Prednisolone 1mg gastro-resistant tabs - problem with supply

[Geno24]

Hello. I’m in UK. I am currently unable to get any 1mg gastro-resistant prednisolone tablets - the pharmacy’s supplier says they have been discontinued (manufacturer is Accord) Has anyone else had problems? Does anyone know of alternative manufacturer? Thanks in anticipation.

[SheffieldJane]

Mine come from Alliance Pharmaceuticals Limited 2018, but they all expire next month.

There are articles that say that there is no evidence that they are effective or worth the extra cost, discussed in a recent thread, on here.

Following approximately 3 years use I have developed pain in my lower abdomen that I do not have a diagnosis for. I am currently wondering if Entric coated Pred has contributed to this symptom as it is in this is the area of the GI tract where the tablets would dissolve.

I had been thinking of switching to uncoated Pred now that I am taking Lansoprazole upon my GP’s assistance. I think there are possibly issues with absorption too and I am hoping that I can manage on less. This is all supposition on my part, based on reading and information on here. Not something my GP would necessarily be aware of or particularly bothered about.

I think this will be my plan B if the supplies have been run down. My secret stash for tapering will be rendered useless at the end of next month.

At least with uncoated Pred we can use a tablet cutter for half mg drops, recommended at the lower doses for adrenal recovery.

[Geno24 in reply to SheffieldJane]

Thanks for your swift reply. I have seen the differing opinions about the benefits of uncoated vs coated pred. My rheumatologist and my GP agree I should have the coated ones. I have been able to reduce my use of omeprazole while on the coated ones, and long term use of omeprazole carries its own risks of side effects. I’d rather my type of drug was decided by my rheumatologist than by a pharma company.

[SheffieldJane in reply to Geno24]

That was exactly why I opted for coated Pred but here I am with what feels like damage. The Lansoprazole seems to be giving me digestive discomfort in my actual stomach, so it’s hard to know what to do. Good luck.

[PMRpro Ambassador in reply to SheffieldJane]

Try a different anti-acid medication would be a first step. Ask for famotidine or cimetidine - do the same thing, but with different side effects.

[SheffieldJane in reply to PMRpro]

You need a doctor for that 😂. Thanks though, I’ll try.

[PMRpro Ambassador in reply to SheffieldJane]

No you don't - you can buy both OTC, at lower dose tablets possibly but you could try it without bothering a doctor.

[SheffieldJane in reply to PMRpro]

I am going to. Thanks for your suggestions. These things seem minor but they can begin to loom large.

[Karendeena in reply to PMRpro]

PMRpro on your advice I went for Famotidine, only taken it a few days but hopefully I will be ok on this as the other PPIs didn't suit me at all

[Karendeena in reply to SheffieldJane]

SheffieldJane Lansoprazole sent me on the slippery slip to GI issues. I had test after test and virtual CT colonoscopy. Found nothing, down to long term use of Lansoprazole. Now have IBS....joy. I am back on 5mg pred with a slow taper have been given famotidine which acts in a different way to PPIs so fingers crossed I will be ok so far so good

[SheffieldJane in reply to Karendeena]

My symptoms match IBS too. I have only taken Lansoprazole for a few days. At one point I felt like I had been punched in the stomach. They shouldn’t be given like smarties (candy for US friends) without some questions at least. I have had oesophageal spasms in the past that could be a contraindication. They are not appropriate for everyone. I am going to try the lower dose Famotidine that PMRPro has recommended. This avoids another confrontation with my “young” doctor. I think we have an irritable mother and daughter dynamic going on.

[PMRpro Ambassador in reply to SheffieldJane]

Doesn't have to be "low" dose - what is the dose you are using?

Prescribed, I'm using 40mg once a day - you can also use 20mg 2x daily according to the prescribing info and it seems the same for most conditions except Zollinger-Ellison syndrome whichis constant production of too much acid - you almost certainly don't have that!

[SheffieldJane in reply to PMRpro]

I haven’t got the drug yet.

Very grateful!

[Sharitone in reply to PMRpro]

How does Famotidine act differently from Omeprazole, please?

[PMRpro Ambassador in reply to Sharitone]

The mechanism by which they work. Famotidine is an H2-antagonist while omeprazole stops a pump in the cells.

"Famotidine works by blocking a substance called histamine in the stomach to decrease acid production."

"Proton-pump inhibitors are a class of medications that cause a profound and prolonged reduction of stomach acid production. They do so by irreversibly inhibiting the stomach's H⁺/K⁺ ATPase proton pump."

They do the same thing, reduce acid production, but in different ways.

[Sharitone in reply to PMRpro]

Thanks. Does this mean that Omeprazole has permanent side effects and Famotidine does not?

