Sorry if this seems a stupid question but why is it only the plain tablets that can be cut? A scenario comes to mind where a GP might choose to only prescribe the coated ones if they don’t agree with the dead slow taper?
Thanks in advance x
The cutting of 1 mg tablets: Sorry if this seems a... - PMRGCAuk
The cutting of 1 mg tablets
63 Replies
•
I think coated ones are prescribed when the patient has indigestion problems, or would benefit from taking the prednisolone at night to get a head start on the cytokines dump in the early morning. not really to aid tapering.
• in reply toMary63
Thanks Mary, that makes sense. I suppose I’m anticipating probs with my own GP when I get to the point of going slower than 1mg at a time, she is very much against me going at my own pace!
Lindaracha• in reply to
Get a new doctor!
From the very beginning, my doctor listened to me, telling her about this forum that I found, and that I've been doing a lot of research on my own, and she has been very supportive of me in my tapering down. Over the past 4 years since I first got PMR, I've actually been telling HER what I want to do, and she almost always completely supports me! I had already fired two rheumatologists in the very beginning... neither of them knew ANYTHING about the DSNS method. My doctor is young, intelligent and open-minded. I'm so lucky to have found her!
...and thank YOU, all you PMR Aunties out there, for ALL your expertise and guidance! You've been a life-saver in helping me get through this horrible curse!
( Started at 15 mg in January, 2018, after suffering through 3 months of debilitating pain and fatigue; now getting ready to taper to 3.5 mg. from 4 mg. Yay!)
Best of luck and success to you, Mazeyq! 🤞
PMRproAmbassador
Because the coating on the outside is to protect your stomach from the irritant effects of pred - it is acid resistant so the entire tablet passes through the stomach to lower down the gut where the environment is more alkaline to dissolve the outside of the tablet and release the pred. If you cut the tablet the pred is exposed so could irritate the stomach. You CAN cut them but you lose that protective effect - but that's the same as taking plain pred.
• in reply toPMRpro
Thats a way round it if necessary, thanks
DorsetLadyPMRGCAuk volunteer
The uncoated ones can’t be cut because they are in a protective coating to avoid issues with your digestive tract…..so if you cut them that defeats the object.
But from what we seen on here, GPs seem to be actively discouraged from prescribing them, and according to one prominent Rheumy (Dr Saravanan) in a reply to a question regarding enteric coated tablets - following his webinar last month - and I quote -
“We have gone off enteric coated due to both cost and reliable supply more than a decade ago. Our practice is to prescribe non-enteric coated mainly. There is no reliable evidence to say enteric coated prevent gastric side effects.”
If you are following a slower taper it doesn’t matter what tablets you are using. Both sorts come in same sizes, so you mix and match….only issue is when you need to take 1.5mg or 0.5mg when using coated.
Except the figures applicable a decade ago about price no longer applied very shortly afterwards when the manufacturers of plain pred put their prices up considerably!
There had been a consultation about it and many GPs just shrugged and said OK - until they stopped prescribing the e/c stuff and had loads of patients returning to complain about what felt like small rodents having a nibble at their stomach having been fine before. Patients on short term pred are probably fine but for a lot of long term patients the e/c pred made such a difference. And of course it is the GPs who have to deal with that side of things.
I saw that reply too! I had hoped we could keep it quiet! 😉I asked my pharmacist previously and her view was that GPs "try and get away with prescribing the uncoated ones if they can"...
• in reply toDorsetLady
Thanks for your reply. I’ve a way to go before I need to worry about it but find my GP’s attitude quite irritating!
Rugger• in reply to
With gastro-coated tablets we don't have to worry until we need a 1.5mg dose, then a 0.5mg dose. The 1, 2.5 and 5mg tablets allow us to take any dose down to 2mg, then 1mg of course.
