Where to buy 1/2 mg Prednisone

[Robinre]

Hi, I live in the U.S. Our pharmacies to not carry Prednisone in 1/2 mg tablets. Also tried to find in Canada. Where do you that take this mg live?

[suzy1959]

I don’t think there is a half mg. pill. What we in UK use is the 2.5 mg pill to get down in half mg stages. Then, when we ( not me yet!) get below 2.5, we may have to cut a 1 mg pill in half. Hope that is clear? !

[Robinre in reply to suzy1959]

Thanks so much. The pills are so tiny I thought they might be too hard to cut as I have tried to cut other even larger pills and they crumble.

[PMRpro Ambassador in reply to Robinre]

What about 5mg tablets? Are they big enough to get a decent 2.5mg by cutting?

[Robinre in reply to PMRpro]

Hi, I am down to 2 mg and have been reading about how other PMR sufferers are tapering off by .5. Thought I might try it.

[Flygirls in reply to Robinre]

I am on 2 mg and cut my 5mg in half. Just a bit crooked to make it 2mg

[Hidden in reply to Robinre]

I cut the 1mg tablets whilst in their blister pack. I use a safety razor blade( the one with the back safety edge) using a sawing action- a thicker blade eg kitchen knife is to thicker blade and smashes up the pill within. And of course a bit of patience.

[Hollyseden]

You can buy a pillcutter online or in a chemist/pharmacy. It happily cuts the 1mg and 5mg in half.

[SheffieldJane]

Get yourself a good pill cutter for half a mg. 1 mg and 2.5 mg are available in the U.K.

[PMRpro Ambassador]

Nowhere in the world has 1/2mg tablets. You take a 1mg and use a pill cutter.

If you are on coated tablets of any sort they must not be cut. There are some varieties of pred that have 2.5mg tablets - and above 2.5mg you can combine them to get 1/2mg doses. Below that - 1mg and cut.

[TooSore]

If you look very carefully the tiny 1 mg prednisone pill does have a line indented in it on one side. Line it up so the blade of the pill splitter will land there and generally you are ok.

[Robinre in reply to TooSore]

Thanks, will try.

[HeronNS in reply to Robinre]

Pretty sure my 1 mg tablets (Canada) have no line, but the pill cutter cuts them anyway.

Takes a bit of practice to get reasonable halves, but can be done.

[PMRpro Ambassador in reply to TooSore]

Some do, some don't!

[Gaijin]

I was really worried about getting 0.5 mgs, too. In Spain, the lowest denomination available is 2.5. When I cut 2.5 in 4 parts, the pieces are uneven but as per PMRpro, it doest matter as it all evens out in the end as you would be getting the full 2.5 within 4 days. If you have 1 mg tables, even easier.. They do crumble sometime though, if they keep you on a tight leash as they do me, every pill counts. Its high time they made prednisone in 0.5 mg tablets. My rheumi who had inicially given me a tapering schedule all the way down to 5mgs by 2.5 mgs, has now said that when I start taperig again, it'll be " drop by drop".

[PMRpro Ambassador in reply to Gaijin]

It simply isn't economic, they would cost almost exactly the same as a 5mg tablet. The economics of the thing mean the denomination that is used most is cheapest - anything rarely used is much more expensive: they don't keep for ever and the equipment has to be set up to make relatively small quantities.

Here in Italy we can have tablets made up for us by the pharmacy in any quantity - large denomination tablets are ground and weighed into capsule casings. They charge - but for my husband about 5 months supply of daily warfarin cost him about 20 euros. He felt it was well worth it to avoid the hassle...

[Gaijin in reply to PMRpro]

Yes, you have me that tip months algo, to order at a compounding pharmacy. I was doing ok with a high end pill cutter I bought in the US which cuts the 2.5 in fourths just fine.

The reason why the doctors here tell everyone to taper by 2.5mgs is because there is nothing smaller available. When I told that rude, young rheumi that I cut the pills in fourths, she was really surprised and then wrote out a tapering schedule that reduced by 6.25. I think they know that smaller reductions are more effective, they just can't prescribe pills that have to be cut to patients.

But now I understand how it wouldnt be cost effective. I thought all conditions treated with prednisone require similar, gradual tapering and there would be a bigger market.

