Coated or non coated pred? - that is the question....

[Ronnie101]

Good morning and I hope you're all enjoying this sunshine as best you can.

I've been taking 2 x 5 MGS of coated pred at 7 pm followed by 2 MGS of uncoated pred at 11 pm (12 mgs in total), and things have been pretty stable. I've now reduced to 11 mgs total (10 mgs coated + 1 mgs uncoated) using the DSNS method and am wondering about the next step.

Will cutting out the uncoated pred (so as to get to 10 mgs) cause a major impact on my body because coated pred is, I believe, less well absorbed? Should I drop by only 1/2 mgs this time?

[DorsetLady PMRGCAuk volunteer]

Hi Ronnie101,

I only ever took uncoated tablets, but my understanding is that the enteric ones come in all sizes as well, so just ask your doctor for what you need. You are going to need smaller doses anyway if you intend to stay on both types as you reduce.

Sure someone answered this previously with a list of the different colours/doses , but can’t remember who!

As for absorption, not sure whether one is better, it’s just that the uncoated get into your system more quickly. So if what you are doing now suits you, then get a selection of smaller doses of enteric tablets - can you do that before your next reduction? If so, then you could stick to an uncoated dose at 11pm and enteric at 7pm. It’s whatever you feel happiest with really.

[maria40 in reply to DorsetLady]

Red = 5mg, brown = 2.5mg, yellow = 1mg . I find this colour coding useful especially so when reducing as I'm pretty muddle headed in the mornings when I take mine so it's easy to see at a glance what I've taken - or not taken.

[DorsetLady PMRGCAuk volunteer in reply to maria40]

Thank you!

[PMRpro Ambassador]

But if I understand you correctly, you are taking the uncoated 4 hours after the coated - so it shouldn't make much difference. The enteric coated is absorbed more slowly, not necessarily less well, and the uncoated will just cause a spike on top of the level due to to the enteric coated at about midnight.

Why can't you manage with just the 10mg you take at 7pm? Why did you choose those times?

[ConventCassie in reply to PMRpro]

Mine are all white. Are they “uncoated”? Doesn’t say.

[PMRpro Ambassador in reply to ConventCassie]

You are in the USA. Enteric coated/gastro-resistant prednisolone is a UK phenomenon.

[ConventCassie in reply to PMRpro]

Thank you. Clears up a lot.

[Rugger]

I was wondering, like PMRpro, why you take the tablets at those times? It seems that the pred from both kinds will be in your system at around the same time - midnightish.

The inflammatory cytokines are released by our bodies in the wee small hours, so I take my coated pred at bedtime - around 10pm, to try and coincide with the cytokines.

Then I take a small dose of uncoated pred at breakfast as a top up, because I think pred doesn't last 24 hours for me.

If you feel that pred lasts 24 hours for you, perhaps try taking the full dose as coated pred and experiment missing out the tiny dose of uncoated.

However, as DorsetLady says, coated pred is available in 5mg, 2.5mg and 1mg tablets, so you could mix and match to get 9mg coated and 1mg uncoated and half mg doses when you need to - I do!

We're all individual, so it's trial and error.

Good luck!

[Ronnie101]

Thanks for all your replies. To answer Pmrpro's question, Over the years I've tried them at different times, and the early / late evening combo seems to be the best for me to avoid pain and discomfort.

I thought I had read somewhere that coated pred, because it is absorbed in the small intestine, may be less effective.

I will try and get 1 mg coated tablets to see how they work.

[PMRpro Ambassador in reply to Ronnie101]

A study was done in Crohn's patients - who will possibly have an impaired absorbance because of the gut disorder. It also tends not to get to such a high peak level as uncoated pred - but it maintains a high level for much longer.

You pays your money - and you takes your choice. What works for you is the important point.