every time (so far 😉)

PMRpro's reply gives you all the ammunition you need! I'm now going to get my gp to prescribe 1mg Gastro-res tabs too 😆

I hope you get this sorted out soon

🍀🍀🍀🍀 coco

Yes, PMRpro linked to the thread I started with this exact same question a few months ago. As you say, the prescription does have to specify "gastro-resistant" as pharmacists won't issue GR unless it is explicit on the script. I also had to shop around, as all but one of my local pharmacists said that their contract with their suppliers did not include GR 1mg tabs.

It was prescribed by my rheumy at the hospital. I handed the carbon copy of that prescription to my GP last month and they have scanned it onto their system so that should be enough evidence for me to get them right?

i would have thought so - my GP said he would (only) write me a script if he had written confirmation from the rheumy - and that is what you have got. But of course, doctors are a bit of a law to themselves, so who knows! x

I take gastro coated pred too as have multiple GI issues, cannot take PPI as gives me frothy urine. I take non gastro 1mg tablets when tapering down, do not think they make them coated. Good Luck.

They do - see above!

Yes , I re read the posts after posting mine. Another case of being told no such thing by Gp. At the moment dwon to ten so ok, for now. x

Good job we have these sites to help. It does get very wearing when trying to sort medication. Had a struggle getting Zentiva brand fro a good while, on it now. x

Personally I wouldn't believe anything about availability I was told by a GP - nothing against GPs but many are totally ignorant when it comes to pharmaceuticals...

To be fair though - 1mg hasn't been available for long!!!!

Ah that might be it then. My pred are on my repeat prescription.

Before xmas my gp dispensary began insisting they can't get zentiva hydroxy any longer. For 6 years they've struggled for me: first getting hold of plaquenil brand & then zentiva. Sometimes I had to wait so long for them to supply that I came close to running out, so I got my gp to stipulate a double supply on my repeats list

But last month my gp dispensary told me that they really properly unable to supply zentiva hydroxy....even the chain pharmacy in my little local market town tells me they can't. I guess all the dispensaries in my little rural backwater share the same supplier? The hydroxy sulphate they can supply me is in the same generic box.

Anyway, my fav chemist 20min away in our big market town can get zentiva & is supplying it to me via the scripts I now have my gp dispensary get me when I need a refill. I just request the script via my surgeries online system...I pick the script up & phone my fav chemist who confirms they have the flippin zentiva boxes waiting by the hill girl me the next time I can get into town

This system is working but is a hassle for me because I'm still relatively housebound due to my health stuff and only can cope with the effort of driving into town occasionally. So I have to get my repeats request timing just right. This is another strain I do not need

Am I not seeing the wood for the trees? How would you get round this? .....Inevitably am having to refuse to worry about my Cellcept supply (when will my gp dispensary try to foist a generic on me etc etc)

Perhaps time to speak to the practice manager (if you haven't already done so). If one chemist can get it - there really is no reason why another can't in some way.

How much would it cost to have a bigger consignment delivered by courier?

THANKS: 👍👍👍👍...had been wondering when we're justified in asking to talk to the office manager! Last week on 'GPS Behind Closed Doors' there was a complex case involving meds supply in which the gp (a good chap) volunteered to the patient that he's see the practice office manger with her to resolve the issues: I thought 👏👏👏👏

Thanks vvv much 🦉PMRpro 🍀😘

Something I forgot to say before - I believe that GPs are supposed to provide the formulation the specialist says.

When OH had cancer he was given tablets - which he couldn't swallow so I had to grind them and mix them with honey for him to get them down which meant I had to be at home all the time. I did the research - and went up to the practice to ask for all the ones that came as liquid formulations to be re-issued. They refused (actually, they denied they were available, liars, I had BNF too!). The next time he was in for chemo - I told the ward, they issued the appropriate stuff and the GP couldn't argue. He got his liquids apart from a single tablet to be taken 1x per week. I could cope with that.

Made the GP hate me even more - but that is another story!

Re my reply above: unfortunately my lupus clinic refuses point blank to stipulate zentiva brand.....and for 6 years they simply won't explain why....I may have to push them harder

Same here, my consultant said its all the same. My gp was the one to help on 2nd request. I checked with my pharmist first and he said "need it on your prescription, that brand" Do get very tired of it all sometimes. Added to that when my prescritpions are reviewed they then try and get me to accept different brands again. never ending.

