Time of absorption for gastro-resistant prednisolone???

[RT18]

Just gone to get mum’s next box 2.5mg & she has been given gastro-resistant tablets 🤷‍♀️🤷‍♀️ Must have been a bad day at pharmacy as they had also written the wrong dose on the box!!

I will order some more asap, but how long do these take to get into the system? She’s on a split dose due to adrenals and I really don’t want to start messing unnecessarily with things as it always feels like a tightrope with her pred.

Mini moan - it’s such a hassle getting her tablets - the pharmacy need a phone call to prompt them to do up the prescription and then the queue is sooo long I never have time and end up having to drive past several days in a row to manage to sneak in. And as for the GP she’s lovely but no clue as to GCA or Adrenal stuff……She told me an adrenal crisis won’t happen quickly…..I nicely put her right and said I had seen it deteriorate in about 5 hrs from pretty normal to complete unconsciousness….

Anyway I digress - if I need to use these in an emergency how many hours before do I need to give them before what I would do with the usuals????

[SheffieldJane]

Mine take about 4 hours to absorb. Try to talk to your Pharmacy or go on-line with your GP her prescriptions ought to be easily put on repeat and they text you when they are ready. If this pharmacy has gone to pot, change it. I have done so twice to improve things.

[PMRnewbie2017]

I think the pharmacy is your first port of call to establish why ec were supplied. It may be because of availability issues. Also if the label is showing the incorrect dose they definitely need to be made aware of that!

[Lonsdalelass]

I can see your frustration, but gastro resistant preds are kinder on the stomach.....maybe it's worth switching to these? I felt much 'safer' on these than the uncoated ones and I could stop the PPI too (was given lansoprozole at the start) which I felt was a bonus. Of course, they're hard almost impossible to cut when tapering at low levels, like at 0.5mg, so I had to use plain pred then, but at such a low dose felt it was worth the risk. Good luck with getting sorted at the pharmacy.....we can do without battles there on top of our illnesses. As SJ says, could you switch pharmacy?

[PMRpro Ambassador in reply to Lonsdalelass]

Not only impossible to cut - you must NOT cut them as that negates the whole point of the coating which is to protect the stomach from the pred.

[PMRpro Ambassador]

4 to 5 hours. -ish - some people are longer. Taking them before bed gives a nice result at 4am.

But back to the pharmacy and make a fuss (I know, I know) - their staff need retraining before they kill someone. That is absolutely not acceptable issuing medication that is incorrectly labelled. If you can't face the pharmacy - the local health authorities??? Don't know for pharmacies in the UK.

Unfortunately 2.5mg coated pred is cheaper than 2.5mg plain, far more reliable to issue 5mg and a pill cutter,

As for your GP - what is her problem with "insufficiency" (creeps up slowly) and "crisis" (happens quickly), Needs a bit of English coaching too.

Is the pharmacy a true independent or a branch of a chain? If the latter - ring Head Office.

[Lonsdalelass in reply to PMRpro]

I always thought coated pred wasn't cheaper than plain pred? This is why I had a battle on my hands to get the coated pred, my then gp just kept on prescribing plain pred until I made a stand. Mind you, this was 5 years ago. Perhaps it's now become cheaper.

[PMRpro Ambassador in reply to Lonsdalelass]

Only the 2.5s - but that is because the plain 2.5s are a silly price as there is no demand.

[DorsetLady PMRGCAuk volunteer in reply to Lonsdalelass]

Depends on the dose and as PMRpro says the demand for a particular size… but recently lots of health authorities have decided the EC ones are not cost effective , and have told GPs in no uncertain terms not to prescribe….

[bussell]

I think time to absorb varies a lot. For me it is about 8 to 10 hours, so I take my dose around 6pm. I appreciate you would like precision, so this may not be the answer you would like to hear! Probably best to assume the shorter time but be aware that it may not be quite right. Good luck!

[RT18]

Thanks All. I’ve been for a long walk whilst mum slept and got some fight back!

I think from what u all say I could use the coated ones for her night time 2.5mg if I gave around 7pm ish if need be. She takes uncoated at 11pm. At the moment I have some 1mg so can use them.

