Coated or uncoated Pred?

Hi Since starting on this journey in Nov 2014 I have been taking uncoated Pred except for a period of about a week when my consultant prescribed coated. I took a PPI for about a year but then decided to just protect my stomach with yoghurt as I had already dropped the AA ( dexa scan was fine) and I really wanted to cut down on medication. Don't know if that was foolhardy or not. Since that initial diagnosis of PMR I then,a year ago, developed what my consultant terms as cranial GCA and despite many attempts at reducing and only at 1 mg a month using the DSNS method I have only managed to reduce to 19mg from 21mg ( which had controlled the symptoms initially after diagnosis) in one year. The consultant has now suggested Leflounomide which I started about two weeks ago and that seems to be going well. I have to take this for 8 weeks before attempting any reduction in Pred.

A long introduction I know but now realising I am probably in for the long haul and adding another medication to the mix I began to wonder if I should take coated Pred? The only thing I did find ,however, when I did just test it for about a week was that it didn't seem, in my body anyway,to be as effective; it did take longer I felt to be absorbed and didn't seem "so strong" a dose. I've read recently on here about coated Pred taking longer to be absorbed and sometimes not reaching that initial "peak" that is better for GCA. I have obtained some coated Pred ,with I must say a lot of difficulty, from my GP who stated that they gave no added protection than the uncoated(?!!!) and that even if they prescribed them they would still prescribe a PPI ( she hasn't also picked up that I haven't had a prescription for this for a year). I did smile sweetly and engaged in the broken record technique of I would really like to try them!! Anyway have now got them but am wondering about the wisdom of trying them as I don't want to upset the apple cart or wondering if I should carry on taking the uncoated with just yoghurt or throw the PPI into the mix with the uncoated! I know this has to be my decision at the end of the day and I can I suppose just try the coated ones for a short time, perhaps much earlier than my 6.30/6.45 dose time. Just thought I'd run it by you all for any comments and advice. Thanks a lot Jackie

28 Replies

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  • Hi Jackie,

    Have never taken the coated variety so cannot help on that aspect, other than to say you are right in thinking that they do take longer to get into the system. About 3-4 hours, compared to uncoated which take about 1-2 hrs.

    I don't know of any reason why you can't take both together if you can get both - depends what's written on the prescription I guess. That may solve the problem of you feeling you are not getting the full benefit from the coated ones. Why do you want to change if you've been taking the uncoated Pred without the PPI for the last year?

    There are many on here who don't take a PPI, and just rely on yogurt to protect stomach, so sure you get advice on that scenario.

    Wondering why Consultant only put your Pred up to 20mg when he diagnosed GCA - seems on the low side, no wonder you are having problems reducing.

    You are definitely correct in assuming you are in for the long haul - but that's the nature of the beast!

  • Thanks Dorset Lady for your comments. I wondered if those taking just yoghurt were also taking coated pred but good if they also, like me, are taking uncoated. I asked Dr Hughes if I needed to go higher with dose of the initial 21mg, which had controlled the symptoms. Most of my pain is at the back of the head and side not in the temporal area and he said that he didn't see any reason to increase the dose as I then, he said,would probably still have difficulty reducing but from a higher base line. Jackie x

  • Jackie

    I started on coated Pred for PMR prescribed by the Consultant but GP would only give me uncoated on the grounds of cost but promptly increased my PPI

    There is definitely a delay in the coated variety working & I'm currently splitting my dose, taking 2.5mg coated before bed & the balance of 4mg uncoated in a morning, I tried this to improve the stiffness in my muscles in a morning & it does seem to be working, so I'm using the coated to my advantage. I also take yogurt with my breakfast in a morning but that's more to try & prevent thrush in my mouth (side effect of Chemo) as l take a PPI for my stomach.

    So think it might come down to wether your GP will prescribe the coated variety.

    Sorry can't offer any other thoughts.

    Best Wishes

    Angela xx

  • Thank you Angela for your thoughts on this. I don't think it's recommended to split the dose for GCA, or certainly what I've read before but so pleased it's working for you and your situation. Think you're doing really well! Jackie x

  • No it's not recommended to split dose with GCA. oumneed the whole dose in one go, but as PMRpro says you can alter time to best suit you!

  • Sorry Jackie I didn't mean to recommend for you to split your dose, it was just that I've taken both types of Pred in the past (both worked) but have recently started splitting my dose & reintroduced the coated at night as I want a slower release overnight to help with the morning stiffness.

    I realise it's different in GCA

    I hope you can find the best option while protecting your stomach.

    I just wish GP's would listen to what we say & the rationale behind it!

    Speak Soon

    Angela x

  • No I didn't think you were recommending that for me Angela, no problem!!

  • It is probably OK at the low doses if you have PMR symptoms that aren't being controlled.

    However, occasionally doctors will suggest splitting the dose even in GCA if taking the dose all at once causes really bad side effects. And even at high doses, in some people the effect doesn't last the full 24 hours - then it is better to split the dose than have a period where the inflammation is not suppressed. But it is up to the doctor then.

  • If I were going to try the enteric coated sort in your position I would take them before bed. They may take up to 7 hours to be absorbed (may, not will) and won't get to as high a blood level but will be present over a longer period.

    No - people use yoghurt alone with normal pred, they don't usually bother with yog with enteric coated unless of course they want to!

    If DrH said it was OK - that's fine! If it is enough to manage all your symptoms that is all that is aimed for.

    What a cynical GP - or she hasn't understood the documentation about enteric coated not giving a better result (which I think is more likely!)

