Shortage of Gastro resistant prednisolone 1mg

[joyce69]

Hi All, I changed to gastro resistant pred last summer after reading your comments and advice on this wonderfully informative forum. The difference for me has been amazing particularly in the mornings, less stiffness and pain and most importantly a clearer head. The pharmacy hasn’t been able to complete my latest prescription because 1mg pred isn’t available. My GP has prescribed non coated pred to keep me going. I’m not sure what to do. I take my coated pills at night. Can I mix coated / uncoated? Do I need to change the time I take them? Has anyone else had a problem with supply?

Thank you in advance.

Age 70

Diagnosed GCA and PMR Dec 2012

Cleared and stopped steroids October 2017

Diagnosed again GCA and PMR August 2018

[Harbel]

Hi joyce69 I posted something similiar under post coated v uncoated a few weeks ago. You might be able to find the helpful replies to it.

[joyce69 in reply to Harbel]

Hi Harbel, thanks for this. I can’t find the post you referred to I’m afraid, could you give me a little more guidance please? Thanks Joyce

[Noosat in reply to Harbel]

I take the uncoated, 3.75 in the morning and 2.5mg at night. Splitting the dose works better for me, no dizzy,fuzzy feeling in daytime as I did with one morning dose.

[scats]

Hi Joyce.

My Dr won't perscribe coated 1mg so I have always mixed the two with no problems. I take them in the evening so always make sure I protect my stomach with yoghurt or kefir. I have had no stomach problems so far. ( fingers still crossed ) Hope this helps.

[joyce69 in reply to scats]

That’s very interesting scats,thanks. I imagine it’s almost like splitting the dose. Is it still effective for around 24 hours? Joyce

[scats in reply to joyce69]

Yes. When I took them in the morning I'd wake up about 3am with leg pains, by taking them in the evening the coated ones are kicking in about then and if the pred is letting me sleep my legs are OK.

[joyce69 in reply to scats]

Brilliant thanks. I wonder why your GP won’t prescribe uncounted 1 mg?

[scats in reply to joyce69]

Cost! It's a matter of pence but he got quite shirty when I asked.

[joyce69 in reply to scats]

Very strange isn’t it? My GP has been prescribing them since last August but this month the pharmacy tells me they can’t get any. Taking them off the market maybe. Time will tell.

[scats in reply to joyce69]

They only became available in the UK last summer as far as I know

[venezia1 in reply to scats]

No - I've had them for 2-3 years. I cannot understand why surgeries don't prescribe them - they are not prohibitively expensive. I feel that patients should be more pro-active in demanding that their practice managers give their GPs the gi-ahead to prescribe them. They are there for us, not the other way round.

[scats in reply to venezia1]

I'm still trying! My GP did not know they existed until I told him. Then he reluctantly looked them up and pointed out how much more expensive they were, then he insulted my intelegence by working out how much this would add up to over a year. I'm lucky that they don't seem to upset my stomach but on the other hand if they did I could use the cost of the gastric meds to help argue my case.

[venezia1 in reply to scats]

Exactly. I still feel you might have more success if you go to your practice manager. Good luck.

[PMRpro Ambassador in reply to scats]

August 2016

[scats in reply to PMRpro]

Thanks, time goes fast when you're enjoying yourself!

[JulianJ]

My last appointment wwith the doctor I just told him how many boxes of each I wanted and he did the script for me

[joyce69 in reply to JulianJ]

Got the prescription thanks but the Pharmacy can’t get the 1mg coated pills. They’ve apparently tried different manufacturers without success. Maybe it’s just a problem in the North East. Thank you.

[JulianJ in reply to joyce69]

I picked mine up on the 2nd from a Well pharmacy, they are made by Alliance Generics.

[joyce69 in reply to JulianJ]

Brilliant thanks, I’ll pass that on.

[Jontie in reply to joyce69]

Can't get them here in Somerset at the moment either. Assume it's the 'B' word.

[GOOD_GRIEF]

I don't know how many 1mg pills you're taking, but if it's just one or two, it should not be a big deal to take uncoated ones. (I mean as far as your stomach is concerned.)

And yes, you can mix coated and uncoated. But you should always take with plenty of water and at least a little something like yogurt or a biscuit. I taker mine about an hour after dinner, with dessert, but we eat dinner at 9PM, so that might not work for you.

The coated ones take longer to digest, of course, so you might want to split your dose, taking the uncoated a couple of hours earlier than the coated. Then it will all hit at approx the same time.

[joyce69 in reply to GOOD_GRIEF]

Thanks Good_Grief. It would mean taking 3 uncoated so probably ok if I’m careful and follow your advice. 😀

[GOOD_GRIEF in reply to joyce69]

There's no law that says you have to take them all at once you know. Try taking each of them an hour apart if you're stomach is tender.

[PMRCanada]

Gastro resistant tablets are not available in Canada, so I take 6mg uncoated tablets at 2am with half a banana or yogurt tube, and 3mg at 2:30pm (split dose, total 9mg every 24 hours), with no problems. Virtually pain free except maybe 12 midnight till dose at 2am, but I’m snoozing by then. The only issue is waking up at 2am, but if it’s a half hour before or after, no big deal.

Good luck with your transition.

[JulianJ in reply to PMRCanada]

I tried the 2am dose before I got the coated ones, didn't like waking to take them, but it was worth it to be able to get up in the morning

[joyce69 in reply to PMRCanada]

Thank you 😀

[PMRCanada]

You are fortunate to have access to coated pred tablets. No such luck here in Canada (sigh).