[PMRpro Ambassador in reply to Gaijin]

No, the majority of pred use is for short-term conditions, a short taper of the variety 15/10/5 stop. we are something of an exception - and that is why rheumies struggle. They use pred for RA flares - as a taper. Long term pred is a mystery to most of them!

[Gaijin in reply to PMRpro]

That explains a lot.. why they are so scared of pred while being so aggressive with AAs, PPIs, statins, inmunosupressants, etc.

[Rachel9319 in reply to Gaijin]

Drug companies are not going to spend the money on a dose that is not prescribed as a theraputic dose for many conditions. Other than very rare adrenal insufficiency patients, i don't know of anyone who would use .5mg prednisone as a theraputic dose. Weaning is different. It is also very short term, and many people don't even utilize a .5mg dose as a step.

So, no, not a big enough incentive to create a .5mg, especially when scpred 1mg tablets are availale. I'm surprised those even exist and are as available as they are.

I would think insurance companies would object to a .5mg as well.

It if were up to them we would all be cutting 20mg tabs.

Each strength of tablet cost pnly slightly less to produce than the higher dosage, so per mg the higher dose tablets are much much more cost efficient.

As for what is actually best medically..

Biologically/Medically speaking it has been shown that for long term steroid users, weaning by 10-20% of the dose, even 4-5 days is the least stressful and best for your body.

This can be achieved not only by reducing dosage amount, but by altering the dosing schedule. After a certain ppint it is recommended that you switch to taking the dose every other day, or reducing the dose every second day at first, then every day, instead of just reducing the mgs.

[Gaijin in reply to Rachel9319]

Here in Spain, the smallest denomination is 2.5, so I always get a tapering schedule that reduces y 2.5. When I told the rheumi I do it by less, she was so surprised.. asked me how I did it!

[PMRpro Ambassador in reply to Rachel9319]

The 1mg gastro-resistant prednisolone has only been available since August 2016 - and it may well be in response to the desire of many of us to be able to taper using it rather than mixing gastro-resistant and plain pred.

You are speaking about medically speaking for other conditions. No-one in their right mind would taper in PMR/GCA every 4 or 5 days - we are tapering to find the ideal dose for long term use, the lowest dose that manages the condition as well as the starting dose did and tapering at that speed would not only miss the endpoint but ensure you had no idea where it all went wrong.

Alternate day dosing is not recommended for PMR and GCA at any point except perhaps the last couple of mg to get to zero. Many people are able to manage their PMR on just a very small dose - but only every day because the anti-inflammatory effect simply does not last long enough to still be there in the second day.

[Joydeck]

Here is a cheap alternative using scales and a weekly pill box.

I have just ordered from eBay, for A$11.69, scales that weigh to the nearest 1 mg. Since a 5 mg prednisolone tablet weighs a little over 50 mg, I will soon be able weigh fragments of these tablets to a precision of almost 0.1 mg of prednisolone: precise enough to taper down to zero by 0.5 mg intervals.

[Rugger in reply to Joydeck]

Joydeck,

That sounds ingenious! However, in the UK the pill cutters are £2 to £3. I found that if a tablet crumbled, I took the crumbs that day and saved the 'good' half for the next day!

[Joydeck in reply to Rugger]

In Australia, the cost of prednisolone in 5 mg tablets is much less than in 1 mg tablets.

Incidentally, in the last three months I've tapered to a 9/7 split dose, weighing fragments of 25 mg tablets (much cheaper than 5 mg tablets) on a A$4.50 scale that can weigh to the nearest mg of prednisolone.

I usually break up the tablets in a new medicine bottle, pick out likely-sized fragments, weigh them, and bottle them by weight (e.g. 5, 6, 7, 8, 9 mg prednisolone). I rarely need to swallow more than 1 fragment.

[Rugger in reply to Joydeck]

How resourceful, Joydeck! We are so lucky in the UK to have the NHS pay for our meds. The pred tablets are around 3p each, if I remember correctly, but just think how much we could save the NHS if we did what you're doing! There's a thought!

[Rachel9319 in reply to Rugger]

Pill cutting is a common practice in the US as well.

Not quite to this extent, but people often get higher dose tablets and cut them even when the actual dose is available because it means they can afford their meds.