Prednisolone

I would be very grateful for some advice about coated (can't remember the word!) or un coated prednisolone... is one more adventageous over the other? My GP mentioned that, when she was training, the coated variety were rather scorned at as the students joked about the pills going straight through! She also said that it was probably a sign of her age and that the coated ones have now improved and she's will one to prescribe them.

Another question... does a perfect rheumy exist in East Sussex?!

19 Replies

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  • Coated pills are not absorbed in the stomach but carry on into the gut first. This means that you do not get the stomach problems some people have with uncoated. It also means you do not need to take PPI pills which help the stomach problems.

  • Hi

    I think the coated ones are only available in 2.5 so becomes difficult to have them all the time when reducing.

    Someone will be along later to let you know if available in other strengths.

    Rose

  • Morning tgca

    Enteric Coated is the word your looking for, they make them in 5mg & 2.5mg.

    My Rheumatologist started me on the coated 5mgx3 but GP refused to prescribe them on grounds of cost but then promptly ordered a stomach protector, which was then two prescription charges!

    I coped with the uncoated, so no real problem. However, if you need 2.5mgs they only come coated & 5mgs & 1mgs are uncoated. You'll get the hang of it, we're all happy to help any time.

    Best Wishes

    Mrs Nails 💅🏼

  • tgca, as piglette has said, enteric-coated Pred is absorbed in a different place to the non-coated pills. The coating is designed to be more stomach-protective. As far as the coated pills are concerned, this process can take a little longer to take effect each day.

    As Mrs Nails has said, many doctors will consider that it is cheaper to prescribe a non-coated pill, but then, of course, it is usual to prescribe a stomach-protecting pill such as Omeprazole or Lansoprazole alongside, thus negating the extra cost of the coated pills!

    I was prescribed enteric-coated Pred throughout my PMR/GCA 'journey'. A stomach protector (PPI) was also prescribed by my GP. However, my bowel rebelled at both PPIs mentioned above and were stopped by my rheumy at my first appointment.

    I'm sorry I'm not aware of any rheumies in East Sussex so unable to recommend one there but there is a "perfect rheumy" in Surrey (St Peter's Hospital, Chertsey) - well worth the journey, and I speak from experience as will many who have travelled far and wide to see him.

  • Can you name the 'perfect rheumy' please??

  • drrahughesrheumatologyltd.com/

    He does NHS and private...

  • The enteric coated or gastroresistant version of pred has the advantage it is less likely to irritate the stomach. As a downside it takes much longer to be absorbed. Ordinary white pred is absorbed from the stomach in less than 2 hours. Enteric coated can take up to 6 hours or even more in some people and in some people it is not absorbed reliably (though that might actually be the case for ordinary pred in the same people, some people only absorb about 50% of what they take).

    The problem here will be that if you are a person for whom the effect of the pred doesn't last 24 hours you may have to wait for a few hours in the morning for your pain and stiffness to resolve. I never had a problem, the effect lasted until the next day. Prof mackie and I have discussed the concept of taking enteric coated late at night as you are going to bed - it would reach the maximum level in the blood in the early morning and avoid early morning stiffness.

    The enteric coated version is available as red 5mg, brown 2.5mg and yellow 1mg pills. The 1mg version has only been available since last summer and there seems to be some ignorance about them! Here is the proof of their existence:

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

    Boots claimed to one patient there weren't such things - strange since they are made by the pharmaceutical company that is part of the same group! A nice independent pharmacist sourced them for the lady. They ARE available.

    I can only support Celtic's rheumy recommendation - he needs to be cloned.

  • Thank you all very much for all your lengthy advice. Interesting about the 1mg as my GP wasn't aware that they existed!

    Due to the fact that my body is getting on well (GCA) with my current dose, would it be wise to swap and to go for the enteric version as I am a bit of a coward when it comes to change... slower to work? but taking into account that it's easier on the tum????

    Would, if I make the leap to enteric, I be able to give up omeprazole???

  • My G P prescribes only the ordinary white pred plus Omeprazol. So I have been searching the internet and found empty capsules enteric and bought them, plus a capsule filler machine ( a bit like cigarettes in the old days) skipped the Omeprazol, no problems untill now.

