At my last GP appointment I asked for a prescription for delayed release prednisolone which he found on his computer and duly prescribed. However on taking it to the pharmacy I have since been told it has been discontinued in UK in all dosages!
Can anyone tell me if this is correct and is it just hard luck or are there any alternatives?
Thanks
If you mean Lodotra then on the NHS in the UK it has only ever been available for patients with rheumatoid arthritis and it was withdrawn for that a couple of years ago on cost grounds - it is very much more expensive than ordinary prednisolone. As far as I know it is possible to get it on a private prescription if you pay the cost yourself - about £25 for 30 tablets of whatever dose. It can cost up to £75-100/month depending on how many tablets you need to make up your dose as it cannot be cut and comes in 1, 2 and 5mg tablets.
Why did you want it?
I didn’t realise it was called Lodotra and my GP never mentioned it wasn’t used for PMR.
As I have been splitting my dose for sometime - currently on 9mg - taking 4 at bedtime I realised after a couple of late nights (out at parties which was exciting in itself!) I took my dose late and felt much better in the morning. Far less stiffness. Had read about delayed release on here and thought I would ask. I know that some just set an alarm for middle of the night and take normal prednisolone but I wanted to try to avoid that if possible.
It IS used for PMR - just not in the UK. I take it.
As Heron says, I (and a PMR/GCA specialist rheumy) suspect it is a lot cheaper to use enteric coated pred to get the same effect - they take about 4 or 5 hours at least to get to a decent level in the blood stream so you could take them before bed and they would be starting to work early morning. I know a couple of people do use them that way - definitely worth a try.
Hi Lochy, I'm also on 9mg and use gastro-resistant (enteric) pred which takes around 5-6 hours to kick in. I take 7mg. at 8a.m. and 2mg between 10-11 p.m. No pain in the morning. Works for me! Available in 5mg, 2.5mg and 1mg.
Hi, thanks for your reply. I did try enteric coated in the early days when I first started splitting my dose but found I didn’t feel like I’d taken anything! So am now frightened of them not working. Sounds a bit silly I know but we all know about the pain. Perhaps I’ll give them another go. Nothing to lose especially if I can’t get the delayed release.
Does anyone know what the difference between gastro resistant and delayed release actually is??
Thanks for everyone’s help.
I did read recently that it's thought some people don't get as good a result from gastro-resistant. The delayed release ones have a special coating which doesn't dissolve in the stomach but is designed to release all the dose at once when it has left the stomach.
Actually the delayed release DO release in the stomach - that fact was an integral part of the patent application. That is why it is important to take them within 3 hours of a main meal or with a substantial snack (bread and meat or cheese). It's enteric coated/gastro resistant that is absorbed low down the gut.
Then what's the point? Isn't that what the regular ones do anyway, which we need to take with food????
The point is you can take them at 10pm before bed and they release 4 hours later, the optimum 2am time for having the peak blood level just before the cytokines are shed in the body. But you don't have to wake up in the night and then lie there wishing you could get back to sleep! Pure convenience...
In my post I I was referring to the ones people take to protect their stomachs, not the delayed release ones you take. So these ones DO go through the stomach before the coating dissolves.
Yes - gastro resistant have a coating that is resistant to the acid in the stomach so don't break down until they are in a less acid environment, probably in the duodenum. The claim they are unreliable made by some doctos is probably as a result of the variation in time for gastric emptying in different patients - achieving the peak blood level can take anything from 5 to 7 hours or even more. So they would work nicely overnight ...
Gastro-resistant do what it says on the tin - they pass through the stomach untouched because of the type of coating, are absorbed lower down the gut and this reduces the irritation of the stomach. The delayed release ones have a different sort of coating that breaks apart in the stomach after 4 hours in the right conditions so it is all available for absorption at the same time, just like ordinary pred but 4 hours later.
I thought food passed through the stomach much more quickly than four hours. More like two. You learn a new thing every day.
No - I thought the same until I was given a link to a copy of the patent application for Lodotra (I've lost it now). The 4 hours thing is a very specific part of that. That is why it has to be a main meal or a substantial snack including bread and cheese or ham - so that it stays in the stomach long enough. They MAY be fibbing off course - but the document was quite clear.
Are those the white ones we use in the US? They are scored & you can split them in half?
Sorry Cassie, I don't know about the US. The gastro-resistant ones in UK are different colours for each dosage and you cannot cut them, the plain pred are white and are ok to cut. PMRpro will know!
No - white tablets are just plain bog-standard prednisone, no coating at all and you can cut them.
Gasto resistant aren't available anywhere except the UK as far as I know but are red for 5mg, brown for 2.5mg and yellow for 1mg - the pills are rounded faces and look a bit like small M&Ms. Rayos/Lodotra are pale yellow, slightly different for each dose, and flat.
I remember that now. From you, I’m sure. So best to take the white ones with food 
I'm wondering if it's the gastro-coated pred in the UK which is going to be discontinued. It's taken my pharmacy 8 days to get my 1mg tablets, but when I asked them whether they were to be discontinued, they didn't know and said they'll check tomorrow.
I've just re-ordered my 2.5 and 5mg tablets in the hope that there are still some at the wholesale pharmacy.
I'll let you know how I get on. Prescription should be ready to collect in 3 days.
My pharmacy seemed sure but then I didn’t query it. I’ve now asked GP for a prescription for gastro resistant to try them so will see what happens.
My pharmacy seemed sure but then I didn’t query it. I’ve now asked GP for a prescription for gastro resistant to try them so will see what happens.
I've just collected my prescription for 2.5mg and 5mg gastro-resistant tablets and the pharmacist said he's not heard that they are to be discontinued, so we'll keep our fingers crossed. I can order more of them and the 1mg tablets in a couple of weeks, so I think I'll stock up just in case!
I am pretty certain they are not being discontinued unless Brexit stops us having any drugs!
I thought the company making gastric resistant was in the UK - but they may still depend on foreign suppliers
You are probably right but according to the press we are going to be without food and must store it up and also all the drugs will disappear too.
I just found out you can't get it in Ohio either
Prednisolone
reducing Prednisolone 
Rayos Time release prednisone