I'm just starting to taper from 5mg to 4.5mg, so this morning I've taken 2 x 1mg tablets and 1 x 2.5mg tablet - all gastro-coated. (That supposes your GP will prescribe all 3 tablet strengths! Mine does and trusts me to re-order just what I need.)
Best wishes.
I changed to ec because I was diagnosed with severe GERD in spite of 40 mg PPI. My GP was a bit reluctant because he said his patients had said they didn’t make a difference . But he usually works with me so I changed and I have noticed a difference. My question is that I am doing well after a bad flare and want to go very slow and take .5 or even .25. Is that enough to irritate my stomach if I take with food. I expect it will absorb at a different time.
That small amount should be okay I would have thought (really depends how sensitive your stomach is!) - maybe take with a couple of spoons of thick yogurt….and yes they will absorb at different times. But of trial and error required probably.
Thank you for your reply. You have been so helpful and supportive through my recent severe flare and GCA scare. It’s taken 10 months but I am so much better. All blood tests normal including HBA1c, fatigue lifted. I still have scalp pain, we now think from a pinched cervical spine nerve, and of course the OA is playing up as I take less steroid but it is nothing compared to the pain and fatigue of PMR. Thanks again.
You’re very welcome…that’s what we are here for…..🌸
Down to 2mg you can reduce 1/2mg at a time by combining 2,5mg and 1mg tablets for the 1/2mg doses. E/C comes in 5, 2.5 and 1mg tablets.
Thanks. I am on 13.5 now. The 2.5 drop was too much. It’s been a struggle from 30 mg. my inflammatory bloods were very high and rising. I finally turned the corner at 30 mg. I am thinking ahead to when I might want to drop 1/2 for a month if struggling. I am in my sixth year and I am desperate not to have that fatigue again. I have learnt so much from the group but it’s so nice to have “turn to” people.
13.5 = 2x5 + 2.5 + 1 and so on ...
It seems a lot of GPs prefer the uncoated ones as they think they are cheaper. Won’t yours prescribe uncoated? I cannot see that they would mind. With the dead slow taper you can get down to 1mg on the coated ones.
Forgetting that with plain pred they usually need to prescribe a PPI too - which costs a similar amount to the pred and entails an extra dispensing fee for the pharmacy. When you add it all up - the difference is pennies. But the major benefit is to eliminate the adverse effects of the PPI ...
Looked online and couldn't find any logic in the pricing. Cheapest of all are the 5mg, either plain or coated, followed by 1mg plain and 2.5mg coated. most expensive of all 1mg coated. It is not a costly drug.Fortunately my GP is very relaxed and lets me tell him what suits best, though he is not prepared to prescribe more that 4 weeks worth at a time.
The 5mg is cheapest because they use a lot so the manufacturers can set up a run and produce loads and quantity means economy. We are about the only people who want 1mg coated - small demand so relatively expensive. The current manufacturers only took it over last autumn - the previous lot obviously decided it wasn't worth the effort.
Thank you, PMRpro, for that perfectly logical explanation! I hadn't thought of the low demand aspect. Clearly the ingredients cost practically nothing - even more of a miracle drug.
• in reply toPMRpro
That’s interesting but fancy us not being worth a company’s effort.....!
• in reply tobussell
You’re lucky with yours, mine is a pain!
I clearly have been really lucky in that my 5mg and 1mg tabs are all EC and never had any resistance from my GP prescribing them.
Thankyou everyone, I always learn something interesting or relevant here
Just for interest sake this is the current NHS England Drug Tariff prices for Prednisolone So this is the price on which pharmacies are remunerated. Note that 2.5mg enteric coated are cheaper than plain tablets.
NHS England DRUG TARIFF.
Reflecting that 2.5mg plain are rarely required - not least because even pharmacists aren't aware they exist! - but 2.5mg e/c are standard and have been all along.
• in reply toHamishPMR
I hate to ask but so curious. Why would anyone need a 20mg prednisolone foam enema?
MrsNails• in reply to
patient.info/medicine/predn...
