GP is refusing to prescribe enteric coated Prednislone

[pinks33]

I want to stop taking lansoprozole and rely on yoghurt instead to protect the stomach from the steroids. I have been taking the uncoated preds and thought the enteric coated version would give added protection, from what I've read on posts on this forum. My GP is refusing, saying that the coated tablets offer no additional protection. Is he right? and should I go ahead and stop the Lansoprazole anyway? Can't understand his refusal to be honest.

[Primarose]

Hi pinks33, I don't know about the protection bit but the enteric coated Prednislone is a lot more expensive than the ordinary ones.

I was given some 2.5 mgs of the enteric coated Prednislone by mistake a while back, don't know why but they gave awful nausea.

I did take the Lansoprazole for a while before taking the preds. I forgot to take the Lansoprazole a few times and didn't notice any stomach problems so I stopped taking them. I make sure I have something solid like porridge before I take the preds and have never had any problems at all.

[pinks33 in reply to Primarose]

Thanks Primarose for that reassurance. On an earlier post someone said the cost of lansoprazole and uncoated pred together was more than coated pred on its own, so I hadn't thought it was a cost issue. But perhaps my GP saw it otherwise. I'll risk stopping the lansoprazole and see how it goes.

[Primarose in reply to pinks33]

The difference with the pred is roughly £8.00 for enteric coated v £1.80 for the normal ones. I don't know how much the the lansoprazole is.

As I said I had no probs taking porridge before the preds. You can see how you feel, I'm sure you will know straight away if your tums plays up.

I was pleased to be off the lansoprazole as some of the side effects include hair loss and bone loss and you get enough of that with the pred.

[SnazzyD in reply to Primarose]

PMRPro did some costings and enteric coated came in no more expensive once you factor out the stomach meds you need to have with the uncoated. I found that non-coated Pred felt like it was burning a hole in my stomach all day no matter how I took it. Once it started 40mg enteric coated that calmed down hugely. I found I had to take enteric coated two hours away from food because the absorption was impaired.

[pinks33 in reply to SnazzyD]

I don't think I'd want to wait 2 hours before I could eat breakfast! 30 minutes with the ppi is bad enough!

[Primarose in reply to SnazzyD]

They reckon they that you shouldn't eat anything for at least an hour either way. I didn't know this when they gave me them by mistake, probably why I felt sick afterwards.

[DorsetLady PMRGCAuk volunteer in reply to Primarose]

I’ve just looked at latest NICE costs - and the enteric ones aren’t as costly as that. This is quoted drug tariff price. All 28 tablets-

Dose. Plain. Enteric

1mg £0.50 £1.92

2.5mg. £1.30. £0.96

5mg. £0.70. £0.97

For Lansoprozole costs are -

15mg - £0.73p ,

30mg - £1.07

Swings and roundabouts really.

On another point, my local nhs hospital site queries the effectiveness of the enteric Pred, and therefore doesn’t recommend GPs prescribing it!

[Primarose in reply to DorsetLady]

Thank you DorsetLady, I think I may have got the private prices.

[DorsetLady PMRGCAuk volunteer in reply to Primarose]

I wasn’t disputing the prices per se, but I just thought I’d check because this seems to be the excuse many patients are given - and it’s not really valid in the great scheme of things! Plus who wants to take two tablets, both with side effects when you could take only one?

[Primarose in reply to DorsetLady]

Absolutely! I read somewhere that PPI's were only meant for temporary use anyway.

[PMRpro Ambassador in reply to Primarose]

About 3+ years ago the costs given by a dispensing pharmacist to a PMRGCA support group were 30 tabs PPI £1.86 and 30 tabs plain pred £1.31. 30 tabs enteric coated were £1.86. Then there is the dispensing fee for each script which can be £1 or more (so writing a script for 3 months-worth saves a fair bit). The difference in price is negligible and removes a whole layer of potential side effects. Not least that a PPI is more likely to lead to low bone density than is pred...

Previously the cost of e/c was about 17x that of plain pred but when the powers that be decided that e/c should be stopped the suppliers put up the price for plain pred so there was little difference.

[pinks33 in reply to PMRpro]

Thanks for confirming that. I haven't challenged my GP about it yet but for now am taking his word that ec tabs don't offer added protection. He may not be thinking in terms of cost. Do some people have problems absorbing the ec tabs? I have more or less stopped the ppi - my GP doesn't know yet - but I do usually get acid reflux if I eat too much in the evenings, and I sometimes then take a ppi the following morning. I'm hoping that managing my diet properly will solve the heartburn and that I can continue without the ppi. If I still get heartburn, I'll speak to my GP about changing to ec tabs and mention the cost comparison.

[PMRpro Ambassador in reply to pinks33]

It depends on the person - I can only say from my own experience that with e/c I had no problems but if I had to use 4mg plain white to make up the dose I felt as if a small rodent was gnawing at the inside of my stomach. I have ALWAYS had a cast iron stomach!! That was what happened when the e/c question came up originally - GPs thought it wouldn't be a problem and then patients who had never had any problem before started coming back with gut problems. Not just the gastric bit - but bloating, diarrhoea and the like. PPIs cause these sort of problems for quite a few patients as well as other longer term things like loss of bone density and low vit B12. None of which are a problem with the e/c pills.

It is less they aren't absorbed as well - after all, a lot of patients don't absorb plain pred as well as others anyway, some absorb 50%, others as much as 90% - but that they also take much longer as they have to travel further down the gut and it can take anything from 4 to 7+ hours. But that makes them ideal to take in the evening so they are working well by the time you get up. It's a swings and roundabouts thing. You only find out by trying.

