Mixing Gastro Resistant and plain Prednisone

[Hidcote]

Having started on 15 mg when I was first diagnosed a year ago, I reduced by 1 mg a month until I reached 10 and then started reducing by 0.5 using Dorset Lady’s plan with some pauses to take account of building work, Christmas and other things. This has worked well and I am now at 8.5 going to 8. I have some musculoskeletal issues and need to keep active in order to do the exercises for my condition in the morning.

My GP, who has now retired, allowed me to manage my reduction which I have done with the help of all the advice on the forum and the local guidelines which he sent. When I stated to go below 10, I asked the surgery for some 2.5 pred as I found cutting 1 mg difficult. Up to now this has been plain, non coated but suddenly they have changed the prescription to coated. I take 20 mg of omeprazole because of stomach issues so don’t need coated. My understanding is that gastro resistant pills dissolve further down the digestive system. As I also have diverticulitis i am worried that this may not be good for me.

Please could someone clarify for me how the gastro resistant and non gastro resistant work and whether there are any issues in mixing them. If there are issues I can then go back to the surgery.

Many thanks for your help

[Hidcote]

I have noticed that the gastro resistant and the plain are prednisolone .sorry for the error

[SheffieldJane]

I have used both Entric coated and uncoated Prednisalone. You will find that Entric coated take between 4 and 6 hours to get fully into your system to begin working. They seem to me to be less absorbent thereby giving you a lower material dose. Although they seem to afford some GI protection I find that after 3 years use I have developed Irritable bowel and urinary symptoms. There has also been a recent difficulty in obtaining 1 mg coated tablets lately. There is very little research evidence that the protective qualities work. I relied too heavily on my assumption that it did.

Uncoated tablets take about 2 hours to enter the system from much higher up in the Digestive Tract. They must be taken with something like Greek style yoghurt or a PPI to protect the upper digestive tract. I experienced painful oesophageal spasms after a year or two of use. I did not use Omeprazole or Lansoprazole against medical advice because of reported and actual side effects. Uncoated Prednisalone can be cut for gentle tapering, unlike coated which must not be cut.

You can see that mixing the two types of Pred could be unpredictable and fraught. Your dose is usually best taken altogether in one dose although some people find splitting their dose useful, at certain stages of treatment.

I know of no shortage with plain Pred and would seek to stick to this. I would try other pharmacies if yours cannot source these for you.

I have a sharp pill cutter that cuts 1 mg uncoated tablets really well. Bought on-line from Amazon I think although I have a good one somewhere from Lloyds Chemist - it has never been an issue.

Has your GP surgery changed your prescription to coated without your say so? That is pretty irresponsible in my view and could cause patient suffering in the uninitiated.

I think you are right to have concerns about Divericulitis being aggravated by the coated pills dissolving in your lower intestine. I think this has been the probable outcome for me. I have always taken uncoated Pred with food and lots of water. I have had PMR/GCA/LVV for about 6 years. Omeprazole caused stomach upset and aches and pains and can lead to health problems. I hope this covers your questions. Happy to discuss further.

[SnazzyD in reply to SheffieldJane]

I think it should be ok though because diverticular disease affects the colon and the coated Pred breaks down in the small intestine higher up the line.

[SheffieldJane in reply to SnazzyD]

My pain radiates from the appendix area. It starts as a sharpish coin sizes pain ( always present) and spreads along the lower abdomen. The doctor believes it to be because I didn’t take a PPI. A recent internal and external CT Scan led to a gynaecologist referral ( non urgent and will take forever) to look at Pelvic Congestion. It seems very bowel oriented to me though with sporadic UTI symptoms.

[SnazzyD in reply to SheffieldJane]

Why would that affect the lower abdomen. Have you read about ileocaecal valve dysfunction? Your description of the point of pain in the right corner and the sporadic nature made me think of it. Have they ruled out any problem with the appendix?

[SheffieldJane in reply to SnazzyD]

The appendix has never been mentioned but I have had the area manually examined by 2 or 3 doctors. I will look up the ileoceacal valve . Why can’t doctors be as curious as people like you and PMRPro? One GP has decided that it’s my fault for not taking a PPI with Pred. Another doctor thinks it maybe Pelvic Congestion caused by varicose veins in that area. I have been told by yet another that a colonoscopy is a last resort because of the danger of tearing the bowel! This seems to be a change of policy. All I know is that it hurts and is definitely something causing IBS type symptoms. I feel like I am back in the “gaslight” area of pre PMR diagnosis. Thanks Snazzy.

[PMRpro Ambassador in reply to SheffieldJane]

So why aren't they planning one of the new techniques instead of colonoscopy? Like virtual colonoscpy? Or a camera capsule colonoscopy?

[SheffieldJane in reply to PMRpro]

That would be so amazing!

[PMRpro Ambassador]

The g/r tablets don't break down in the stomach because the coating on them resists the action if the stomach acid, They pass through whole and then are broken down and absorbed from the duodenum which means it is a delayed effect and then it isn't a sudden spike of pred reaching the bloodstream - it's like hump-backed bridge, it rises slowly, remains at a lower peak than the spike would achieve and then falls off more slowly too. That means it is present in the system for longer but at a lower, more sustained level. It takes about 4 hours for it to get into the blood, sometimes longer. Plain pred is absorbed quickly and forms a spike in the blood and then the level falls off.

It depends - some people find that longer presence helps extent the duration of the anti-inflammatory effect. Others find that the lower peak isn't enough at the stage they are at. Some people mix them by taking the g/r before bed so it is working by morning when they get up and then take the plain pred the to work on through the day. I don't think the diverticulitis will be a problem - the study originally was to see if g/r pred would be better for low GI tract problems as it is absorbed in that region so might have a local effect. Didn't appear to and some people didn't absorb it as well which is why they got a bit of a down on it as being unreliable. But it does suit some people well.

Why didn't you just cut 5mg tablets?