Questions, questions: Combining gastro-resistant and plain Pred

[JanetRosslyn]

Oh wise ones, can you help?

My GP diagnosed PMR and started me on 15mg Pred on 01/12/16 with 'magic' results. I am due to see Rheumatologist (Vanessa Quick) for a first appointment on 20/02/17. Through this wonderful forum I was able to source a document co-written by the Rheumy and present it to my GP yesterday and he is very happy for me to follow her reduction plan, dropping from 15mg to 12.5mg in a couple of weeks' time.

My question... finally, sorry I ramble a bit... I now have just enough Pred in a combination of 5mg, 2.5mg and 1mg sizes to last me until I see the Rheumy, but the 2.5mg size are labelled 'gastro-resistant'. Does that mean they will take longer to be absorbed into my system? I currently take 3x5mg tablets early morning with breakfast and they 'kick in' properly about 3 hours later. When I change to 2x5mg plus 1x2.5mg tablet am I to expect a delay in relief?

One other thing... sorry, I did warn you I ramble... reading the leaflet with the2.5mg tablets I was surprised to read "Avoid eating liquorice whilst taking Prednisolone" as I have not read this on the 5mg leaflet. I absolutely LOVE liquorice!!!

[DorsetLady PMRGCAuk volunteer]

Hi,

The 2.5mg tablets are coated aren't they? So that means they take longer to get into your system because they travel farther before they dissolve, about 4 hours I think - sure someone will explain it better! The uncoated white ones usually take a couple of hours to start working, or in your case three.

You may notice a slight change, but hopefully not enough to cause you problems. Not sure how many people take a combination of coated and uncoated tablets, but sure you will get some advice.

Can't comment on the liquorice, I've eaten it with the uncoated tablets without any adverse effects, depends on how much you eat I suppose!

FYI if you have uncoated tablets, you can cut them, so that may be a way around the slow release or the liquorice problem!

[JanetRosslyn in reply to DorsetLady]

Thanks for that. If I get any problems I'll take your advice and cut up the 5mg tablets.... though I'll have to get more on prescription as I don't have too many left. Or I wonder if the dispensing chemist would swap the 2.5mg coated ones for uncoated? I didn't notice they were coated until I got home. As far as I recall, the prescription didn't specify coated.

[DorsetLady PMRGCAuk volunteer in reply to JanetRosslyn]

Not sure, but don't think they make uncoated ones in 2.5mg strength - why I don't know, don't make sense to me. But there you are.

[PMRpro Ambassador in reply to DorsetLady]

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

Scroll right down to the bottom!

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Thanks for that.

Unfortunately it seems not all drug companies make all varieties, nor do all dispensaries stock them, so we, the patient, get Hobson's Choice! Ce la vie!

[PMRpro Ambassador in reply to DorsetLady]

I know they are relatively rare birds these days but making a friend of a local independent chemist is well worth the trouble. Someone wanted 1mg enteric coated pred tablets - which are available - and was told by Boots they weren't. Strange that seemed - since they are made by the company that is the chemist in Boots and the data sheet was dated August 2016! Her husband went to a local independent (at my suggestion) and the lady pharmacist found them. He said she seemed quite quietly triumphant!

No, not all companies make all - that's why I gave the data sheet with the company name. If in doubt - go to the horse's mouth.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Hoping I won't need to again🤞

[PMRpro Ambassador in reply to JanetRosslyn]

You cannot return medications once they have left the counter - the Elves from Safety and all that! You might have interfered with them...

[piglette in reply to JanetRosslyn]

Coated ones are good in my opinion in that they do not get absorbed in the stomach, but further down in the gut, so reduce stomach problems, personally I prefer the coated to the non coated for this reason. If the prescription asked for 2.5mg that may be why you got coated as you cannot get 2.5mg uncoated.

When I started pred I was told that I must not eat liquorice.

[PMRpro Ambassador in reply to piglette]

Yes you can

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

Right at the bottom.

[Mrsd12f in reply to JanetRosslyn]

Hello Janet, I may be mistaken, but I think the latest batch of 2.5mg tablets I received are uncoated. The brand name is Pevanti and they're plain white; in fact, they're virtually indistinguishable from the 5mg and 1mg uncoated, apart from a very slight difference in size. (I wish they would make them all a different colour or shape, as it's so easy to muddle them up!) I'd previously had some 2.5 which were black, but thinking about it, they probably were coated.

Hope this helps!

[PMRpro Ambassador in reply to Mrsd12f]

Amazing really what we are told and what we can find isn't it?

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

This datasheet also mentions not eating liquorice with pred.

They are from the same company that makes the gastro-resistant tablets. All the non-gastro-resistant tables have a score line on one side - they are designed to be broken if necessary. This company doesn't do 1mg tablets - but all the others are different colours so you can tell the difference.