  • You learn something new every day on this site! I've been on pred for GCA for nearly 2.5 years, taking a mixture of 5, 2.5 and 1mg tabs. The 5 and 2.5mgs have always been enteric coated, because my GP said that 1mg came only in uncoated. I'll put him right at my next appointment next month. I'm currently on 12.5mgs = 2x5 and 1x2.5, all coated, which means I've stopped taking lansoprazole tabs. There's been no adverse effect on my tummy.

    My goal is to take as few tabs as possible of any kind, eventually coming off all together. At my current rate of reduction that could be sometime 2018/19. I started on 50mgs (ESR reading 147), then down (too quickly) to 6mgs. A relapse took me up to 30mgs and now 12.5mgs.

    GCA is a life of snakes and ladders. I've been bitten twice by the snake, but am now on a ladder.

  • Don't be too harsh on your GP - they are VERY new and a few years ago on of the companies said it wouldn't be cost-effective to produce a 1mg version. I take a different delayed release form of pred - the 1mg tablets cost exactly the same as the 5mg ones - so 6mg costs twice as much as 5mg!

  • Don't get me wrong, my GP is wonderful...she listens,cares and discusses unlike others in the practice so I'm v lucky. How's the snow?

  • Snow? What snow? We have had no precipitation of any sort for the last 50 days! It all went south - literally! However - snow IS forecast for tonight and tomorrow. We'll see...

  • It's quite useful to have some 1mg uncoated pred when you reduce as you can cut them, which you can't do with the enteric variety.

    I have 5mg and 2.5mg coated and can reduce very slowly by cutting half, or even a quarter, of 1mg to try and lull the ever-vigilant body into not noticing and this has also (so far) avoided steroid withdrawal symptoms. I'm presently on 7mg so I take 2.5mg plus 2x1mg at breakfast which means I get a boost in a couple of hours from the faster-acting uncoated (and at such a low dose I have no stomach problems) followed by a mid-afternoon energy surge (well, maybe more of a warm fuzzy feeling !) and at bedtime I take 2.5mg coated which kicks in around 4a.m. which is when the inflammation starts to bite. It works for me, and I've also discovered 'Snore and Peace' tea (by Clipper) which does just that ! Drink about 20 minutes before bed and away you go :-)

  • Thanks Slowdown, I have not tried splitting the dose. I, too, thought about keeping the 1mgs for just the same reason !

  • That is why cutting and grinding and filling the empty capsule with the white Pred yourself is so much cheaper. And on top of that, you can use exactly the grams you need for a capsule, and swallow just one.

  • Yes, but as someone - think it was Shirley Conran - once said -"life is too short to stuff a mushroom".

    Got more exiting things to do!

  • Hi, I just wanted to mention that I don't take a PPI and I use the uncoated Pred. I did for the first couple of months then decided to drop it. I just try to make sure I've had something to eat before I take my pills. Usually start the day with some Onken natural yogurt followed by some cereal with fruit then take the pred.

    I haven't had any problems (touch wood) and I did occasionally have to take PPI s before GCA set in so certainly don't have a cast iron constitution. Perhaps you could do without them too. Check with your doctor first though. You can always start again if you need to. Good luck.

  • All summer I have been taking 6.5 mg and have had no problems to speak of, but as soon as I drop to 6 mg I start getting headaches in the afternoon. I'm beginning to think that this is because I hadn't realised that the 6.5 mg were 2.5 mg enteric coated and 4 mg uncoated. When I dropped to 6 mg it was all uncoated. I'm now going to try taking the 6 mg as a mixture of coated and uncoated, the same as the 6.5 mg were. I think this might be working like splitting the dose because the enteric coated begin to work when the coated ones are past their greatest effectiveness. Actually splitting the dose would be a recipe for disaster for me because I always forget to take pills in the evening.

    Fortunately neither my doctor, my rheumatologist nor my pharmacist could give a hoot as to whether I take coated or uncoated tablets and I have to take omeprazole anyway for a pre-existing stomach problem.

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