I am on my 3rd day of taking a different brand of pred. I am noticing increasing stiffness in my hips and neck. I have PMR and GCA and I'm down to 3.5mg.
The old brand was Wockhardt. Now I've been given Strides Pharma. The new tablets have no line down the middle so are harder to cut in half. (Neither are gastro resistant).
Could it be due to the brand change, a coincidence, the cold weather, or am I heading for a flare?
Recent post on similar subject -except other member mychilddoll can’t get Strides!
healthunlocked.com/pmrgcauk...
Thanks, I have just read it. Same problem as me but reverse the brands! I guess it's what you're used to?
Could be, but as others have said you do have other things going on as well…so probably a combination,
It does sound that the dose may not be quite enough to suppress the PMR. You could try increasing by 5mg for a week and then dropping back to just above your current dose for a while if everything seems OK.
I've been on the dose for two weeks (previously 4mg). Is it likely to take that long to affect me?
It could. If the effect is a bit weaker then it can take a while for the inflammation to build up to a level that causes symptoms.
The only other thing that's changed recently is that my statins have been upped from 10mg to 20mg. I wonder if that could be it?
Yes. I managed to taper to zero in 2020. It took a few weeks, but by the end of the sixth week I had to go back on pred, back to my former lowest best dose of about 2 mg!
This is why my current new attempt at tapering below 2 has been so "dead slow" as to indeed be "nearly stop"!
Possibly all of the above. But a change of filler in the tablets can have an effect.
I've had this problem a couple of times with different medications than my steroids , but in each case , my symptoms built up gradually over a week and I felt as though I hadn't taken the medication at all.In my case it was probably the fillers as with my HRT , for one example, I also can't take the tablets made in the European factory of the same brand of pill as they use the filler that I seem to have an issue with but they don't use it in the Dublin factory!!
So , it's worth noting the ingredients in the pills in the box you have which might be causing the issue and comparing it to your usual one, even if it is the same brand but made in different factories. Especially as if you get new medication in the future you can look to see which version uses that filler and make sure you get an alternative instead.
Another issue can be a bad batch , as in the dose per pill isn't as high as it should be in that particular factory run, which can happen quite often with generic or cheaper brands and with brands produced more cheaply in certain countries, because they are not as rigourously tested for these quality control mishaps as they are in most UK, US or EU countries. Not all pills are created equally either so if I pill isn't designed to be split ( and sometimes even if they are) the dose per half is not going to be 50/50 all of the time , sometimes one half could have very little active ingredient while the other has the majority of it. This happens more often with more cheaply produced medications too. My pharmacist is very anti pill cutting unless it's absolutely necessary for this reason.
If you have an issue you can request a new prescription specifying the brand, ask the surgery to note that you need that brand for all repeats specifically on your notes , and explain the situation to the pharmacist. The pharmacist should order in the brand you need willingly if they do not stock it , it should only be a 24-48 hour wait for this. If they use a supply shortage as an excuse this is easy to check by putting stock shortage and the name of the brand into Google search, these notifications are reported daily.
The pharmacist should then contact sister pharmacies and other local chemists to check if they have it , return your script and ask the other chemist to hold it for you. If they refuse to order in your brand or to do these checks you are better off asking for your prescription to be returned to you so you can go elsewhere as just trying a brand again , 'just in case ' isn't worth the potential flare , take it from someone whose been there,
If you get the medications supplied by a surgery pharmacy you can also specify that they order in your brand for you or give you a prescription to take to a chemist outside the surgery because of your needs. Surgery pharmacies quite often try to give generic medications instead of branded ones , and even ones bought with unusual boxes and descriptors for other countries to save cash. You don't have to accept these if you could have an issue with fillers or lack confidence in them.
Hope you get things sorted out soon , Bee
Thank you that's really helpful. I'll go to the pharmacy tomorrow. It's probably easier to sort out that way than to try to work out other causes.
if I pill isn't designed to be split ( and sometimes even if they are) the dose per half is not going to be 50/50 all of the time , sometimes one half could have very little active ingredient while the other has the majority of it.
