Newbie questions - your patience required

[Theziggy]

Hi

I read here that I needed calcium and vit D3 which it was suggested should be prescribed automatically with being put on steroids. So I rang my GP practice and have brought home a box of Adcal 750mg/200 t.u.

Now my question is, I read here - take Prednisone in the morning (2 a.m. preferably) and the calcium in the midday - my prescription says take two tabs twice daily - in morning and at night, so should I stick with the timings on the box or change to midday and night?

Second question is about the blue card. Is a blue card issued automatically or should I request one. I have been on steroids now for well over two months (gp put me on them to wait for my rheumatologist appointment)?

Thanks in advance champs.

[Pongo13]

I take my pred with breakfast 7.30 ish, adcal with lunch and then supper. Blue card was only given automatically with first prescription. Subsequent cards I have had to request.

[patriciawhite]

I have a rheumy at St Helens Hospital ,they give you address labels and if you hand them one with every blood test they send you a blue card . Ask when you have your blood test what the procedure is . Possibly you have to request each time

[Soraya_PMR]

Pharmacist should be able to give you a steroid card.

[Chrob]

Got a card from boots chemist and one when I joined pmrgcauk , take adcal at lunch and evening meal , pred as soon as I wake with yogurt . Took a photo on phone of steroid card and put it as screen .

[Soraya_PMR in reply to Chrob]

Good idea re photo.

[CT-5012]

Get my card from the pharmacy, sometimes have to be persistent. Pred and calcium are not good playmates need to be at least two hours apart, I take my pred with breakfast, calcium for lunch and dinner. All good wishes.

[SheffieldJane]

Yes you are right about the Adcal - keep it away from the Pred. So lunchtime and dinner time perhaps.

I have never had a blue card. Ask the GP.

[Rugger in reply to SheffieldJane]

Jane, you must carry a blue steroid card, especially as you are wondering about your adrenal function. It tells us on the leaflet inside the boxes of prednisolone tablets!

Your pharmacist should have them, but PMRGCAuk send one every year - when you first join and then at renewal - I've just received my third one from them. pmrgcauk.com

We are also advised to carry the card for a year after we stop taking pred.

[piglette in reply to Rugger]

I have never been sent a blue card by PMRGCAuk. I did get mine from the chemist though. I also wear a bracelet which I thought would be more obvious if I got taken to hospital.

[Rugger in reply to piglette]

That's strange - I received my latest one just this week, with acknowledgement of my annual renewal. The previous 2 were specially printed with PMRGCAuk details, but this one is the sort you get from the pharmacy with a PMRGCAuk sticker attached. The most important thing is to make people aware we are on steroids, by whatever means.

[piglette in reply to Rugger]

I received my annual renewal info but no card. Not that it matters too much though.

[SheffieldJane in reply to Rugger]

You are the first person to tell me that. Where on the site is the info. ?

[Rugger in reply to SheffieldJane]

Jane, I've just typed 'Blue Steroid Card' into the search box at the top of this page and quite a few posts came up.

Better late than never! You could ask at your up-coming Out Patient appointment if they have any cards.

I've checked the leaflet in my box of prenisolone tablets and it's the sixth point on the first page.

[SheffieldJane in reply to Rugger]

My pharmacy is pretty good. Husband well briefed, rarely out alone these days. Crikey that’s so true!

[HeronNS]

Let me get this straight. Your calcium is tablets of 750 mg? And you have been told to take two twice a day? Or is 750 the total dose for the day? What does 200 t.u. mean?

The body can only absorb about 400 mg in a single dose. If you take more you risk complications.

Never take calcium and pred at the same time. Pred changes the way calcium is metabolized so it is less effective, and calcium tends to interfere with the absorption of a lot of other things, including pred.

[AmberAliona in reply to HeronNS]

No one has explained that to me. I take my Adcal with 4 other meds before breakfast, and then the pred about 10 minutes later with my breakfast. The 2nd Adcal I take with my evening meds. I was diagnosed in December, but have not been referred to a Rheumatologist! Should I request this. I am currently on 16mgs pred but am doing this all on my own. Haven’t heard from or seen a doctor since January. Advice please

[PMRpro Ambassador in reply to AmberAliona]

Don't take the pred and Adcal within 2 hours of each other. Pred for breakfast, Adcal for lunch and tea/dinner - it is better with food for a few reasons.

[HeronNS in reply to AmberAliona]

Most of us manage without a rheumatologist. There may seem to be a lot of people on the forums who do see a specialist, but I suspect this is because people on forums are often those who've been having some problems. Dare I say that some of these problems are the result of mismanagement by the GP, but a reasonable GP who keeps informed and listens to the patient is all most of us need. I started out with a GP and have never seen a specialist. Have had a reasonably smooth journey, thanks to the information on this and Patient forums.

You certainly should be monitored by a doctor, however, if only to make sure your blood results stay normal and to make sure your pred taper is continuing uneventfully.

I wasn't told about the pred/calcium interaction either. I now think it best to avoid taking calcium with any other medication (I don't include vitamins with this, although it can interfere with absorption of some other minerals).

[karools16]

Well now, this is news to me. My Adcal is 15oomg each, twice a day. Box says it is = to 6oomg calcium and 400 I.U colecalciferol=to 10 micrograms Vit D. Am I also taking too much then?

[PMRpro Ambassador in reply to karools16]

No - that is the usual dose. The body will absorb at least 500 of the calcium each time but will only absorb about 500 even if you took both together.

[karools16 in reply to PMRpro]

Thank you.

[1602]

Hi there - I would talk this through with my pharmacist. They give excellent advise about dosages etc. I take Calcichew/D = 500mg/400iu daily. NEVER take with Pred. I take Pred in morning after breakfast and Calcichew p.m. Do ask though as this seems to be an unnecessarily high level. Good luck xxx

[Rugger]

My calcium and vitamin D is AccreteD3 - 600mg calcium and 400IU Vitamin D to be taken twice a day - same as the others, with lunch and evening meal, away from the pred.

If you join PMRGCAuk they send you a blue card each year. It's only £15 / year and you get newsletters and they pay for us to benefit from this amazing forum, as well as promoting awareness of and research into PMR & GCA. pmrgcauk.com

[maria40]

The rule is to leave two hours between taking steroids and Adcal so you can fit this in with your pred dose times.

My pharmacist asks me regularly whether I need a new blue card but previously I used to ask my GP.

[Candydog]

Hi, am new to this so not so sure about the timings but would have thought lunch and evending meal would be fine. My GP didn't mention the blue card but I asked at the chemist when collecting the steroids as I had read about it and was given one then.

[Theziggy in reply to Candydog]

I take my adcal at lunch and with my evening meal - when I remember!

I am also on a ppi - omeprazole and take this an hour after my steroids - is this the correct way to do it?

[PMRpro Ambassador in reply to Theziggy]

I believe the argument is that a PPI should be taken BEFORE the item that that may cause trouble. But don't quote me - I just know that most people would take a PPI in the morning before food to reduce acid production and that if the problem was night time reflux the effect would have worn off by then. So 2x daily dosing or taking the PPI at night would be more appropriate in that case.

[Theziggy in reply to PMRpro]

Thank you PMRpro - that;s what I was thinking - I may change my timings for the PPI and the steroids - thoigh I have had no issues with my current regime - steroids first thing in morning and PPIs an hour later