Problem with different make of prednisolone

[mychilddoll]

Hello all, I have been taking prednisolone now since December 2022 and my chemist has now given me a different brand, I am taking 13 1/2 mg. trying to taper slowly as finding it difficult, was on 15mg got to 12 1/2 and had return of pain so went back up a bit. I included a 1mg of the new ones with my last dose and feel really awful, can't believe it, legs like jelly, neck and shoulders painful, hips stiff, and feel dizzy, can this 1mg change in brand have caused all this. Anyone know how I could get the ones I have been taking for over six months and have got used to, as much as you do get used to, but don't want to feel like this on a different brand, the pharmacist at surgery just tells me to ring around chemist shops , we only have two in our small town and I can't travel miles to others.

Feel like I was when starting on Pred. Be glad of any help with this, thanks in advance

[piglette]

It could be that the 2.5mg drop was too much for you and you had started a flare and the extra 1mg increase was not enough to hit the PMR on the head.

[mychilddoll in reply to piglette]

Thanks, don't think I explained right, been reducing slowly from 15 last December to 12 1/2 by May this year but pain returned so went up to 13 1/2 which seemed ok till I took a different brand of pred, just 1mg in with the rest of my original tablets, I can't believe how it's affected me, don't know how to get more of my original brand as almost run out, five days left, thought if I introduced the new ones slowly I would manage ok, have to say I have problems with most medication the older I have got.

[PMRpro Ambassador]

The most likely problem with a different brand is that you have reacted to the fillers being different but I'm surprised it was that much with such a small dose.

DId you mean you were tapering from 15 to 12,5 and it didn't work? Like piglette, I'd suspect that change in dose was simply too much and the 1mg increase wasn't enough.

What a helpful pharmacist - NOT! He could have phoned the suppliers for you,

[mychilddoll in reply to PMRpro]

Thanks, sorry seem to have said it wrong, I started on 15mg last December, tapered to 12 1/2 by May but pain returned so increased to 13 1/2, was supposed to taper again from today but after taking 1mg of new tablets with the rest of dose still of the original ones I feel so dreadful, just like I did at the beginning of this. not sure what to do. Will run out of my original pred in five days, so only have the new ones then. I will try to get the GP surgery pharmacist on Monday but she will say to ring around chemists who say they only get delivered whatever comes in and can't specially order for me, this happened with another medication a while ago.

[Kendrew in reply to mychilddoll]

Are the old ones and new ones both gastro-resistant OR non gastro-resistant OR a combination of both?

[mychilddoll in reply to Kendrew]

They are both non gastro resistant, just a different brand, seems the chemist gives whatever they get sent and can't order specifically.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

I see what you are saying but when did you increase to 13.5mg?

What we are trying to say is that the increase of 1mg may not have been enough to get things under control and you would have felt rubbish by now whether on you were on the old or the new brand of 1mg tablets.

PS

Plus looking at previous posts you do seem to have struggled pretty much from the get go, so I would be blaming uncontrolled PMR rather than different brand of Pred….so maybe just coincidence…

[mychilddoll in reply to DorsetLady]

Thank you for reply, have been feeling pretty ok for weeks now with occasional very tired day but nothing like this until got to 12 1/2, then upped it to 13 1/2 and felt better again, still on 13 1/2 so decided to introduce new ones slowly that's why I took 1mg with my usual pred and had this reaction, I am not very good with tablets and often have bad reactions to things, just glad it wasn't the complete dose I took of these new ones. Will have to get back to surgery pharmacist but she is not much help nor is GP. Have considered contacting maker myself to see if they can suggest anything.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Okay -well you may be correct in thinking it’s different brand - but just monitor things-and hope you can get your usual ones.

[PMRpro Ambassador in reply to mychilddoll]

That isn't true. If the GP specifies a brand of a drug - they are supposed to get it for you.

