How much Prednisolone am I getting?

[podo]

I was interested to hear (from PMRPro I think) that the gut absorbs only 50-80% of the Pred that you take. Presumably the amount excreted is due to a number of factors, How "fast" your gut works, Vit D, Calcium and Magnesium levels to mention a few. In my case, I am on 4mg, which I take in enteric coated form (because of an earlier gastric ulcer), but am also taking Omeprozole, 2 hours before the Pred which could reduce the absorbtion further. I also think that my gut works very quickly (as dtermined by the Beetroot Test!). So, all in all, I could be getting the benefit of only about 2mg Pred or even less! Does anyone have any links to research into this aspect of medication, PMR related or otherwise?

[PMRpro Ambassador]

It doesn't really matter because with pred (like a lot of other medications where there is vaiation in absorption/metabolism) you "titrate" your dose: you start at a dose that should be too high and then reduce slowly to a point where the symptoms return. Then you go back to the previous effective dose. That has taken all the variables into account.

The starting dose should be "the lowest effective dose in the range 12.5 to 25mg" - and you can imagine the advantages of reducing slowly so you don't overshoot the mark, If you need a higher starting dose - it is likely you will need a higher maintenance dose. The duration and level of activity of the underlying disease also plays a part - more active needs more and it may vary over time, falling off at one point only to increase for some reason later.

Titration can be done both ways, sometimes you start low and increase until you get to the first dose that does the job well. With pred you start high with a typically adequate dose and then go down - the higher dose did a better job at clearing out the existing inflammation and then you look for the lowest dose that deals with each day's new batch of inflammatory substances, provided you have cleared out the existing puddle of inflammation you have only got to deal with today's drip.