[PMRpro Ambassador in reply to Sharitone]

No, I don't think it works like that. I imagine that the receptors renew over time and the effects reverse. Don't quote me though. People who have stopped their PPIs also recover from the problems

[Karendeena in reply to SheffieldJane]

SheffieldJane I think you are right. See my post, my friend who is a chemist and owns a pharmaceutical company informed me the same

[SheffieldJane in reply to Karendeena]

You mean about the difficulty in getting Entric coated Prednisalone and the fact that they are expensive without much evidence to support their use? I have been told they are unavailable at Waitrose Boots today and that I will need a new prescription for uncoated 1 mg Pred. It’s a good job I have some in hand but they all expire on the 22 April.

[Karendeena in reply to SheffieldJane]

Hi SheffieldJane, I was referring to the so called 'benefits' compared to non-coated pred. My Chemist friend agrees with the science that there is little evidence to support they are any better and that they may hinder absorption too

[SheffieldJane in reply to Karendeena]

Yes I thought you were. Although it could just be lack of funded research. I was told this about Methotrexate which is more shocking really given how reliant Rheumatologists are on it for GCA/LVV and PMR steroid sparing.

[Highlandtiger]

Someone got them just the other day and posted on here. Have a look at recent posts. The new expiry date is October 2023 apparently. So they do exist!

Someone else posted a few weeks ago giving details of the manufacturer and so on and what the plan was after the expiry date of April 2022 on the current ones.

[Highlandtiger]

healthunlocked.com/pmrgcauk...

Here's one of the posts I mentioned. See

joyce69 post half way through the thread for details of manufacturer etc.

[Geno24 in reply to Highlandtiger]

Many thanks, this is useful. I’ll follow up with the pharmacist.

[piglette in reply to Geno24]

It was true that they were not available as I believe there was a manufacturing problem. They are back again now. Not many people seem to have the 1mg so perhaps your pharmacist remembers when there was problems.

[Geno24 in reply to piglette]

Thank you. And thanks to all for your responses. I checked again with my pharmacist and they have today received a new batch. Hooray! 😅

[piglette in reply to Geno24]

It is always worth checking. The number of times I have just been told No as it is easier!!

[Highlandtiger in reply to piglette]

It seems to happen every time we approach the expiry date of each batch. They only manufacture one batch at a time and the expiry date is approximately 18 months on from the previous one. So the problem arises when pharmacies understandably won’t dispense meds that are about to expire but haven’t received the new ones yet. Also pharmacists sometimes have to ring round different wholesalers to source these ones. I know mine did last time after I provided her with information I found on here. Good pharmacists should be able (and willing) to do this.

[diana1998]

I haven't been able to get them either so switched back to uncoated without any problems.

[1602]

I got some this week but was told several months ago by new GP that 5mg no longer available. Now in England as opposed to Wales. There you go. Take care x

[PMRpro Ambassador in reply to 1602]

I would suggest that isn't true! A doctor trying to get out of something more like!

[1602 in reply to PMRpro]

I was told they are on the black list?

[DorsetLady PMRGCAuk volunteer in reply to 1602]

Really? Whose black list?

[1602 in reply to DorsetLady]

No idea, not been an issue up to now as brought a supply with me. Que Sera

[DorsetLady PMRGCAuk volunteer in reply to 1602]

I think maybe they have a shortage at times -and then doctors/pharmacists go into a panic.

Much like lots of other things over the last 2 years!

[PMRpro Ambassador in reply to 1602]

B*££^(&s or something ... Except maybe for that practice.

[Hildalew]

Have you ever tried using good, plain, 'live' yoghurt as a 'protector'?

I swear by goat's milk* 'live' yoghurt which I 'take' when I take my Pred. (*not cow's milk because, my system reacts badly to large quantities of 'commercially-produced' cow's milk.) And I have not, so far, in three and a half years on Pred, suffered from digestive problems.

I should mention that I don't take any other medication. (In spite of the rheumy, a young GP and a pharmacist wanting to put me on Omeprazole).

So my digestive system is presented with the challenges of only some fruit and veg, eg tomatoes, which I sometimes simply can't resist eating although I know they result in slight variations of events in the loo!

PS I have toyed with the idea of vegan yoghurt but haven't done enough research on whether they have the same 'cultures' in them and haven't pushed myself because they are more expensive.

[Polymialgia]

I too have managed to avoid any stomach problems by taking my prednisone after full fat live yogurt

[SheffieldJane in reply to Polymialgia]

I have echoed that many times - the Greek style thick yoghurt. However, I have had Prednisalone for 6 years now and for the first time I have developed GI symptoms that have lasted every day for over 2 months. It would be surprising if the two things are unrelated. When I resisted Lansoprazole the GP said “do you really want an ulcer that bleeds out”? No steps to investigate whether I have an ulcer are being taken though.

[Karendeena]

I asked about these as I am on am anticoagulant I was told scientific studies have found that there is no difference in terms of risk compared to ordinary prednusolone, in fact enteric coated are not so well absorbed (confirmed by a close friend of mine who manufactures these in his pharmaceutical company). I stick with ordinary pred