[mychilddoll in reply to PMRpro]

I will have to ask again if they can get it for me, don't hold out much hope. The surgery makes up prescriptions for anyone who is over five miles away so I might ask if they can order correct ones for me, thanks for reply

[Kendrew in reply to mychilddoll]

I have to agree with Pro. A couple of years ago we had an issue accessing 1mg tabs. Some pharmacies were telling us they were no longer available. I did some research and contacted the manufacturers and what had actually happened was that they'd repackaged the 1mg tabs and to order them the pharmacy needed the new PIP number. I tell you all this because the pharmacy should order whatever the GP stipulates and can do so by simply using the appropriate pip number. I suspect cost may come into yhis!!

[mychilddoll in reply to Kendrew]

Yes I think it is cost as well, the pharmacist at chemist's was not helpful, think I will go in and speak to them, thanks for that tip about PIP number, good idea.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Doubt it’s cost - I’ve just looked at prices -most are the same.

That only comes into play when comparing gastro-resistant to plain tablets …

Edit -

just read HamishPMR reply, so I’ll defer to his knowledge on this.

[mychilddoll in reply to DorsetLady]

Thanks, my chemist just says they take what is sent to them so seems they don't order specific brands, will ask why they can't get them for me or change to Boots which is only other one near me and see if they can do better, last time we had to ring around all over the place to find that local Boots had a packet I could have.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Don't need all that stress when on meds.... thought they were there to provide a service. 😏...oh sorry, silly me!

Hope you get it sorted..

[mychilddoll in reply to DorsetLady]

Thank you

[Kendrew in reply to mychilddoll]

Which steroid tablets (that worked for you) were you taking?

[mychilddoll in reply to Kendrew]

They are from STRIDES PHARMA UK on the packet. Just been given contact address so will try to get in touch if no joy with chemist tomorrow, non of this should be down to me to have to do really, my surgery should be helping with this surely.

[Kendrew in reply to mychilddoll]

Yes they should so keep on at them explaining your situation. Hopefully they'll eventually act on it.Wishing you luck.

[mychilddoll in reply to Kendrew]

Thanks, seems it's all down to me to find a chemist that can order the right ones, not happy at the lack of help from surgery, back to same problem today only got two days 5mg left now.

[mychilddoll in reply to Kendrew]

Thank you

[superses in reply to PMRpro]

Afraid not...Pharmacists are reimbursed at Drug Tariff prices since prednisolone 5mg tablet is in part VIIIA of the drug tariff. (reimbursement price is fixed)Brand names added to the generic name will be ignored by the Pricing Bureau. Brand names would need to be specified separately but supply can be erratic . Pharmacy wholesalers generally do not offer the ability to specify manufacturer/brand for generic orders.

[PMRpro Ambassador in reply to superses]

But GPs CAN specify a brand - it has been the case with Zentiva hydroxychloroquine for some years as some patients don't respond to other brands. No point giving a patient a drug that doesn't work for them. Pharmacists don't LIKE it as it costs them.

sps.nhs.uk/articles/prescri...

[BlueLara in reply to PMRpro]

My pharmacy (Boots branch) simply cancels the prescription if they haven't got the brand in stock and tells me to go back to the surgery to ask for a generic or different brand. I have had to do this with two different medications recently. The prednisolone is a generic prescription but this has not caused a problem so far.

[mychilddoll in reply to BlueLara]

That's not very helpful, I was going to try our Boots branch, only got two 5 mg left and getting very worried, I put in for my prescription last Monday but takes so long to get them it was almost the weekend before I knew I had a problem so by today that's what I have left with a few 1mg. Waiting now for surgery pharmacist to ring back not that she is much use but have to follow procedure.

[mychilddoll in reply to PMRpro]

Wish my surgery would be more helpful, only got two days 5mg left and trying to find somewhere to supply again today

[PMRpro Ambassador in reply to mychilddoll]

It really isn't good enough - you must not stop pred suddenly, you could become very unwell.

[mychilddoll in reply to PMRpro]

I know, my chemist has one pack of 5mg which I am hoping I can have tomorrow if the prescription has been sent to them today, I don't understand why they can't get them in for me.