Exhausting & boring...the system sometimes seems to wilfully put us through this sort of aggro...and raises its eyebrows if we complain. We have to make such efforts to work through this stuff. On the other hand, the system instructs us not to mess it around 😂😂😂😂

I am really pleased you got a good outcome for your persistence. The doctor I spoke to yesterday blatantly lied to me. Many of the doctors and receptionist at my GP surgery speak to and treat patients with utter contempt most of the time. Having to deal with a chronic debilitating illness is challenging enough, we should not have to deal with this attitude along with that. It makes you feel so worthless at times.

thanks for your reply

Thanks everyone for your feed back its really appreciated. I have gained so much helpful info. Its good to talk!!

Hi Field

Sorry to hear you are having a tough time with getting the Pred you need.

I have been on Pred for around 4 years now. Can't get off them. Every time I get to 5mg I flare. The Pred irritate my stomach and my Doc did not hesitate on prescribing the coated ones.

She said the coated ones are 3 times more expensive that the undercoated ones but in my case there was a clear justification on why I needed them so I have been prescribed the coated ones for the last 4 years. I would be in big trouble if I could not take the coated ones.

I have to take Lansprazole as well but I guess you know that you should leave a gap of 4hrs between taking Pred and ANY antacid as it reduces the effect of the Pred otherwise.

Not sure how you solve this one..... could you not just get the hospital to keep prescribing them or just change docs??

They are NOT 3 times the price - or at least, not unless the price has changed since I started this odyssey! I wish they wouldn't exaggerate!

30 tabs plain pred £1.31

30 tabs PPI £1.86

30 tabs enteric coated pred £1.86

And 2 dispensing fees for the chemist instead of one when they give plain pred plus a PPI.

Those were the figures quoted to us by the dispensing chemist who did a lecture for the Surrey PMRGCA support group two and a half years ago. I can't check as BNF is not available outside the UK.

Thanks once again PMRpro.

My quote of 3 times the price is from 2012. That is what the GP told me back then. So once again I guess my info is out of date.

Or the GP told porkies. Alternative facts as it is now known...

My GP is a star. On a couple of occasions over the last 5 years of having this disease my GP has suggested I ignore the Rheumatologist's advice as she said "Joy you know more than I and the Rheumatologist on this one". And she was right!

A lot of us scientists don't live in today's world of alternative facts - here's hoping the alternative facts world is a very short lived phenomenon.

Quite! It does worry me that young scientists don't appear to learn to be as critical as we were. And as for most young people - OMG!!!!!! They have little chance of sorting the wheat from the chaff...

I had them for years then a GP changed them to the white ones telling me that they no longer did the enteric coated ones , the chemist told me that was rubbish so I spoke to the GP again who then admitted she had changed them because the enteric coated are more expensive and she said because I am on omeprazole I don't need them . I am with a different gp now and I said due to terrible stomach problems I wanted to be put back onto enteric coated ones and they do give them to me now .I have stopped taking omeprazole now after being advised that they can cause diarrhoea and I have been a lot better since , taking ranitidine instead . I have also always had the gastro resistant slow release form of Mycophenolate ( myfortic) . If a consultant prescribes enteric coated then that's what a GP should give you , I would insist if I were you .

Yep: for chronic oesophagitis + gastritis + gastroparesis I was on daily PPI (Nexium) for 6 years with them causing diarrhoea! There are other makes of PPI but I can't bring myself to try them...lucky for me, I did manage to damp down my upper GI stuff during those 6 years. But now my medics want me to take PPI when I'm on certain of my repeat meds. Am refusing & doing intensive lifestyle management instead...so far so good....my lower GI is just as messed up as my upper GI....what a life

Is ranitidine also a problem? Nothing would persuade me to try a PPI again - but ranitidine does the same thing but has a different mechanism and so different side-effects.

👍👍👍👍I know: you explained this to me a while ago...so, I checked out the PI alternatives online...and discussed them with my gp & rheumy. ...we agreed that if I run into gastric trouble I can't manage myself, I'll try ranitidine...but at the mo am doing everything I can to avoid adding more oral meds to my daily cocktail...am going to be asking gastroenterology about this at my 2nd appt in early April after the gastroscopy+colonoscopy + the colon transit study...,& on & on 💃🍀😘

I have the same problems and get them in a repeat prescription from my GP. I did have a problem with the pharmacy as rightly they can only supply what's on the script. I went back to my doctor and explained the problem and he changed them on his system no problems since.

Hope you will be able to do the same

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