Never thought of that before. Not myself a pill-halver, but I think that might be quite an important point for those who are. Good to have it flagged up - thanks.
Here in Italy it is common to be expected to cut a tablet to get 1/2 the dose. It doesn't seem to make much difference.
In fact, the way tablets are made, the likelihood of the drug not being evenly distributed through the entire tablet is pretty small. You will though find differing opinions on the internet. The obvious way to get around the problem is to use the split tablets on consecutive doses when you will then get the entire dose over 2 doses. Since that is what you usually need to do while tapering it is fine. When tapering it isn't really an issue - you just want less than the whole tablet.
Agreed. I can never split it exactly in half, even with the brand with the score mark on. One half usually crumbles as well.
Is that with a pill splitter? Someone said they struggled if the splitter was on the table but worked OK if they held it in the air.
Yes, and I've tried it both ways.
Sometimes pill splitters need to be changed out for a new one as the blade tends to get dull over time causing the pill to be split to crumble.
This has happened to me.
My husband and I had identical pill splitters - I had no problems with mine, no way could I get his to work well!!!
😅
~Oh well it sounded a good idea! But in the context of brands, I'd think anything dispensed in the UK has to meet BP standards so far as quality and quantity of ingredients go - but maybe not in how well the cake is mixed.
You would not believe the stringent standards and quality control tests that are performed in the process of pharmaceutical manufacturing. including sampling of the finished product. I can assure you that "the cake" will be mixed to perfection.
Worldwide? I'd love to believe the highest standards of British pharmacology are adhered to the world over but I'm not sure I do,
But to be sold in uk it has to have a PL number issued by MHRA. The days of dodgy medicines being supplied on NHS are over. Internet shoppers are a different story.
They're closely monitoring my lipids though... Also I've been on the 10mg for years, no probs.
coincidence, probably. The active ingredient will always be the same. The fillers or stabilisers might vary slightly but would probably only affect someone who is lactose intolerant for example.
So here you are, folks! I did my research. Goodness, I retired 2 years ago, can't believe I still have my work hat on. 🤣
Wockhardt UK Ltd - Prednisolone 5 mg
Other ingredients: lactose, maize starch, stearic acid, purified talc, magnesium stearate
Strides Pharma UK Ltd - Prednisolone 5 mg
Other Ingredients: lactose, maize starch, sodium starch glycollate, stearic acid, magnesium stearate, colloidal silicon dioxide, starch paste 15%.
If you want me to find out what is in any other brand, it's easy enough to do.
Interesting that there is an unspecified starch paste in the Strides, and I have just realised that is the one that I have been switched to. I've been a bit achy the last few days and put it down to life's ups and downs. I have to go out, so I will drop by the pharmacy on my way back to check they are gluten free.
The rest are just standard pharmaceutical ingredients used in many tablets and I have no reason to suspect them. The active ingredient is present as the same form.
There will be no difference in strength of active between the makes. Manufacturers have to prove that they deliver the same dose as part of the pre market licensing process, so if there is a difference between them, I do not believe that one is more or less efficacious than the other.
oh good grief! I've just had an interesting chat with the pharmacist. The Stride tablets contain starch paste, which is wheat based and I am wheat intolerant and possibly celiac, so I follow a gluten free diet.
Last few days I have been achey and had an upset tummy, the symptoms of my wheat intolerance, but I had thought that maybe I had been careless with my diet or the PMR was being cranky. I have been taking Wockhardt until a few days ago when I opened a new pack, which is made by Stride. Anyway, the pharmacist has sorted it out and I have been given enough tablets as an emergency to last me until I can get a prescription from the doctor.
I can't thank you enough, to the two people who first raised the question. I might not have looked at the leaflet and queried that ingredient otherwise and I would have been wondering why I felt so unwell. This group is brilliant! Thank you.