[mychilddoll in reply to superses]

Thanks for the info about ordering

[Mayadill in reply to mychilddoll]

Emergency supply

nhs.uk/nhs-services/prescri...

[mychilddoll in reply to Mayadill]

Thank you I will read this properly in the morning when brain working better.

[Fifegran]

I have the same brand all the time after trying others which gave me an upset stomach due to the fillers. My GP put the information on my script that I must have this certain brand and, if the pharmacy don’t have it, they phone around to get it. I don’t know about other places, but here in Scotland, it is the pharmacy’s job to obtain this for you, it’s not up to you to phone around! Stick to your guns, say these others don’t agree with you. I know what it’s like and am sorry you have this problem.

[mychilddoll in reply to Fifegran]

Thanks for your reply, I will speak to pharmacist at doctors surgery again, she did that with another medication Ihad problems with but chemist just said they got whatever came in and that was that, they couldn't order specially, they all seem to be chains these days no independant chemists shops any more who would likely be more helpful.

[HamishPMR]

Do you remember which is the brand that you were happy with?

[mychilddoll in reply to HamishPMR]

Yes, it's STRIDES PHARMA UK, think I may try to contact them and ask why I am having this problem, they may be more use. Thanks for your reply

[HamishPMR in reply to mychilddoll]

Your problem arises because nearly all, perhaps all, draw their stocks daily from their wholesalers. These wholesalers will be doing "deals" with the generic companies SOLELY on price, no other consideration.

[mychilddoll in reply to HamishPMR]

Totally agree with you on that, thanks

[HamishPMR in reply to mychilddoll]

Accord UK is a BRITISH manufacturer of generic tablets and can be trusted. Many of the other brands are Indian.

[mychilddoll in reply to HamishPMR]

Thank you, as far as I can work out they are from a British manufacturer

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Try this - if you haven't already found -

stridespharma.co.uk/contact...

[HamishPMR in reply to DorsetLady]

Yes they supplying the two main wholesalers AAH and Alliance.

[HamishPMR in reply to DorsetLady]

I see that Strides manufacture in Pudacherry in India, nice place. Accord are in Devon, used to called Cox Pharmaceuticals who had a great reputation. Many years ago they manufactured Lasix 40mg for Hoescht at about £50 for 500 at the same time supplying Frusamide 40mg at £1.50 for 500. I always told GPs about price differential but they still prescribed Lasix. Hey ho, old memories.

[mychilddoll in reply to HamishPMR]

Thanks, and I thought they were in this country.

[mychilddoll in reply to DorsetLady]

Thanks very much, will have a look.

[Gimme]

From my pharma experience, I would really be very surprised if the change you described would cause that much difference (though not impossible, but highly unlikely). All brands and generics are meant to be equivalent, and part of the licensing of a new brand is to show that it is equivalent to the original (though there are some specific exceptions and pred is not one of them). Though as PMRpro describes, the fillers can be different. If you look at the in-pack leaflet at the end, the inactive ingredients are listed, so you could compare the two to see if there is a difference. However, I would think highly unlikely to cause such an extreme reaction. What dorsetlady says about a flare seems much more likely. Or possibly something unrelated has caused it, coincidentally at the same time. I mention this because I am discovering that I am hugely reactive to what I eat. I had a long car journey yesterday and went overboard on eating crisps and snacks; my neck and arms are so stiff today and it hurts just to move my head. Is there anything of that nature that has suddenly changed for you?

