Coated or uncoated

[bowler]

Several years ago I was changed from coated Pred to uncoated, I was told they were not cost effective  . Over the years my digestive system has been getting worse, diverticular, IBS, hiatus hernia, gallstones, and an inflamed stomach. 

 I see my Rheumy in 2 weeks time and was thinking of asking him/her [ I never see the same Rheumy twice ]   about changing back to coated Pred.  as I feel they MAY help with the inflamed stomach ?  [ I'm not on any stomach meds. they didn't agree] but do take Gaviscon when needed.   

Has anyone on the site changed back to coated Pred. after being on the uncoated for several years, and would I have to alter the time I take the coated ones ? I find that the uncoated takes about 2 hours to kick in,  and   I don't want to mess up my slow reduction  by changing over,   If that makes sense, I'm now on 12mgs. Pred,   OR should I leave well enough alone ?

    

[DorsetLady PMRGCAuk volunteer]

Hi bowler,

Only ever been on uncoated ones so can't help, sorry. I know the coated ones are more expensive, so obviously not the 1st choice of the Doctor! However, if you have stomach problems and they are getting worse and cannot take PPIs then surely you should be considered for coated ones. I think they do take longer to get into the system, so you may have to alter your timings.

Got a feeling PMRpro has posted about them before, so maybe she is on them, sure she'll respond idc. 

Hope you get some relief from your stomach pains - PMR is bad enough without other things thrown in the mix! 

[bowler in reply to DorsetLady]

Thanks DL

Because of my Gastro problems,  I'm hoping  my Rheumy will say yes to the coated pred.  My worry is,  as I'm doing a slow taper  will a change of Pred.  "mess me up"  on my reduction ?  

 I have been on Pred for GCA/PMR for 16 years, and desperate to get to a lower dose YET  again.   I have never been completely off it and  I don't suppose I ever will,  seems I get a cold, or urine infection, [ I have stage 3 kidney disease ]  which seems to set me back, and gives me a flare.

I was on the coated Pred when I was first diagnosed with GCA/PMR all those years ago,  but like I said it wasn't cost effective, so they took me off it,   

PMRpro did post on here a while back re the cost of coated or uncoated and it worked out cheaper to have the coated,  especially if the uncoated upset the stomach, so therefore the Dr. has to also prescribe stomach Meds. as well,  so uncoated Pred plus stomach meds, work out more expensive and just taking coated.  

Maybe the Rheumy will give me some advice when I go in 2 weeks time, but as I never see the the same one twice they all have their different opinions,  I get more info on here than from them !!!

[DorsetLady PMRGCAuk volunteer in reply to bowler]

Unfortunately as PMRpro says they don't do a smaller dose than 2.5mg in the coated varity, so that makes reducing more difficult unless you mix and match. Still if you had to take 1mg or 0.5mg uncoated ones alongside the coated ones maybe that would be easier on your gastric problems. Hope you get a sensible answer on your next Rheumy appointment. 

[PMRpro Ambassador in reply to DorsetLady]

No - PMRpro posts to disperse the misapprehension they cost more! I'm on Lodotra - now that really IS more expensive! And someone has posted today asking about switching from soluble to ordinary - there is a 30-fold disparity in price there! It's almost as much as my Lodotra!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Sorry, knew you had posted about them, but wasn't sure why, and also knew you were on expensive ones! 

[PMRpro Ambassador]

To reiterate, the figures we were quoted by a pharmacist a couple of years ago were:

30 days of 5mg plain white non-coated pred costs £1.31

30 days of a PPI as stomach protection costs £1.86 - usually prescribed along with white pred to protect the stomach

30 days of 5mg enteric-coated pred costs £1.86

For each prescription there is a dispensing fee paid by the NHS to the pharmacist, approx. 70p to £1(so 2 required for pred plus a PPI)

Those of you who are good at arithmetic will realise that plain white pred plus a PPI costs significantly more than enteric coated pred. 

Enteric coated pred takes up to about 6 to 8 hours to be absorbed - it passes straight through the stomach with your food and is finally broken down lower down the gut. That is how it protects the stomach. You could take it at night - and it would probably be working beautifully by early morning but if you take it in the morning it can take quite a long time to start working. I did discuss this with Prof Mackie in Leeds - apparently there was an attempt to get a comparative study done between the plain pred, enteric-coated and Lodotra. The Lodotra manufacturers declined - and we did wonder whether they realise that taking enteric-coated tablets at night would almost certainly work just as well as their very expensive formulation (30 tablets of any strength approx. £25 in the UK, $1,700 in the US!).

I was first on plain white, no problem, was later offered and used enteric coated - also no problems. Until I got a couple of batches of "loose" pills, not in a blister pack. The red 5mg ones were useless, I had an immediate flare, whereas the brown 2.5mg ones were still fine. Dodgy or counterfeit tablets I assume. 

The biggest problem with the enteric coated version is they only come in 2.5 and 5mg doses so to do a slow reduction does mean using white ones to make up the dose or the "Dead slow" approach repeating every stage a few times - it can work. They mustn't be cut - that takes away the point as the pred is exposed to the stomach acid.

[Peggy76]

Hi. God luck & hope you can get a better result from your ailments.

Peggy 🌹

[tallgal]

I too was given uncoated tablets initially and they upset my stomach big time. Later I saw a different GP and she said, when the doc puts  coated pred in the computer a pop up says to change to uncoated as it is cheaper. But she said it isn't because I now have to prescribe something for your stomach! She also said that someone of my age should never be given uncoated as we are more susceptable to stomach problems. She had no qualms about prescribing me coated pills.