[piglette in reply to Primarose]

I think it used to be much more expensive in days gone by, but the price has dropped and as Dorset Lady points out the prices are much closer now and cheaper if you stop the PPI.

[Longtimer]

I have never experienced any stomach problems with none coated pred, and I am sensitive to medication, I have been taking them for 7 years now.

I smother my breakfast with bio yogurt, perhaps this is the answer….

[Constance13]

They’re too expensive!

If you have a stomach acid attack chew some raw porridge. I even do this in the middle of the night, better than popping unnecessary pills!!

[pinks33 in reply to Constance13]

TH

Thanks everyone. I hadn't realised there was such a price difference. I always have oats and/or yoghurt for breakfast, and feel happier now to give the lansoprazole a miss. If you don't really need a drug and it has unwanted side effects, it makes sense to do without it if possible.

[Primarose in reply to pinks33]

I think that oats would be perfect before the pred.

[Primarose in reply to Constance13]

I've had thick porridge before taking pred for over a year now and not had any probs.

[CT-5012]

Hi, I don’t think there is much difference in cost overall. I have been on uncoated pred for two and a half years without having any problems just so long as you eat something before taking pred you should be fine. All the best.

[Chrob]

Have mine with thick Greek yougurt first thing ,just drop each pill in a spoon full .

[pinks33 in reply to Chrob]

Will do.

[Bonnie-ma]

Hello Pinks33

I believe your GP is right. At least I have asked two GPs about this and they both agreed that research suggests that there is no extra protection offered by EC Prednisolone. I was told this about six months ago. Small caveat - I am always a bit suspicious when there is a cost implication!! And how can I argue with research! Haven't seen the research evidence either. If you have other medical reasons for using enteric coated Pred such as a pre existing condition that makes you more vulnerable then I believe you will get it. Make of this what you will.

[pinks33 in reply to Bonnie-ma]

I don't feel so cross with my GP now!

[SuziCutie]

Is lanssoaprole same as opeprazole? Spelling probably wrong😩. Never heard of hair loss with later. Bothered about that

[piglette in reply to SuziCutie]

Effectively they are the same, both are PPIs. Lanzoprasol is only available on prescription in U.K. while omeprazole I believe can be purchased over the counter.

[xdbx]

I take the enteric coated Pred and was lucky that my GP prescribed them without a murmur, but I used to take the uncoated ones with an oatcake and/or a little yogurt.

I stopped taking Lansoprazole several months ago and if you're going to do that I recommend a slow taper, a bit like a DSNS Pred taper. I did it like that over a couple of weeks and it worked a treat!

[Sheilamac]

If you do have reflux or heartburn, use Ranitidine instead of the PPI's it doesn't have the horrendous side effects. My GP prescribed it when I refused the PPI's.

[pinks33]

Thanks Xdbx and Sheilamac for those tips. I took no PPI's yesterday and had my uncoated preds with a little muesli and yoghurt. Obviously early days but no ill effects so far. I've only been on PPI's for about three months and think I'll risk not tapering them off, but I agree that if you have been on them for years a slow tapering would be advisable.

[HeronNS in reply to pinks33]

Perhaps keep some ranitidine on hand in case you do experience some acid rebound in these early days? I've never taken anything with pred, but always ate a largish breakfast. In early days I'd tend to take pred in the middle of the meal, now I just remember to take my 2 mg at the end before starting my day. Yoghurt really does help, although there people who can't manage any kind of dairy, even the fermented kind, especially from cows' milk.

[pinks33 in reply to HeronNS]

Good idea about ranitidine and I will get some. I'm on a higher dose of pred than you - 20mg pred at the moment - but other posters have said they've never taken ppi even on higher doses than this. I don't always get acid reflux, and when I do i'm sure it's because of my evening snacking habits. It would do no harm to bring that under control, and it would also help to stabilise my weight. I lost a lot of weight before the GCA diagnosis and continued to lose weight on pred, but it is beginning to creep back on now. It has been really helpful for me that others with GCA have shared their experiences and offered advice, so thank you.

[HeronNS in reply to pinks33]

I started at 15, and just made sure to have food right from the very beginning. It was the main thing I was cautioned about at the pharmacy. In big letters a sticker on my prescription container TAKE WITH FOOD. Mind you, they never said anything about not taking my calcium supplement at the same time, which one shouldn't, and I only learned that by accident after about three months. Now I take calcium at lunch and bedtime (the bedtime one with some yoghurt).

[pinks33 in reply to HeronNS]

LIke you I have also been taking my calcium tabs early afternoon and late evening. I think I read somewhere recently in the papers that calcium is best taken in the evenings? I will try the evening dose with yoghurt. Without ppi my breakfast has been a generous helping of bircher topped with homemade greek yoghurt, then the pred, then a couple of cups of coffee. Never too sure about how the coffee interacts with the food/pred, but I do love my morning coffee. I sometimes have it on rising, then the food and pred some time later. Will try not to eat at least 3 hours before bed, and see how it affects the heartburn.

[PMRpro Ambassador in reply to pinks33]

Everyone is different!

But there is a lot of evidence that cutting carbs not only helps reduce weight gain with pred, it also helps with reflux. Especially at night...

[pinks33 in reply to PMRpro]

Good advice, and I have been mindful of needing to teduce the carbs for weight reasons. If that also reduces reflux, so much the better, and a bigger incentive to stop the dreaded evening snacking on non-nutritious food! Thanks for sharing your experience with ec and uncoated pred. If my GP sticks to his guns in not prescribing ec, then I'll continue to try and work around it.