[mychilddoll in reply to Gimme]

Thanks for reply, this has happened twice on the same different brand so think it's more than coincidence now, first time I added just half of 1mg and felt rough with that and this time took a whole 1mg with my usual brand of the rest of dose and it really badly affected me, up till now I have felt reasonably well, apart from tired somedays but not as I described after taking these different pills, it felt as if I had not taken the full dose, checked the fillers and seem to be the same, I do have weird reactions to some things, just want my usual brand, can't be that hard to get surely. Careful what I eat trying to keep carbs fairly low because of huge weight gain all over, but do eat sensibly

[Gimme]

I see you are based in the UK. If you consider that it is a potential drug reaction, you can report it as a patient to the MHRA, our medicine's licensing authority. There is an online form here for reporting: yellowcard.mhra.gov.uk/ It should ask you if you are a patient or medical practitioner when you enter the name of the medicine and then direct you to the right form. I hope that posting links aren't against the rules here, though it is an official government website, so I am not directing you towards dodgy information. You may not hear back from them, but it will be logged and if other people have reacted the same, then it will be investigated.

[mychilddoll in reply to Gimme]

Thank you, I took all dose in usual pred I have left and feel so different today so feel sure it is something in the different brand causing it as this is second time it's happened on them. Thanks for the info on yellow card as well.

[PMRnewbie2017]

Hi. I was a pharmacist and during part of my career I worked in manufacturing and licensing of pharmaceutical products. Can you send me the manufacturer names and PL numbers of the Prednisolone tablets that work and don't work. I'll see what I can find out for you.

[mychilddoll in reply to PMRnewbie2017]

Thank you , I have been taking pred for six months from Strides Pharma UK and used to them. The ones that seem to cause problems are from Wockhardt. What are the PL numbers, can't find anything on the packet.

[Broseley in reply to mychilddoll]

That's so strange, I have just posted that I am having problems with Strides - but Wockhardt are OK! Same problem as you but in reverse!

[mychilddoll in reply to Broseley]

Hi, how strange, just proves not every brand suits everyone, find it very stressful every month hoping I can get the right ones, just had a whole months supply of wrong brand and trouble getting the others, managed to get two packs of 5mg at last minute, thank goodness.

[Broseley in reply to mychilddoll]

Yes, I hope it's all OK now.

[mychilddoll in reply to Broseley]

Still trying to get the 1mg I need as seems chemist unable to get them, hoping doctor can give more 5's to get through this month, waiting for call back from him, very annoying never knowing what time he will ring

[Broseley in reply to mychilddoll]

Funny that I got them instead of my usual Wockhardt. I'm in Cheshire - obviously no shortage of Strides here.

[DorsetLady PMRGCAuk volunteer in reply to Broseley]

May well be the chain of pharmacies -as HamishPMR stated further up in thread - different chemists have different contracts with certain suppliers.

[mychilddoll in reply to DorsetLady]

It's the co-op chemists I go to, they have given me the 5mg now but say there is a problem getting the 1mg which make it difficult to make up my dose of 13 1/2, waiting for doctor to call me back to see what to do.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Very difficult- sorry to hear you are having so many problems…

[mychilddoll in reply to DorsetLady]

Thank you, still waiting to hear from doctor.

[mychilddoll in reply to Broseley]

Pity I am not nearer, in Lincolnshire.

[Broseley in reply to mychilddoll]

I use a Knights pharmacy. There are 90 across the UK according to Google. It might be worth seeing if there's one near you.

[mychilddoll in reply to Broseley]

Thanks, never heard of that name, we don't seem to have much of anything around here, anything involves travelling miles, will have a look though, thank you.

[mychilddoll in reply to Broseley]

Just looked and guess what, nothing anywhere near here, wish we had stayed in Leicestershire, moved here 15 years ago, big mistake.

[Broseley in reply to mychilddoll]

So sorry.