I called pharmacy and they checked that they had copied what was on the prescription so mistakes came from the GP. A sudden drop from 10mg to 7.5mg which was what the mistake was could easily lead to adrenal problems for her!! Same GP who is going further down in my estimation.

A letter will be going in at lunchtime!

I will ask for the uncoated 2.5mg which the pharmacy said they could order….but i wonder if I will be denied and I will be told to cut 5mgs

Problem is as a carer for GCA, Ai and dementia my time and energies are limited!

[DorsetLady PMRGCAuk volunteer in reply to RT18]

I will ask for the uncoated 2.5mg which the pharmacy said they could order….but i wonder if I will be denied and I will be told to cut 5mgs

Cutting 5mg [plain] is no great issue…. if the 2.5mg aren’t forthcoming…. And yes do as you suggest re the evening dose until things are better organised.

..and agree a drop from 10-7.5mg is a no,no….

[tangocharlie]

I put my uncoated Pred into gastro resistant gel tablets. On the product infirmation leaflet that comes with the gel capsules it estimates that absorbion is delayed by 20-40 minutes. I also learned from using a continuous blood sugar montior that it takes about 3-4 hours for the Pred to affect blood sugar, so I presume it takes about that long for them to kick in and work on inflammation too.

[PMRpro Ambassador in reply to tangocharlie]

That can't be right if they are gastro-resistant and taken when there is food in the stomach. They won't be absorbed in the stomach but travel through to further down the gut and normal gastric emptying takes much longer than that with food present. Only then will the breakdown of the g/r capsule start and absorption of the pred tablet which must also be broken down,

[Sharitone in reply to PMRpro]

Does that mean that even a rather stroppy stomach that loves to produce acid will be ok taking ec pred with nothing else?

[PMRpro Ambassador in reply to Sharitone]

Depends - I think SnazzyD needed belt, braces and velcro! But for a lot of people yes, e/c does the job. In fact, you shouldn't really take PPIs with e/c pred since they are designed to stop production of acis so the pH of the stomach changes a bit and that may affect how the e/c pred is processed and it can be released in the stomach which is exactly what they are trying to prevent.

[SnazzyD in reply to Sharitone]

Quite possibly. I still had to have an evening dose of Gaviscon on high doses of Pred when I was on E/C. This was 100% better than uncoated with stomach meds.

[Sharitone in reply to SnazzyD]

But the Gaviscon + e/c worked without Omeprazole? I ask because I have osteoporosis and a recent gastroscopy showed up benign polyps, probably due to the prolonged use of Omeprazole. My stomach is also affected by hayfever. The doctor who did the gastroscopy advised taking the lowest dose possible of Omeprazole to control symptoms. The GP thinks I should stay on O whilst on pred, but it now seems the pred is likely to be permanent. I would love to have the courage to drop to 10mg per day, but that would require the GP giving new prescription, which I think he would be loath to do.

[PMRpro Ambassador in reply to Sharitone]

Then at the least they should be trying an H2-antagonist. And I would listen to the gastroscopy doc before the GP!

[Sharitone in reply to PMRpro]

Thank you

[SnazzyD in reply to Sharitone]

Yes it did, for me and my particular stroppy stomach. When I said I felt rubbish on Omeprazole they agreed to try a different type now replaced by Famotidine, the type PMRPro has mentioned. It worked well without the side effects of the PPI, though I still got some bloating after a fortnight. Sadly, I started to get rebound acid so I bargained with the GP saying the cost of a PPI plus the much cheaper uncoated Pred was more expensive (at the time in 2017) than E/C Pred on it’s own.

[tangocharlie in reply to PMRpro]

I may well have misunderstood, I'm no techie. This is a link to the suppliers website which explains it better capsuline.com/products/caps...

Our enteric capsules:

• Pass through the stomach intact – These capsules are formulated to be naturally resistant to gastric acids. They travel intact through the acids of the stomach and do not begin to dissolve until they reach the small intestine. This means they do not dissolve for at least 2 hours, typically being fully dissolved by the 2.5 or 2.75-hour point.

Actually I'm now wondering if this is why there was a delay in my blood sugar rising after steroids as seen on my CGM?