[Patience47 in reply to PMRCanada]

Don't think we have coated pred in the US either. ☹

[PMRpro Ambassador in reply to Patience47]

Enteric coated is a UK thing - no idea why!

[Patience47 in reply to PMRpro]

It is a mystery, and wish I knew the answer.

[PMRCanada in reply to Patience47]

I believe it is available in the US under the name Rayos (called Lodotra in Europe).

[PMRpro Ambassador in reply to PMRCanada]

Not the same thing at all.

Enteric coated pred has an outer coating which is resistant to gastric acid so that it passes through the stomach and then dissolves further down the gut when it reaches a less acidic environment where it is less likely that damage to the cells lining the gut will occur.

Lodotra/Rayos has an outer coating that relies on the correct acid environment in the stomach to break down after 4 hours, still in the stomach and then the pred is absorbed in one spike just as plain pred is absorbed. The difference is that it is 4 hours later - you took it at 10pm, it is absorbed at 2am. You create the correct conditions by having either eaten a full meal in the previous 3 hours or by eating a substantial snack with the Lodotra tablets - that slows down the emptying of the stomach.

[PMRCanada in reply to PMRpro]

My bad. Thanks for the clarification.

[Bronni in reply to Patience47]

Hmm. Just when I was thinking I should ask for some!

[PMRpro Ambassador in reply to Bronni]

You can always ask - at worst they'' not have them ...

[PMRpro Ambassador]

Take what you have of enteric coated at night and the balance in the morning using the 1mg plain ones - in the middle of breakfast is best if you are worried.

But I wouldn't be surprised if the shortage got worse.

[joyce69 in reply to PMRpro]

What a good idea, thanks. There are times when I just don’t seem to think very clearly. Any particular reason why you think the shortage will get worse?

[GOOD_GRIEF in reply to joyce69]

There's a political word that starts with a 'B' and ends with an "it" that we' aren't supposed to discuss on the forum that would explain it. In fact, there may be shortages of everything that comes from the EU to the UK soon.

[Suffererc in reply to GOOD_GRIEF]

Do you really think that Europe will stop supplying the UK. If that be the case perhaps we will stop supplying Europe with things the need. It will be it for tat

[GOOD_GRIEF in reply to Suffererc]

It's about dealing with customs issues. You haven't had to do that for 30+ years, and no longer have the institutions, people or policies in place. Supplies will be sitting on the docks with no way to get off.

[Suffererc in reply to GOOD_GRIEF]

All predictions and scaremongering. It won’t happen even if we leave with no desk

[GOOD_GRIEF in reply to Suffererc]

You have no idea how much luck I wish you with that.

[Suffererc in reply to Suffererc]

Thank you. We very resilient in the Uk

[GOOD_GRIEF in reply to Suffererc]

I agree.

[Bronni in reply to GOOD_GRIEF]

And we are now seeing a bipartisan push in US to import drugs from Canada, which will supposedly create shortages there. World’s in a mess!

[Casia]

Ive been taking coated (2.5) and uncoated (1) at the same time after a very good breakfast and haven’t noticed any difference . My pharmacist has to order the coated in specially. I hope your shortage isn’t due to the B word !

Good luck.

[maria40]

Went to collect my regular prescription yesterday and everything was there except for 1mg e/c prednisolone which I've been told to go back for. The thought crossed my mind that they might be unavailable; I have been stockpiling a little bit so have enough for the time being but do hope they will be back because like you I find they do make a difference.

[borednow]

Hi I've been on both coated and uncoated pred (and mixed them when necessary) and have noticed no difference at all. I have always taken gastro-resistant Omeprazole as well.

There are currently no problems with supply at the moment here in West Yorkshire.

Hope this helps and best wishes for a speedy recovery.

[joyce69 in reply to borednow]

Thank you and vest wishes to you too.

[joyce69]

I’m beginning to get to the bottom of this one, I think. I spoke to Alliance Pharmaceuticals, who hold the licence, this morning and they tell me there are no supply issues. They passed me to the next company down in the chain on the way to the pharmacies and they don’t have any pred 1mg g/r. They are expecting more at the beginning of March once they receive orders from wholesalers. On the face of it, this appears to be a short term problem which is helpful to know. Thank you all for your responses, very much appreciated. You encouraged me to pull my finger out and do something positive. I must be feeling better😂

[Floridafan in reply to joyce69]

Have you managed to get the 1mg coated tablets yet? My pharmacist still hasn’t been able to get them for me, apparently they get them direct from Alliance

[joyce69 in reply to Floridafan]

I have, isn't that wonderful! I posted earlier in the week to let people know. I'm not sure how you'll find it - maybe by searching on my name? I spoke to a different pharmacist about the messiness of splitting doses when taking coated and uncoated at different times she was very helpful. So much so she's made a note in the pharmacy diary to order them before my next prescription is due.

The supply chain from manufacturer to patient seems very complicated and varied. Good luck.

[Floridafan in reply to joyce69]

Thanks for your reply. I found your post so tomorrow I shall hot foot it to the pharmacy as soon as they open and hope they have my prescription in stock now

[joyce69]

I wish you the best of luck. I think it helped when I mentioned that I'd made quite a few phone calls to try to find out why there is a shortage including the manufacturer. So far none of them has admitted that they are the cause. 😇