  • Do appreciate your time PMRpro and everyone's quick replies - it really helps when trying to think something through. Don't understand the GP at all and her thinking on this- I don't think she really understood herself either! Just used to saying no!!!? Jackie x

  • Hello Jackoh. AA isn't the only PPI you know. I also had problems with it, and took myself off them. I now take I Ibandronic Acid Mylan tablet once a month. In fact, have just taken this month's tablet, today. Works well for me.

  • Thanks for your reply Karools16 . In actual fact AA isn't a PPI. Didn't list the PPI that I was on as couldn't remember how to spell it! But good that you're finding your tablet suits you. Didn't want to go on any form of AA personally for various reasons but one of these being a lot of dental work I have/ need doing. I think sometimes, me obviously included, we use a lot of abbreviations and this can be confusing. Jackie

  • Realised Karools16 that my reply to you wasn't particularly helpful to anyone else reading this. A PPI (Proton Pump Inhibitor) is for protection of the stomach e.g Omeprazole( looked it up!) AA( Alendronic acid) is given as protection against osteoporosis.

    Jackie

  • Ive been using coated 5 and 2.5 mg pred for some time, and found (coincidence or not) my reflux has got a lot better - I've stopped my PPI - though I've also stopped AA. After a lot of experimenting, I think my best time for coated pred is 10 or 10.30 pm.

    The difficulty is when you're reducing your dose, because the coated tabs can't be split. I've tried both splitting the dose (I've GCA), coated in the evening, non coated in the early morning, so that they coincide in their effect, and also tried taken them all together in the late evening. The latter works best for me.

  • Hi,

    When you say it works best, what do you mean?

  • It seemed to control the symptoms better.i suspect we're all different though!

  • I'm interested as I'm at the very beginning of all this lark and am trying to work out what is best too. No idea if I'm supposed to be free of all symptoms at this stage five weeks in. Trying to tinker about with food too timing and enteric and non enteric coated Pred. Evening pills are definitely better for my functioning on a practical level but I definitely think food has a big impact on my absorption.

  • Depends Snazzy - very few people ever achieve total freedom from pain. I'd say I am most of the time - but weather changes (like this week) can cause pain! But I've had PMR 13 years, nearly 8 years of pred and I refuse to take less than I need for optimum symptom management. I had quite bad trochanteric bursitis - while I had a miracle 90% response in 6 hours for the stiffness and most of the muscle pain, the bursitis and tendonitis in hips, hands and feet took much longer. perhaps 4 or 5 months to really notice a difference. Though suddenly I realised it had gone. I had a return of the hip problems when I had had a BIG flare due to messed up meds and other things - but by then I was here in Italy, asked the cardiologist what painkillers I could use to go with the a/f medication and was told "Basically - nothing!" and was sent immediately for steroid injections in A&E. Which worked brilliantly.

    Which bit of food and pred? Enteric coated can take up to 7 or 8 hours whether you have eaten or not, depends on the person. And presence of food will always slow down absorption.

  • I think I'll start a separate post so I can set out my findings of various combinations, endeavouring to make it not to long winded.

  • Thank you Ronnie101 - really helps to see other folk's experiences. XJackie

  • Hi Jackoh, I was diagnosed with GCA in March 2015 and began the long journey with 30mgs uncoated pred plus PPIs. I have been tapering slowly and cautiously and recently discovered from our friendly experts here that a) PPIs are baddies that b) there are such things as coated preds c) that my doctor prescribed the coated ones (2 years later!) without a fuss. I haven't had any problems with switching to the 'new' pred and willingly gave up the PPIs and, so far, all is well. I have never split the dose. I am now on 9mgs and have kept back some uncoated 1mg pred as, again on this wonderful site, the advice is, if tapering at the next slow stage to 8.5, uncoated pills are easier to cut in half. Good luck.

  • Thanks tcga for your encouragement. My doctor balks at prescribing coated. No idea why but have got some now! Tried taking them last night before I went to bed as when I'd tried them for a very short period ages ago they seemed to take a long time to "kick" in for me. So far so good this morning. Thank you for sharing your experience- that's really helpful, also about not splitting your dose. Realise we're all different- have to really find what works for us all individually! XJackie

  • They think they are more expensive - they were at one time, about 17x the price it was claimed. Shortly afterwards the manufacturers put up the price of ordinary pred so that now there isn't a lot of difference. Three years ago 30 plain tablets cost £1.31 and 30 enteric coated £1.86. Since 30 omeprazole cost £1.86 and there is a payment to the pharmacy for each substance dispensed - plain pred plus PPI costs more than just enteric coated. But they don't think of that.

  • Yes I went back on line where you itemised all this, wrote it down and took it to the surgery. I could see we were heading for a confrontation so I changed tack and said my Consultant had suggested them ( which he had) and continued on the broken record technique of asking for them. She said it had nothing to do with cost(?!) and even if I had coated she would prescribe a PPI therefore not saving on this cost(??!!) Don't really understand where she's coming from. Have only got 2 weeks supply so it will be interesting what happens next!!

    Jackie

  • But the whole point is that you don't need the PPI - unless you have another problem! Crackers...

    You know what REALLY annoys me though - they hand out pred and alendronic acid together as if joined at the hip. But when they put a patient on a PPI for another reason they don't do anything. And PPIs are as likely to cause osteoporosis as pred - probably more so!

  • Totally agree.

  • I'm prescribed 5mg coated and 1mg uncoated. It's useful as I can halve the uncoated ones when reducing. Had to up the dose recently due to another flare but going down again!

    Following angina and stent 2 years ago (before GCA) I was on Lansoprozole, omeprezole and tried every zole going. Spectacular diarrhoea from all of them. As I'm on heart meds as well as preds, GP suggested Ranitidine. No problems at all. Some people might like to give it a try?

    A big thank you to you all for the support..

  • Sorry. What's PPI. 🤔

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