Coated versus uncoated Pred

[Zebedee44]

I have finally managed to get some 2.5mg coated pred tablets to aid my tapering from 8mg to 7.5 mg, taking the 2.5 at bedtime and the 5mg first thing in the morning. I’m using a slow taper process and currently alternating the bedtime dose 2.5 coated / 3 x 1mg

But I’m finding myself in considerable pain on the days I take the lower dose, mainly in my groin area, feet, hands and shoulders. And a constant dull headache.

I’m wondering if anybody else finds that the uncoated tablets are more effective than the coated ones or that the two types don’t work so well together. Would it be better if I split a 1mg tablet to achieve the 2.5mg dose?

[Rugger]

The only way to find out is to try it for a while and see if you notice any difference in your pains when you use the uncoated tablets vs the coated.

It could be that your body is complaining about the drop to 7.5 from 8mg. Rather than alternating 2.5 and 3mg, maybe try the DSNS taper which is even slower.

Trial and error! Slow but sure.....

🌻

[PMRpro Ambassador]

Are the 5mg tablets plain pred? If it were me, I'd start by taking the 8mg dose for a bit longer to work out how that feels - taking the 2.5mg coated tablet before bed and the 5mg as normal. The 2.5mg at bedtime won't be doing much until early morning but should make a start on the morning inflammation before you top it up. But it is perfectly possible that 8mg is where you need to be still - even 1/2mg can make a big difference.

[Zebedee44 in reply to PMRpro]

I am forcing myself to try this taper after three years on 8mg, having finally managed to get the coated 2.5mg from my new GP practice (not issued by the previous practice) and quite shocked at the resistance of my body to accept this tiny reduction. I thought the coated tablet would work better on the release of cytokines but It’s almost as if I was omitting the evening dose completely. Still fine on the nights I take the full 3mg.

I shall try as RUGGER suggested with 2 and a half 1mg tablets over an extended period and see if that is better. Maybe my body doesn’t like the coated version.

[PMRpro Ambassador in reply to Zebedee44]

Perfectly possible - I was fine on the coated version for a long time then picked up a new prescription from the UK which turned out to be large tubs of loose tablets instead of blister packs as they had always been. The new 5mg tablets were useless - I flared in a couple of days. The same dose of 2,5mg tablets was fine - there was definitely something dodgy about the 5mg ones. But of course I was going through them at a rate of knots. That resulted in having to switch to methyl pred here - no prednisolone at all and the only prednisone is Lodotra which wasn't on offer at first. My 7 or 8 months on Medrol were absolutely awful - it didn't work as well for me either, even 20mg taken before bed didn't give me relief until early afternoon. And the side effects were even worse! Once my GP suggested Lodotra I went from 20mg Medrol that did not a lot to 15mg Lodotra that produced the same minor miracle I'd had originally with prednisolone in the UK. And no side effects.

[Zebedee44 in reply to PMRpro]

You have certainly had a huge amount of experience in managing PMR one way or another and I think we are all lucky to benefit from your experiences, especially when you don’t have the benefit (!) of the NHS free treatment and prescriptions.

[PMRpro Ambassador in reply to Zebedee44]

Most of it is free - and prescriptions are not expensive. Just you have to pay a contribution if your income is high enough unless exempt - most chronic illness is exempt, but PMR isn't! I also get things here I wouldn't get in the UK so it all balances out.