[HeronNS]

webmd.com/vitamins-suppleme...

See "Interactions"

[JanetRosslyn in reply to HeronNS]

Very interesting! Thank you so much, HeronNS. Much appreciated.

[PMRpro Ambassador]

Yes - liquorice allsorts in quantity and pred are not good to mix! Another lady discovered that a few xmases ago - with a LARGE box of liquorice to hand. She was rather miffed!

The plain tablets take about an hour to be absorbed, and up to 2 hours to get the peak level in the blood. The enteric coated (gastro resistant) can take up to 7 hours to reach their peak and that peak will be lower than the same dose of plain pred. This leads to the problem that taking just enteric coated can take a long time to have a result if you take it in the morning (you get 5mg enteric coated too). I do wish GPs would think before prescribing them as a mix!

It depends whether the dose of plain pred is enough to combat the morning dose of inflammation - overall it may help as the effect from the enteric coated will last longer than the plain stuff. You can only find out by trying.

[JanetRosslyn in reply to PMRpro]

Once again, thank you for sharing your knowledge! As I am not experiencing any problems with the plain Pred (fingers crossed for long-term) I might ask if I can just stick with them and not a mixture, keeping things simple.

[PMRpro Ambassador in reply to JanetRosslyn]

I have this suspicion that you can take enteric coated at night, just before bed, and they will start to work in the early morning which is when you need the effect - and then you can take the rest early in the morning...

It is now possible (with some effort) to get 1mg gastro-resistant. Beats me WHY doctors mix them.

[Slowdown]

Hi Janet, I've been taking a mixture of coated 5mg and 2.5mg plus 1mg uncoated as I reduced from 8.5mg to my present level of 7.5mg. I took 5mg + 1mg uncoated with breakfast, and 2.5mg before bed which worked very well - as PMRpro says the bedtime pill starts to work just when the inflammation gets going around 4a.m. and the 5+1 gave me a nice little morning boost! The advantage of the 1mg uncoated is the ability to cut it to what you want - I sometimes made it .75mg if I felt I needed it as I reduced to 8mg - at 7.5mg it's just the two coated ones and now I have to work out the next step to 7mg - complicated maths versus effects sometimes! Good luck, and Happy New Year

[Hidden]

Interestingly, my 1st Rheumatologist prescribed me enteric coated 5mgx3 but GP refused point blank to do the same! He said they were too expensive & prescribed uncoated 5mg but promptly doubled the dose of my Lansoprozole to protect my stomach!

I've had 2.5mg coated at times & at 7.5mg l did notice a slight difference. Now l cut 5mg's in half when l need a •5mg & add 1mg to the 'now' 2.5mg to get the required dose, l have a good Pill Cutter!

Wish me Luck 🍀 I'm starting the Slow Method of Reduction tomorrow to 6.5mg! 🍀 l have a Spread Sheet on my iPad!

Reading this thread has made me wonder about taking an enteric coated tablet at night when I do have to get up & out 'early' in a morning, which isn't often as I'm now Retired!

Four Years ago today was the last day l worked!

Very Best Wishes to Everyone for 2017 & may we all have a Healthy New Year! 🥂

Big Year for My Lovely Husband & l as we Celebrate Our Ruby Wedding Anniversary in September ❤️❤️

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

Well done on the Ruby! Hope you get some 💍💍🍾🍾. Would have been our Golden this year, but unfortunately only managed 46, never mind they were good.

[Hidden in reply to DorsetLady]

We have lots of Plans PMR permitting. Doubling up on the Celebrations as everything got put on hold for my 60th as Chemo rather over took things. But please God all will be well for 2017 🙏🏼

All The Best & Good Health for Us All in 2017 🥂

[PMRpro Ambassador in reply to Hidden]

I've posted so often on the arithmetic - plain pred plus a PPI costs almost double what the enteric coated costs (the PPI costs the same as the entric coated pred and involves 2 dispensing fees). As well as adding in an extra set of side effects and long term consequences.

As soon as the recommendation to not use enteric coated on grounds of cost was issued, the manufacturers put up the cost of plain pred so there was no longer the claimed 17-fold difference in price. So the GPs who bothered to look were not amused - especially when patients started coming back with awful gastric problems. Mostly due to the PPI it has to be said!

I got a bottle of red wine for my 40th - whose tasting notes extolled its ruby colour... Which is better than this year - where the modern gift is groceries!!!! Whose idea was that!

[Hidden in reply to PMRpro]

I very nearly asked him to write me a Private Prescription but thought better of it, he was just cross as he didn't believe I had PMR ~ too Young! 😂

All The Best 🥂

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Obviously not a woman! She'd have more sense, and taste!

Must be a supermarket ploy.