Mixing coated and uncoated pred

[Noraflorence]

Another question that I think I have seen the answer to somewhere here but as I have just booked a consultation with the GP I would like to be sure of my ground before we have our conversation!

Having been 'diagnosed' with GCA in April 2021 and started on 40 mg.

I am gradually reducing my pred, currently on 10 mg and have been having the enteric coated tablets (2,5 and 5 mg). I am now going to 9 mg and have been given 1 mg tablets in non enteric coated form. Having spoken with the pharmacist he says that the enteric coated 1 mg are available but difficult to get hold of. ( also more expensive I imagine), He thinks however the GP can request these. I am concerned about the non coated ones as I am not taking any stomach protecting medicine since the consultant says she never prescribes this as it's not necessary.

1) Can one mix coated and non coated tablets?

2) If taking non coated is it essential to have a stomach protector and if so which one is recommended?

Thanks in advance. I feel totally abandoned having had my next consultation postponed til Feb, to muddle my way throught this minefield and so thankful for everyone here.

[PMRpro Ambassador]

You can mix them and I found that the small numbers required to make up the dose didn't bother my stomach at all. Taken with yoghurt or in the middle of a meal they are probably fine but everyone is different so you would have to try and see how you get on. She is quite right about not needing it for enteric coated - in fact, you shouldn't take a PPI and enteric coated pred as it could mess up the absorption.

The main problem is that e/c takes at least 4 hours to be absorbed and sometimes as much as 7 hours - they pass all the way through the stomach to the lower GI tract before being absorbed. Plain white pred is absorbed in an hour directly from the stomach. You can account for that by taking the e/c before bed and the plain white pred early in the morning which gets the two peaks closer. OTOH, taking it before bed is likely to give you a good morning, and then you can take the plain pred with breakfast to extend the duration of the antiinflammatory effect.

Once they work out where to get the 1mg e/c it isn't that difficult - we have had a lot of discussion about it in the past for various reasons! Small independent (if there are such things these days) are usually better about it - and Boots has a poor reputation!

[Noraflorence in reply to PMRpro]

Thank you I shall have to work out a timetable! My pharmacy is a small local one which might be helpful.

[Portobello in reply to PMRpro]

Is it ok to take an H2 blocker with e/c Pred? Trying to get from 2 to 1.5 using DL's method and suffering from horrible acid reflux. Take 1mg e/c at bedtime and 0.5 plain with breakfast. Thanks in advance.

[PMRpro Ambassador in reply to Portobello]

Hmmm - not sure but I'm pretty sure that they would be included in the warning against antacid medications.

If you have severe acid reflux at that dose - has it been investigated? You can't always blame pred and PMR.

[Portobello in reply to PMRpro]

You're right of course. Had a video consultation with gastroenterology earlier this year. He diagnosed GORD and suggested H2 because I also have osteoporosis. Beginning to wonder if it's a hiatus hernia. Not constant though- comes in bouts. Difficult to relate to specific foods. 😏

[PMRpro Ambassador in reply to Portobello]

Difficult isn't it - have you kept a food diary? Sometimes it can be other factors though - like stress and not always something you'd identify as stress.

[Portobello in reply to PMRpro]

Must try a food diary- lazy. And I like what I like 🙄, You may be on to something re "stress" though. Many thanks, as always.

[PMRpro Ambassador in reply to Portobello]

Could be as banal as being in a hurry to cook/eat or feeling pressured to get something done.

[Portobello in reply to PMRpro]

Will give this more thought 👍

[SnazzyD]

I used a mixture when I couldn’t do the maths without being able to cut through a 1mg. I just gave my enteric coated a 4-5 hour head start. The small amounts didn’t affect my stomach and I made sure I had the non coated with a meal.

[Sharitone]

I feel my experience may not be scientifically justifiable, but in case it helps: I have e/c 1mg and 5mg pred tablets, but the 2.5mg are not e/c. I have gone down from 14.5mg to 14mg, simply to avoid using the 2.5s because my stomach got sore. I had a week or so of taking the pred in the small hours with yogurt or kefir, and that was great for the stiffness, but lousy for the stomach, which inflated. There was no prob with getting the 1mg e/c; in fact, nothing else was offered - a pharmacy chain.It seems there is nothing for it but to try various types of tablets, and times of taking them!

[Noraflorence in reply to Sharitone]

Thanks Sharitone looks like trial and error is the best option.

[Koalajane]

My tablets are non coated and I take them with my breakfast. I have not been prescribed a PPI and had no problems in nearly 5 years

[SheffieldJane]

It is worth shopping around for 1 mg Entric coated tablets. I have no trouble at all at the Boots consession in Waitrose. The alternative has been explained. Before I moved on to Entric coated I used to take my Pred with live greek yoghurt and honey. No problems for 4 years.

[PMRCanada]

I take a split dose of pred….6mg plain tablets stuffed into an enteric capsule at 11pm (as we don’t have enteric coated pred here in Canada), and 3mg plain uncoated with yoghurt at 11am. I don’t take any stomach protection medication, no need.

Not sure about taking coated and uncoated all in one dose as they are processed/absorbed by the body differently.

[Exflex]

I’m taking a mix of e/c and uncoated Pred and have for some time. The e/c’s are in 2.5mg and has allowed my 0.5mg reductions. (I’m using DSNS.) Currently on 5.5mg and at some point, sub-5mg, I will need to start splitting 0.5mg tabs, but even if not precisely cut the averaging effect over 2 days will counteract the impression.PS I still take Omeprazole and haven’t noticed any contraindications... yet!