[mychilddoll in reply to Broseley]

Thanks for your help

[Zappata in reply to mychilddoll]

Hi I'm in Leicestershire and like you can only tolerate Stride. I was started on Stride by the hospital but my local dispensary changed the brand and I was violently ill on them (Accord I think) and getting worse. Dispensary said no control over what they get. I had to ring round Leicester pharmacies to find one that could get Stride which means a 20 mile journey from here each month which is a pain but the change for me was dramatic. Why my local dispensary (at local doctors surgery) can't specify them for me I'm not sure. When I was suffering so badly the doctor I saw poo pooed the idea that it could be the brand change

[mychilddoll in reply to Zappata]

Sorry to hear your reaction and problems getting them, doctor needs to understand things better, at least mine knows I have bad reactions and they can put the brand on the prescription for you, do you do order from surgery online as with ours I can put the brand name needed myself I just discovered this last time. It's just the chemist's gave me all wrong ones as it seems there is a problem getting the 1mg at the moment and they must have thought give her the lot in whatever they had all the same. I am trying to work out how to get 13 1/2 out of 5mg tabs as it's all I have managed to get in Strides . It's a long way to have to go to get the right ones, is it a chain as in Boots or Superdrug etc or a privately owned pharmacy who will order specially for you.

[Zappata in reply to mychilddoll]

It's a private pharmacy but they don't seem to get Stride 1mg either. A pill cutter may be the answer

[mychilddoll in reply to Zappata]

No, seems to be a problem with the 1mg, I read some time ago that this has happened before. Have a pill cutter, still trying to work out 13 1/2 from 5mg tablets.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Not going to get exactly -

but maybe 2x 5mg..

then if you can cut a 5mg into half and then one half into half again - so you get 2.5mg plus 1.25mg - so you end up with 3.75mg or near as damn it!

Add all together and you get 13.75mg....😊

[mychilddoll in reply to DorsetLady]

Thank you, been puzzling over this for days , will give it a try.

[DorsetLady PMRGCAuk volunteer in reply to mychilddoll]

Bit fiddly-but better than feeling rubbish…. 😊

[mychilddoll in reply to DorsetLady]

I agree with that, thanks

[Nagswoman]

Doesn't it list the ingredients on drug packets/information sheet? I am not at home so can't go and look

[mychilddoll in reply to Nagswoman]

Yes , says same ingredients but something not right, tried them twice now with same horrible feelings each time, tried half 1mg and this time full 1mg and even worse. Hoped it would be ok but after going back to usual brand felt much better, really hoped they would be all right if this is what I will be given every time untill they get changed to yet another brand.

[PMRnewbie2017]

The PL number will be in very small print on the box possibly near to the manufacturer's address and a box with POM inside it. It will be there somewhere - it has to be. Could it be obscured by the Pharmacist's label?

[mychilddoll in reply to PMRnewbie2017]

Yes you are right , it was under the label. the pred I have been on six months is Strides Pharma UK PL number 13606/0036

The new ones are WOCKHARDT PL no 29831/0177

Thanks for your help

[PMRnewbie2017]

I have found the lists of excipients for the Strides and the Wockhardt brands of Pred 1mg.

As expected they are very similar and I list them below:

Strides Pharma: Lactose, Maize starch, sodium starch glycollate, stearic acid, magnesium stearate, colloidal silicon dioxide and 15%w/w starch paste.

Wockhardt: Lactose, Maize starch, stearic acid, purified talc (magnesium silicate) magnesium stearate.

The first named items are in the largest quantitiy. They are added to Prednisolone powder to aid dissolving in the stomach and also to bind the tablet together when the power is compressed into tablets in a machine.

If you are having a reaction to the Wockhardt brand you can contact them directly via their side effect reporting page. Or you can use the MHRA Yellow card reporting scheme You will have to list the batch number and PL number together with an explanation of your problems. I suggest you copy the information in writing to your GP as Wockhardt will not respond to you but to your GP or Pharmacist.

I hope all this helps. Anecdotally in 30+ years of practice I came across this problem very rarely. There was an issue 25 years ago with Imuran/Azathioprine tablets but my research on behalf of the patient directly with the companies found nothing. The only possible answer to your experience is that there has been a major incident in the manufacturing process but all the post production quality control procedures would have picked that up. Since the Wockhardt brand contains fewer excipients perhaps you are sensitive to the talc?

[mychilddoll in reply to PMRnewbie2017]

Many thanks, waiting for surgery pharmacist to call me back, you may be right about the talc, need to get sorted fast with this.