Coated/uncoated advice

[jaycee444]

Have been on 15mg Prednisolone for past 5 weeks - firstly uncoated with Omeprazole then because of problems with the PPI switched to coated. Because of delayed timing with these I then reverted back to uncoated taken with thick Greek yoghurt to protect my stomach. The Prednisolone worked fine except for some break through pain and stiffness in the early hours. I have now found something that works for me. I take the 15mg at my normal breakfasting time of 5am but as a split dose of 10mg uncoated and 5mg coated and this seems to have solved the early hours pain problem. I see my Dr again in a fortnight and she will want to start a taper. My question is - if I still want to use both coated and uncoated together (which makes sense as it works) then how is the best way to do it? If she reduces me to 12.5mg should I keep to the 5m coated and the rest uncoated? Taking them all at once has worked for me so getting the balance whilst tapering might be tricky?

[Hidden]

Hi jaycee

Well done on working out what suits you best, as you’ve suggested hang on to the coated 5mg & start reducing the uncoated.

As you get further down 10mg ie 5mg Coated/5mg Uncoated then you’ll need some 1mg/2.5mg in both kinds but we can have a chat about that nearer the time.

Good Luck 🍀 with your first taper.

MrsN

[Hidden]

Hi Jaycee...it's great that you have found your own path through this process and have taken control. c

I have had 5mg coated pills and 1mg uncoated since 14mg At 6mg so obviously 5mg coated 1mg uncoated now. I did start taking the 5mg at @10pm a few weeks ago and then had the 1mg at some point in the late morning and that worked well. I had to rethink as the adcal was left out of the rotation if I didn't take it at the right time. One day I wanted the pred to kick in quickly as I had morning appts so I took all 1mgs with a pot of full fat greek yoghurt. I took zantac just in case. I am 3 years in and trying new strategies. 🤔

[SheffieldJane]

Clever! We become our own expert in time. Carry on using your intuition and listening to your body.

[PMRpro Ambassador]

Either way you need to ask for 1mg tablets of both and then experiment a bit to find how little of the "instant" pred you need for morning relief. Did you try taking the enteric coated at night? That seems to work for early morning pain for many people.

[jaycee444 in reply to PMRpro]

As my GP has been so good and did originally say to take the 15mg as one dose in the morning I haven't wanted to go against her. When I see her again I can talk to her about varying times but for the present I am happy with the mixed AM dosage.

[Hidden in reply to jaycee444]

Don't think of it as against her...its FOR you. Whatever changes or non-changes you make.

[PMRpro Ambassador in reply to jaycee444]

Taking the dose all at one in the morning is the normal approach to reduce potential adrenal suppression. That works when patients are on a short reducing course of steroids which is how it is used by GPs for most of their patients. However we are on pred at high enough a dose for long enough - potentially years - that there will be adrenal suppression whenever we take the dose. That means it makes sense to take the dose at the time that works best for us. In fact, splitting or changing the time often means we can manage well with a lower dose without adding in so-called steroid sparers.

Most GPs (and many rheumies) aren't aware of that aspect - it isn't going against her, it is using experience gained by many patients in the past.