• in reply toMrsNails
Oh my! I’m so very ignorant when it comes to things medical. Thanks Mrs Nails.
MrsNails• in reply to
You can’t be expected to know if you’ve never come across it in your own experience but in this case it’s used in the specific area; like a hydrocortisone cream would be applied topically to the skin or an inhaled Steroid into the lungs for an Asthmatic. For us the inflammation is in our muscles so the oral route is good for us. We learn something new every day 😉
Hi my Gp called me yesterday and I said I was tapering slowly and she said no 12.5 down to 10 now Iv been on 12.5 2.5 weeks I told her the advice from this site and she said oh you shouldn’t be listening to a Facebook page 😂I said it’s not a Facebook page and explained. But she insisted I follow what she said so I said ok. But I’m not I’m tapering slowly coz I really don’t want to go back to constant horrible effects of pmr.
• in reply toUglow
Can relate to your experience absolutely, your GP sounds just like mine! So frustrating when she insists she knows best in spite of everything I’ve tried to explain to her.
I am fortunate enough to be on a low dose of prednisolone and I find the 5mg tablets easier to divide up than 1mg tablets. At present I am taking 1/4 of a 5mg tablet a day. And I adjust slightly up or down according to what is working best for me. I always take it with my porridge to avoid gut problems.
• in reply toCjcc
Are yours the uncoated ones Cjcc?
Cjcc• in reply to
Yes uncoated 5mg are easy to cut.
I’m really lucky. My GP is brilliant. We’ve discussed tapering and the schedules on here at length and she lets me order what I want … I am cutting plain 2.5s and 1s as necessary to come down in 1/4mg increments … slowly … and so far, touch wood, it’s going relatively ok 😊
• in reply toLookingforideas
Lucky you 👍
I don't cut the 1mg. I use half of a 5 mg plus the right number of ones whole to make the dose.I have indigestion problems.
You can get 2.5mgs
Thank you - will request them next time.
Make sure you get the same type as your other tablets - 2.5mg tablets can be enteric coated or plain
Hi MazeyqI am reducing down from 2 mg to 1 3/4 ha ha !! So I have a pill cutter and cut the 1 mg in half then in half again, it’s a bit fiddly so looking forward to getting down to 1 1/2 mg xx
Wish they did different sizes
Best wishes
The 2.5mg split very easily so will give you a 1.25mg dose 😉 to make up the dose you require.
• in reply toMrsNails
Thanks Mrs Nails
I didn’t know you could get 2.5 mg . I’ll ask next time I order thank you x
You may have to educate them - they might have to look it up. And both enteric coated and plain pred are available as 2.5mg doses.
Sometimes the GP’s aren’t aware of them & the Pharmacist may have to order them in but they are most definitely available & they are a different colour too 😉 like a pale straw/yellow. You just need to remind GP that you don’t want the E/C 2.5mg (Enteric Coated)
• in reply to9lives
Me too. Thanks 9lives
MAZEYQ. OK I know a lot has been discussed on this following your post. Very informative and thank you so much all contributors.I have been on a very low dose of 2.5mg (much higher when first diagnosed) now tapering to 2mg, then down over weeks to 1.5mg (under instructions of GP) and then lower.
The 2.5mg were always coated (not at my request) so I was prescribed a PPI (Omeprazole) of 10mg a day. The 2mg dose is 2x1mg is uncoated, so I take 20mg of .Omeprazole.
The 1mg tablets are just so hard to cut in half - and yet this tiny amount seems to make so much difference if you are trying to come off Pred.
WAKE UP PHARMACY INDUSTRY!
They have woken up - when I first started on pred there was no enteric coated 1mg dose but it was introduced in 2016, despite not being really financially viable. At such a low dose cutting plain tablets is unlikley to cause problems. The demand is tiny - probably not more than us with PMR in the UK since enteric coated isn't available anywhere else in the world and there are other ways of getting round it.
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