Delayed release prednisolone: At my last GP... - PMRGCAuk

PMRGCAuk

20,122 members37,704 posts

Delayed release prednisolone

Lochy profile image
33 Replies

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

Written by
Lochy profile image
Lochy
To view profiles and participate in discussions please or .
Read more about...
33 Replies
PMRpro profile image
PMRproAmbassador

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Lodotra then on the NHS in the UK it has only ever been available for patients with rheumatoid arthritis and it was withdrawn for that a couple of years ago on cost grounds - it is very much more expensive than ordinary prednisolone.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?

Lochy profile image
Lochy in reply to PMRpro

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.

PMRpro profile image
PMRproAmbassador in reply to Lochy

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.

HeronNS profile image
HeronNS in reply to PMRpro

Aren't gastro-resistant tablets available in UK. Would they have a similar effect, at least insofar as they take longer to get into the bloodstream? I know the coating used is different.

Slowdown profile image
Slowdown

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.

Lochy profile image
Lochy in reply to Slowdown

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.

HeronNS profile image
HeronNS in reply to Lochy

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.

PMRpro profile image
PMRproAmbassador in reply to HeronNS

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.

HeronNS profile image
HeronNS in reply to PMRpro

Then what's the point? Isn't that what the regular ones do anyway, which we need to take with food????

PMRpro profile image
PMRproAmbassador in reply to HeronNS

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...

HeronNS profile image
HeronNS in reply to PMRpro

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.

PMRpro profile image
PMRproAmbassador in reply to HeronNS

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 ...

PMRpro profile image
PMRproAmbassador in reply to Lochy

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.

HeronNS profile image
HeronNS in reply to PMRpro

I thought food passed through the stomach much more quickly than four hours. More like two. You learn a new thing every day.

PMRpro profile image
PMRproAmbassador in reply to HeronNS

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.

HeronNS profile image
HeronNS in reply to PMRpro

Well it's been working for you for quite a while!

PMRpro profile image
PMRproAmbassador in reply to HeronNS

It has :-)

ConventCassie profile image
ConventCassie in reply to Slowdown

Are those the white ones we use in the US? They are scored & you can split them in half?

Slowdown profile image
Slowdown in reply to ConventCassie

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!

PMRpro profile image
PMRproAmbassador in reply to ConventCassie

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.

ConventCassie profile image
ConventCassie in reply to PMRpro

I remember that now. From you, I’m sure. So best to take the white ones with food :)

Rugger profile image
Rugger

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.

HeronNS profile image
HeronNS in reply to Rugger

Apparently there are often worldwide shortages of, often, common drugs because Pharma doesn't seem to care.

Lochy profile image
Lochy

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.

PMRpro profile image
PMRproAmbassador in reply to Lochy

Most pharmacies won't ever have come across Lodotra - it really isn't used much in the UK at all.

Lochy profile image
Lochy

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.

Rugger profile image
Rugger in reply to Lochy

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!

piglette profile image
piglette in reply to Rugger

I am pretty certain they are not being discontinued unless Brexit stops us having any drugs!

PMRpro profile image
PMRproAmbassador in reply to piglette

I thought the company making gastric resistant was in the UK - but they may still depend on foreign suppliers

piglette profile image
piglette in reply to PMRpro

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.

PMRpro profile image
PMRproAmbassador in reply to piglette

That was what I meant actually - even if things are made in the UK they still need supplies from the other side of the channel/Atlantic...

piglette profile image
piglette in reply to PMRpro

I think it is all scaremongering personally. Frightening everyone.

Linny3 profile image
Linny3

I just found out you can't get it in Ohio either

You may also like...

delaying Prednisolone by a few hours

one hour before the test. I usually have my Prednisolone between 7 and 9 am , with breakfast. I...

Delayed release and Enteric coated Prednisone

Initial trial of delayed-release prednisalone on PMR

zed-open-label-dose-ranging-study-of-oral-delayed-release-prednisone-in-patients-with-untreated-poly

Delay taking prednisolone until after blood test carried out?

and I'm considering taking my daily dose of prednisolone (6.25mg) after my blood test this time to...

Prednisolone...

have a couple of queries:- I have been prescribed 15 mg Prednisolone together with Omeprazole...