Gastro-resistant puzzle

[Pollyanna16]

Just about to sort my tablets for the week & notice, for the 1st time, that the 1 mg pred are not gastro-resistant but the 5mg & 2.5mg (new to help me reduce) are. Thanks to this site I have become aware of the difference. Are there 1mg gastro-resistant available? If so can I dispense with Omeprazole? I have just started on 10mg instead of 20mg to see if it reduces stomach upsets.

[piglette]

Unfortunately the coated version is only available in 2.5 mg and 5mg. There is a newer steroid called Lodotra that is coated and has 1mg tablets, but it is only available as a private prescription in UK, so is a bit pricey.

[PMRpro Ambassador]

No - we did ask why not and were told it wasn't cost-effective. As piglette says, Lodotra comes as a coated version in 1,2 and 5mg tablets but 1 x 5mg tablet costs the same a 1x 1mg tablet! It would be the same with enteric coated tablets.

If you have trouble with omeprazole (not uncommon) you could try Zantac/ranitidine which does the same job nearly as well and with far fewer side effects. Others have found that yoghurt also helps greatly with gastric problems, as does eating half your breakfast, taking your tablets then eating the rest of your breakfast.

This reduction scheme has been used with some success by people who can only reduce using enteric coated tablets:

healthunlocked.com/pmrgcauk...

However, others have found they are still able to reduce with mixing the types of pills despite them being absorbed at different rates. Enteric coated take about 6 hours to reach the peak level in your blood, sometimes longer. You COULD try taking the enteric coated before bed and the rest in the morning and see how that works. The enteric coated would reach a peak in the blood in the early morning, ordinary pred takes 2 hours to get to its peak.

That is a similar idea to taking the Lodotra we mentioned at night so it works in the morning and something I discussed with a top PMR rheumatologist in the UK. Apparently there was a suggestion that a trial be done comparing Lodotra with enteric coated tablets - but the Lodotra company declined. We wonderd if they thought knowing you could do the same with enteric coated might affect their sales!

[Pollyanna16 in reply to PMRpro]

Ok ..... So I take the enteric at bed time, with food? The others in the morning, as usual. So some days I.e. When I just take 4mg it would be breakfast time & then that evening I might be taking the next day's dose of a 5mg tablet. This is all new to me. I do always have plain love yogurt with my breakfast, trying to keep my dairy up. Tummy upset is most mornings when I wake. GP has agreed to try ranitidine if 10mg Omeprazole doesn't work.

Thanks for all the info

[PMRpro Ambassador in reply to Pollyanna16]

You don't actually NEED food with enteric coated - they have the coating so that they pass straight through the stomach and are absorbed further down the gut - and so that avoids irritation of the stomach wall.

[Jilldrog]

Not sure where you find whether the pred. I take for PMR is gastro-resistant ? Quite anxious about this, although have not had serious stomach upsets yet. In 2012 I was rushed into hospital with near kidney failure and after 10 days there it was decided that the kidney disease was caused by incompability of Omeprazole and the NSAID I was taking for Arthritis. I was taken off both forever and put on a six month reduction plan of pred. Iam never able to take NSAID or Omeprazole again, just Cocodamol for pain.