Missed dose and Adrenal Failure

[Loco99]

I hope that someone has experience of this and can help.

I take 5mg of Prednisolone daily and have done for over ten years. I have never missed a dose until now but due to a supply problem at the online pharmacy I use and problems with the NHS computer system I am in real danger of running out of tablets!

Is the danger of adrenal failure serious when you are taking a low dose of Prednisolone or would it be safe to miss a few days worth of tablets? What would the likely side effects be?

Can Prednisone be taken instead of Prednisolone?

I’m really hoping that I can sort this out today over the phone to my GP’s surgery and the pharmacy and don’t have to resort to missing doses but any information would be most welcome.

[SheffieldJane]

Gosh yes it would be dangerous to miss a few doses of Prednisalone and put you at risk of an Adrenal crisis. The Pharmacy will know this and should prioritise your need. Prednisone is the US version of Prednisalone. There are differences but both protect you against an Adrenal crisis. Can’t your doctor provide you with a prescription to use in any Chemist? As far as I know, there isn’t a general shortage in the U.K.

[PMRpro Ambassador]

Yes - at 5mg you are at the real borderline where production is still suppressed and the adrenals are very unlikely to be producing any. You must not stop it suddenly or you are at risk of an adrenal crisis:

uclahealth.org/medical-serv...

If you go to a local pharmacy and explain the situation they should provide you with an emergency supply - it is one of the reasons that using your local pharmacy is a distinct positive - they know you and your needs. On an online pharmacy you are just an account number - and the computer doesn't know that you almost certainly have adrenal insufficiency after 10 years on pred. By using your local pharmacy you are contributing to keeping it in business in the long term and they will usually look after you as best they can.

[Loco99 in reply to PMRpro]

Thank you very much for the helpful information. I have managed to get my prescription filled in the nick of time.

I wish I could get my medication from a local pharmacy but they are few and far between where I live and are often closed because of a shortage of pharmacists. I changed to an online pharmacy during the Covid pandemic due to long queues and insufficient social distancing at the nearest local pharmacy.

The online pharmacy usually works very well but occasionally they drop the ball and run out of something - usually my prednisolone! One more slip up and they are out!

[PMRpro Ambassador in reply to Loco99]

Oh yes, I know the pitfalls in the UK. My grandson is traing to be a pharmacist but slightly dropped the ball over an OSCE exam last year which was an essential to proceeding to the next year and he can't continue and sit it again later so all delayed by a year. Still - he learnt that mum DID know what she was talking about in this particular case!!! After all, she has sat enough of them ...

[nuigini]

"Can Prednisone be taken instead of Prednisolone?"

As far as I know they are equivalent, but processed differently by the body.

I ran into difficulty while out of the my home country during covid and replaced prednisone with prednisolone without any difficulty.

[PMRpro Ambassador in reply to nuigini]

Oops missed that!!! Thanks for reminding me!

The doses are identical for prednisone and prednisolone. Prednisone must be processed by the liver to produce prednisolone which is the active form of the drug,