Delayed release and Enteric coated Prednisone

[Linny3]

I am trying to figure out if these act the same. I have looked it up but still don't understand. Brain struggling today.

[SnazzyD]

I don’t know but I’ve to see enteric coated after trying uncoated on high doses for GCA. Enteric coated definitely is delayed in effect from my experience. Maximum effect from non-coated Pred was about 2 hours with effects starting to kick in at 1hour. With enteric coated, although I could detect something after a couple of hours, the full effect wasn’t until 4-5 hours later. I found that absorption was adversely affected by taking it with a meal too.

[PMRpro Ambassador]

No, they don't. The only similarity is that they both take longer than plain white pred tablets to get into the system.

Delayed release tablets, Lodotra/Rayos, have a patented thick coating that takes 4 hours to disintegrate which happens suddenly, like cracking a nutshell, freeing the pred in the shape of an ordinary pred tablet (like the kernel of a nut) and it is then absorbed in the following hour. This is all in the stomach and possibly the duodenum but intended to be in the stomach. Then the blood level follows exactly the same pattern as with plain white pred - it shoots up quickly to a peak and then falls off more slowly. The only difference between it and plain pred is that the coating delays the absorption by 4 hours. The dynamics are the same.

Enteric coated pred has an acid-resistant coating which doesn't dissolve in the stomach at all to avoid irritation of the stomach lining. Only after it leaves the stomach into the different pH (acidity/alkalinity measure) of the lower gut does the coating start to dissolve and release the pred inside it. It should take about 4 hours for the tablet to pass through and out of the stomach to start with if there is food in the stomach, if you take it on an empty stomach it will pass through more quickly. Then the outside takes some time to dissolve in the more alkaline conditions which it does as the pill passes through the rest of the gut and the pred is also released. The blood level of the pred rises slowly, if you measured it and plotted a graph it would show a gradual rise to a high level which then remains stable for a short time before falling off in a similar way to that seen with plain pred. The e/c pred will be absorbed over a long time as the pill passes through the gut and be absorbed at different parts.

The time it takes for the e/c pill to be absorbed depends on the person and the speed their gut works at and the amount of food they have eaten before or after taking the pill. In some it can be as little as 3 hours, in some it may be as much as 7 or 8 hours so it is quite variable and that is what some doctors don't like about it. The peak level it achieves in the blood also tends to be lower so it may not work as well if the person needs a high amount to combat the inflammation. On the other hand, there is some presence in the body for much longer and for some people that will work in the same way as splitting the dose.

[PMRCanada in reply to PMRpro]

Thank you for this very understandable difference between these types of medication!! Got it now! I purchased Clear Enteric Coated/Vegetarian K-caps Capsules (size 00) and stuff them with the 2/3 part of my split dose. I take it at 11pm and the dose is on board by 4am, saving me getting up every night at 2am to take that dose. Works like a charm! Take the other part of my split dose (1/3), at 11am. This regime works wonderful and I have very little stiffness or pain throughout 24hrs, it just took some time and experimentation to get here. Where there’s a will, there’s a way.

Please note I discussed splitting my dose with my GP prior to implementation (as I was still stiff until early afternoon each day when taking single morning dose). Best to check with your physician before changing how you take your pred dose.

[SheffieldJane in reply to PMRpro]

What an interesting thread! Stomach pain and upset became my worst (PMR period) symptom after 4 years and Entric Coated Prednisalone resolved the problem. For my subsequent GCA,Coated Pred plus Tocilizumab is still effective, keeping all symptoms at bay except spells of fatigue and occasional mild viral feelings.

[Linny3 in reply to PMRpro]

Thank you for the clear understanding. I take Rayos, so that is simply a delayed release pill. No protection for the stomach?

[PMRpro Ambassador in reply to Linny3]

Exactly - but I have never had any gastric effects and I've been on it about 6 years now.