Why no pred tablets below 1mg?

[Daisy-Roots]

The concensus here and in the literature seems to be that a tapering method of some kind DSNS or version of, and 10% max reduction in pred dose is the way to go. So why no low dose tablets to facilitate this? Commercial drug companies don't usually miss a possible target market! I read in one article that 1mg tablets are not available in some countries, surely this is condemning us to longer on steroids than necessary and certainly making it harder for us, and more profitable for pill cutter manufacturers...

[Soraya_PMR]

There are paediatric suspensions. There used to be soluble tablets, but I found those in an old BNF, don’t think they exist anymore.

My pill cutter was cheap! Years old. Use it for me and the dog 🐶😅😅 Not much profit to be had there 😉

[SnazzyD in reply to Soraya_PMR]

Just got my pill cutter for about £3 for both me and the dog.

[Soraya_PMR in reply to SnazzyD]

I have to be really careful and stop and think through the brain fog. Is this the right dog? Is this the correct pill? Cushings dog is on tramadol (not a disaster if I took one) and vetoryl, an anti cortisone! Luckily they mustn’t be cut, so no contamination of the prized pill cutter, but oh! If I did! Absolute disaster! I sometimes think I should use gloves before handling it 🧤🧤

[PMRpro Ambassador in reply to Soraya_PMR]

Someone is on a soluble version of pred - Wysolone is manufactured by Pfizer and is available via Indian websites.

[Soraya_PMR in reply to PMRpro]

Oh is that soluble? Didn’t check the preps when I googled it. That’ll be Iwillwin, sorry can’t tag.

[DorsetLady PMRGCAuk volunteer]

Maybe because steroids are used for many different illnesses, and on a short sharp treatment basis.

So in an acute attack (although it may be a chronic illness like asthma) a larger amount is given for a shorter term (1,2 or 3 weeks) without unduly affecting the adrenal glands.

In a chronic illness (once adrenals affected) like ours we need to taper over a much longer time and also need much smaller doses to enable us to do that successfully - but nowhere in the guidelines for both illnesses does it say use 0.5mg reductions.

Perhaps if the powers to be realised how many patients were doing that then someone may be able to put pressure on NICE to pressure the drug companies! But don’t hold your breath! I imagine cost comes into it!

However until you get below 2mg you can always mix 1mg, 2.5mgs and 5mg (if higher) to get the dose you need. In that case you may need a calculator rather than a pill cutter!,

[SnazzyD]

Because i don’t think the medical or pharmaceutical world has caught up with the notion of ultra gentle reduction plans.

[PMRpro Ambassador]

The cost of producing low dose tablets is identical to those of high doses - the cost of the pred is pence. So the relative cost per tablet is higher - and the demand is relatively small anyway so the healthcare systems cannot negotiate a lower price. The same applies for liquid formulations - liquid pred in the UK is 30 times more expensive than tablets so the instructions are to keep it for the patients who need it: paediatric use or patients with gastric absorption issues.

It is possible to get 5mg, 2.5mg and 1mg tablets in both enteric coated varieties (UK only) and plain. It is perfectly possible to mix those easily available denominations to be able to reduce 1/2mg at a time right down to 2mg. Then cut to get 1.5mg, 1mg is easy, cut to get 0.5mg. Hardly rocket science I think.

[Blearyeyed]

Think you've answered your own question there.

Without half mg tabs pill cutters need to be purchased by the patient (£££) it might take longer or be harder to reduce steroids so again ( £££).

Why go into the cost of production when you can get the patient to do the work at home , possibly ruining some pills in cutting , wasting some tablets , and therefore creating the need to get another prescription.

There not missing a trick they just have more uncaring ones of their own!

[artfingers]

I just break the 1 mg tablet along the line with my finger nail. Usually does just fine. Don't even bother with a pill cutter.

[HeronNS in reply to artfingers]

My 1 mg do not have a line. Pillcutter does okay, although usually one part bigger than the other. My pillcutter was given to me free by the pharmacist. It had a drug company logo on it, long since worn off and forgotten. The ones they have for sale are not expensive.