Taking coated and uncoated Pred together?

[Caro12line]

Hi. I normally take uncoated Pred. Recently I had Pluerisy and GP upped the Pred to 30mg (I had got down to 7mg) for a week with quick taper. He prescribed the coated Gastro-resistant Pred. I am now down to 10mg (Coated) and feel ready to drop to 9mg. Is it safe to take 5mg Coated and 4x1mg uncoated? Or should I just put the coated ones aside and go back to my normal uncoated . Thanks

[PMRpro Ambassador]

It is perfectly safe to mix them and many people do.

The only difference is that enteric coated pred takes about 6 or 7 hours to reach its peak level in the blood as it is absorbed much further down the gut, passing through the stomach first so it takes longer to get there. White pred tablets are absorbed within a short time of getting to the stomach and the peak level in the blood is after 2 hours at most.

How that affects your PMR symptoms depends on YOU. If you take them all first thing in the morning the white ones will be absorbed quickly and the enteric coated ones much later. The question becomes is the amount of white tablets enough to manage your early morning pain/stiffness. The increasing amount due to the enteric coated ones later in the day will just keep working.

Alternatively, you could take the enteric coated pills before bed, then they should be working by the time you get up, and you then top up with the rest of the dose early in the morning.

You may find it makes your day better - or not. The only way to find out is to try. Enteric coated also come in a 2.5mg version - so you can have 7.5mg of enteric coated and less white pred.

[Caro12line in reply to PMRpro]

Thank you PMRPro .... I don't have PMR (yet, fingers crossed) "just" GCA so the morning effectiveness is not an issue. Can you believe (after 13 months) I have only just found out about the coated version! My GP said that I probably hadn't been prescribed it before because of cost. I will give the mix a try and see how it goes.... If all ok when I get next prescription filled I think I will ask for coated ... Even with a mix it has to be a bit kinder on the stomach? I take Omeprazole and have zero fat live yoghurt for breakfast before I take Pred and have had no problems so far. Thank you again. You always have the answers X

[PMRpro Ambassador in reply to Caro12line]

Honestly - the cost bit is rubbish! Originally there WAS a big difference in price and a directive was issued that enteric coated weren't any better so ordinary should be used. The GPs agreed - but were horrified when so many of their patients started coming complaining of upset stomachs - not just the plain pred but also the omeprazole they were told to prescribe at the same time.

Anyway, in the meantime the pharma suppliers put up the price of PLAIN pred so it was no longer so much cheaper.

As a comparison:

30x5mg plain white pred = £1.31

omeprazole x 30 = £1.86

plus 2x dispensing fee ca. £1.40 (paid to the pharmacist for every substance and different dose on a prescription)

30x 5mg enteric coated = £1.86

no omeprazole needed

1x dispensing fee ca. 70p

and only 1 tablet to take improves compliance and eliminates one lot of potential side effects and possible interactions.

The figures were supplied by a pharmacist a couple of years ago.

The usual standard of housekeeping by people who don't understand how it all works...

[Caro12line in reply to PMRpro]

Wow! Thank you so much ... I shall go armed with that info. I have to pay for my prescriptions £8.40 per item... So they are actually making money out of me!! Outrageous! I assume though while tapering "dead slow" I still have to take the Omeprazole because of the uncoated 1mg? X

[PMRpro Ambassador in reply to Caro12line]

Presumably your doctor gives you a few months of each dose at one time though? If he doesn't he's mean. And if any prescription is cheaper to pay for yourself rather than the prescription charge the pharmacist is supposed to tell you.

I've never taken omeprazole, whatever sort of pred I was on. Yoghurt was enough.

Get yourself a prepayment certificate - it works out cheaper if you need more than 3 prescriptions a quarter/12 per year. They come in 3 month and 12 month versions:

nhs.uk/NHSEngland/Healthcos...

A good pharmacist should tell their patients - mine would come out and say you have 4 things here, here's the form. Boots were useless - they lost the application. But you can also do it by phone which is simpler.

I used to get a 3 month one, stock up just before it expired and then get a new one next time round. But of course that meant I had to remember...

Why do I know all these things????????????

[Caro12line in reply to PMRpro]

I didn't know that about the pharmacist telling you if it was cheaper. I thought that only applied if the Dr prescribes something like Asprin (or any OTC med) then the Pharmasist normally says this is cheaper if you just buy it. But I didn't think they were allowed to sell prescription only med! I shall ask. I actually do have a Pre Payment certificate.. I found out about that from the pharmacist after several of my monthly visits! Think they felt sorry for me!! Yes my GP has it all on monthly repeat.

[PMRpro Ambassador in reply to Caro12line]

Monthly repeat? Stingy pig - that means you pay for each prescription - if he gave you 3 months worth of each dosage at a time it would STILL only be 1 prescription charge. It's fine for the people who don't have a chronic illness but it doesn't half add up. My cousin developed hypothyroid after baby no 2 - it will never go away and she MUST have replacement therapy. Her GP insisted on 1 month at a time supplies - and even got shirty if she pointed out she was going on holiday so would need it early.

No, they can't sell POMs but if you have an NHS prescription they can (I think) sell it you at cost, the same as a private prescription. I may be wrong though. If the drugs cost £3 and the prescription charge is £8.70 it's a no-brainer.

I remember at some point they claimed only 10% of the population had to pay for their prescriptions - had never included me! So if that is all - why not remove the charge as is the case in Wales and (possibly) Scotland...