Fillers in generics can be a nightmare. And it is appalling that they don't declare the wheat component on the pack. Mind you - I heard of a GP telling a patient with severe lactose intolerance there was "only a little bit of lactose"!
Just to add - I just got a feed in my email inbox which is discussing what labels hide. The author says
"Companies must declare whether there is any possibility that the food contains one of eight foods considered to be “major food allergens.” These are milk, eggs, fish, crustacean shellfish, tree nuts, wheat, peanuts and soybeans. These foods are responsible for over 90% of food allergies."
Now that is in the US I assume - but you would think it applies to medications everywhere ...
Medicines and food are sold under different regulations.
Foods have to declare all ingredients, but if there is a complex ingredient (such as a spice, which might also contain a filler, for e.g.), the filler might not show up on the label. Hence, the requirement to list all the specified allergens.
Medicines definitely have to declare all ingredients and there are specific warnings for certain ingredients that should appear on the in-pack leaflet. I don't remember off the top of my head if wheat is one of them. Oddly, I don't think it is, but it is a pretty big deal for celiacs.
The lactose one is an odd one. It's not an allergy, but a malabsorption issue, causing GI symptoms. People who can tolerate no lactose are very rare, and for most people there is a threshold, so I can partly see where the pharmacist is coming from, but he should be listening to what the patient is telling him about intolerances. Like this morning, as soon as I started looking at those ingredients, I knew that I had had wheat, even though it wasn't specified in the leaflet. Though it might have taken me longer to figure it out, if I hadn't been reading this conversation.
That's brilliant that you have sorted out what you didn't even know was a pred related issue! There should be a warning on the packs of Stride! I have been having diarrhoea lately but tested negative for coeliac. GP says I'll just have to put up with it. Psyllium was helping, but doesn't seem to be any more.
You may be negative for coeliac, it doesn't mean you aren't gluten or wheat intolerant. At long last the medical world is realising that - even if your GP doesn't!
schaer.com/en-us/a/celiac-v...
Thanks. Maybe I'll try going gluten free. As I'm on a low carb diet, I only eat 2 slices of one of those tiny low calories loaves per day, so it would be easy to cut that out or swap it for gluten free.
You'll need to read labels too - wheat and gluten get EVERYWHERE!!!!!
As a general comment, there is no chance that one half of the tablet has a different content to the other half. If that were possible, it would also be possible to have whole tablets that contained either too much or too little. And if that happened, it would be a major drug safety issue and the manufacturing plant would be closed down, because it would mean that the manufacturing processes would have failed.
When making a tablet, first the ingredients are mixed as a powder and then the powder tested for uniformity of content to make sure that the active ingredient is distributed evenly throughout the whole batch. This is done for every new batch . Only then is the powder pressed into individual tablets. Before and after the tablet is packed, the batch receives final Quality Control to make sure that it contains the right ingredients in the right amounts to make sure that "bad batches" are not released onto the market. It is something that manufacturers go to great lengths to avoid, as product recalls are shockingly expensive, massive loss of reputation for the company and possible enforcement action from the regulatory agency.
And before manufacturers can put a tablet on the market, the manufacturing process has to be validated and the data submitted to the local regulatory authority for approval before the manufacturer is given a licence to sell the product. Manufacturers are also regularly inspected to make sure that they are following Good Manufacturing Process and that they are manufacturing their products in line with the product licence.
All medicinal products sold in the UK have a UK product licence and regardless of which country they are made in, they have to meet UK standards of quality, safety and efficacy before the product is issued with a licence. I think a lot of people would be surprised how many of our medicines are made in China or India. The UK manufacturing base for medicines is ever shrinking and we get a very high percentage of our medicines from overseas.
By the way, our regulatory agency doesn't like pill splitting, not because the ingredients aren't adequately mixed, but because you cannot guarantee that the patient will be able to split them exactly in half.
Anyway, I am retired, so I will shut up now. 
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