Lodotra

[piglette]

I currently have coated pred 2.5mg and 5mg. I live in UK and was wondering if anyone knew if my GP would let me have a private prescription for Lodotra whether I could mix and match 1mg Lodotra with the prednisolone I have at the moment if I took them at different times?

[PMRpro Ambassador]

You can't really mix and match different sorts of pred. Lodotra is designed to release after 4 hours, peaking inthe blood at about 5+ hours and comes in 1, 2 and 5mg tablets. It mustn't be cut. Enteric coated comes as 2.5 and 5mg pills, also must not be cut and can take from 4 to 8 hours to reach the peak in the blood but without rather complicated testing you don't know how long you take to deal with the enteric coated sort - everyone is different. So it is a bit difficult to mix them.

You don't have to take the same dose every day so if you can only use enteric coated pred you can use my scheme to reduce but using a big gap to start with and repeating stages:

For example:

1 day new dose, 10 days old dose

1 day new dose, 9 days old dose

1 day new dose, 8 days old dose...

and so on down to alternate days old/new. Then you build up the number of days of new dose. At any point you can repeat the stage if you feel you need to. That way it will work to reduce 2.5mg at a time, you just need to spread it out even more.

[piglette in reply to PMRpro]

Thanks PMRPro. I have been using your slow reduction system, which has worked quite well at the higher doses, but I was a bit worried about reducing by 2.5mg at a time when getting below 10mg even using the slow method, as I do seem quite sensitive to reducing.

[Trenny in reply to PMRpro]

PMRpro - I have been mixing gastro resisitant Pred 2.5mg (on NHS prescription) with uncoated Pred since I started on this lark 20 months ago, without problems. I wondered about the absorption times, but don't notice any difference from when I take all uncoated.

[piglette]

Thanks for that information Trenny, I was wondering if mixing coated and non coated worked OK.

[PMRpro Ambassador in reply to piglette]

Lots of people have mixed ordinary and enteric coated - I did but the reductions didn't work for me using that. a lot of people were struggling with their reductions, especially when they got to the lower doses where the uncoated pred becomes a higher percentage of the total dose so I began to wonder about how it worked.

If you take, say, 5mg enteric coated and 1mg ordinary at the same time to make a 6mg dose the ordianry will achieve a low blood level within a couple of hours and then be almost gone before the enteric coated enters the circulation at all, you are effectively splitting the dose whether you want to or not. It seems to me that you remain needing a higher total dose - I suppose that doesn't matter so much as long as it works.

I have asked if it would be possible to use enteric coated in the same way as Lodotra - taking them at night so they are working by the time you get up. The rheumy I asked thought it was possible - and apparently the company that makes Lodotra isn't willing to do a head-to-head comparison. That does make me suspicious!! If it does work then you could achieve the same result much more cheaply of course.

If you did that then it might work well if you took the enteric coated late evening and then the balance of ordinary pred first thing in the morning - you'd have relief from the morning stiffness and then top it up to last longer into the day. Do you see what I mean? If you take enteric coated and ordinary together in the morning though it takes ages for the effect to kick in. And surely - if you are taking some ordinary pred then by those doses you might as well take all ordinary pred which removes the problem.

But you are quite right - it would also work in the same way mixing enteric coated and Lodotra with a bit of adjusting: enteric coated would just be a bit slower and less reliable releasing than the Lodotra. You would have to take them all at night though.

[piglette]

Thanks so much for checking with your rheumy PMRPro, I really appreciate that. My main reason for mixing was I wanted 1mg coated. I have never had morning stiffness. Before I started pred I was in intense pain and could hardly move so any stiffness would have been covered up. Since taking pred I had a miracle happen within twenty four hours with an 80% improvement, and no morning stiffness. I do have some pain though which varies from day to day. I am actually better in the morning and the pain increases during the day. I have some stiffness in my knees but I think that is nothing to do with PMR and I had it before. I reckon the pred lasts me about thirty hours before it wears off. I take it after I get up at the same time each day. If I get up early I may not take it for an hour or so. I must admit I have wondered if I have something else as I don't have the stiffness, but goodness knows what. I was tested for RA which was negative.