[Caro12line in reply to PMRpro]

Totally agree.... Yes only monthly repeat and that is the same for my Amlodopine and Alendronic Acid too! So that's at least 4 different meds a month ... But I do have the Pre payment card... Which is £29 something every 3 months. It's an unfair system with Chronic Illness. A friend of mine has an under active thyroid and has to have Thyroxine (Sp) but because of this she gets all prescriptions free of charge. Doesn't seem a fair system to me. But I will certainly ask about buying meds that are prescribed and see if I can get a three month supply. Because it is 100% sure thing! I am still in this long term. Thank you for your helpful and knowledgeable advice X

[PMRpro Ambassador in reply to Caro12line]

Once you have the pre-pay it doesn't make any difference how they dispense it or how you pay - except it saves on the dispensing fee for the NHS who pay the pharmacists to do the job in that way. The annual one works out cheaper - and you can pay it in 10 instalments.

Here your friend would get her thyroxine free - but not other stuff. Which I think is much fairer. The expression on my husband's face on his 60th birthday was priceless - I'd made him wait to go to the chemist until his birthday and it saved him a small fortune. Which he simply wasn't expecting!

[Caro12line in reply to PMRpro]

I'm 59 this June... And hoping that maybe I won't need the meds by the time I'm 60 ... False hope maybe? But like only getting 3 month prepayment and not a year... False hope I won't need it that long! And always in the back of my mind is that the government will put the age up on free prescriptions in exactly the same way they did with our pensions... So I'm looking at another 8 years working and still paying! Thought life was supposed to get easier as you get older? ☹️ But smile through... Don't let it get you down 😊 X

[linda49 in reply to PMRpro]

PMRpro,

Is your cousin having to pay prescription charges for her thyroxine replacement therapy? I too am hypothyroid and before I reached age 60 had a medical exemption certificate as this is one of the listed medical conditions which qualifies for exemption from prescription charges. Details at

nhsbsa.nhs.uk/HealthCosts/1...

Linda

[PMRpro Ambassador in reply to linda49]

No - if you have one exemption it covers everything, that was the point of the discussion we were having. How is it fair that everything should be exempt? Needing an antibiotic has nothing to do with being hypothyroid. I have a chronic illness that requires me to pay for far more prescriptions related to the illness than she needed - it isn't exempt.

And as I said, here she wouldn't have to pay for the thyroxine but she would have to pay for, say, abx. Anyway - now she is over 60.

My comment about the refusal of her doctor to provide prescriptions for, say, 3 months was more to do with the fact it was totally unrealistic and unhelpful as she had to request the refill, collect the script and go to the pharmacy. She lives in the country. And he even refused to issue a script early without making a major fuss when she was going on holiday and would run out in the middle of the time away. It wasn't as if after 25 years she was suddenly not going to need it was it?

[paddyfields]

I've had 3 goes at doing a post with my newly acquired smartphone so this will be a bit Kurt it is absolutely beyond them to understand the principle of priming the pump so that you have a month spare to save you from all at anxiety caused by perhaps being too sick to collect your prescription or god forbid you might want to go on holiday. If the doctor prescribes the medication Midway between your usual monthly collection when you go to collect it again computer won't let me have a month because you had some two weeks ago. I've even resorted to drawing a timeline and explaining. I was even told off for revealing I had a store Laid by on the same occasion when they were telling me that the medication in question was could not get it. And we are talking about medication which you must not stop suddenly.....

.grrrh

[PMRpro Ambassador in reply to paddyfields]

So they'd prefer you to risk an adrenal crisis and an A&E visit! Anybody would think it was class A drugs!

In fact, we used to recommend - on the basis of advice from doctors - that anyone who had GCA should keep a stock of enough tablets to take 60mg as a single dose if they had any visual symptoms to reduce the risk of loss of vision until they got to A&E. Technically, since PMR can be a symptom of GCA that should also apply to patients with PMR too. And the tablets should be checked for expiry date every so often and recycled into the daily dose and replaced.

[Caro12line in reply to PMRpro]

Absolutely agree. Over the past 14 months I have managed to get a bit of a back up stock and make sure I rotate them. I know how dangerous it can be if I haven't got them. I have a small stock at work and I always carry some in my handbag. Just in case out for the day and something happens and I can't get home.

[PMRpro Ambassador in reply to Caro12line]

Yup - the dosette box goes in the handbag if I'm going out for a drive up the valley! And the whole bag of packs when I'm off to Innsbruck - you never know...

[Nap1]

I am looking for the coated prednisone. We do not have it in the US or Canada. Where do you live? I have no answer to your question naturally, but I do know that the uncoated dissolve faster in the upper stomach than the coated that dissolve in the lower stomach.

[Caro12line in reply to Nap1]

I'm in UK. The coated ones I have are 5mg. Prednisolone Gastro-resistant Tablets ... Drug company actavis. I think the coated is only available in 5mg and 2.5mg. I am currently on 6mg so take 1x5mg coated and 1x1mg uncoated... That is working very well. Hope this helps X

[Nap1]

Interesting the drug manufacturer is in New Jersey US, but does not sell here. I will keep trying.

[Caro12line in reply to Nap1]

Maybe they are awaiting U.S. License? Or maybe they only make Prednisolone and not Prednisone which seems to be prescribed more in the USA?

[Nap1]

Just told about drug called Rayos. Am checking it out. It is available in the US I believe. Probably mega bucks like all our other drugs that are less than 10 years on the market. Thank you for responding.