Prednisolone enteric coated

[Ladyhillingdon]

I restarted prednisolone 10 days ago, I was previously given two short courses in May and June July , I then had a period of a couple of months without, there were a number of medical reasons for this gap . My question to the group-I am taking 12.5 mg at breakfast comprising 2x 5 mg plain pred and for some reason the chemist dispensed 2.5 mg enteric coated tablets. Approximately 3 hours after taking the morning dose at 11.30a.m I start to feel really unwell. Symptoms- sick, shaking , it actually feels if I have been poisoned, I have some stomach pain along with feeling very unwell. It lasts for about 5-6 hours. I did not have these side effects last time I took. The only explanation I can think of is the enteric coated 2.5mg, I find the taste of the coating very unpleasant but I wonder if there is some other explanation for feeling this way?

My GP is not in the practice until tomorrow, I am under her care now she is prescribing the prednisolone.

[DorsetLady PMRGCAuk volunteer]

There does seem to be some issues with the 2.5mg tablets at the moment.

Unusually, the enteric coated 2.5mg are cheaper than the plain ones - which is maybe one reason the pharmacy dispensed them or there many be a general shortage of the plain ones - they don’t seem as readily available.

You can either gentle wipe the EC tablets with a damp cloth to try and remove the dye, some people do have issues with the coating… or if you have enough 5mg plain tablets cut some in half to get 2.5mg dose.

But do speak the pharmacy and tell them, they may not be able to change for plain ones, but if they have to dispense EC ones in future they may be able to source another brand… and contact GP next week.

As a short term measure, if you are really stuck with the EC ones, might be worth taking just them last thing at night [and hope you sleep through the worst] and the other 10mg in morning as usual..

[Ladyhillingdon in reply to DorsetLady]

Thank you for your reply -it was my feeling that it might be the e.c. coated 2.5 mg tablets causing the problem as they are broken down later after passing through stomach which explains the sudden onset later.

[Janann25 in reply to DorsetLady]

I’m a bit confused! My pharmacist grumbles about having to get enteric coated tablets because they are so expensive. Has he been wrong all along?

[DorsetLady PMRGCAuk volunteer in reply to Janann25]

No, in most cases the EC are more expensive than plain Pred, APART from the 2.5mg which are cheaper! No, doesn’t make sense to me either…. but guess it’s down to supply and demand..

[Janann25 in reply to DorsetLady]

Thank you

[PMRpro Ambassador in reply to Janann25]

They aren't THAT much more expensive - especially when you consider e/c tablets obviate the need for a PPI for "stomach protection" reducing cost and potential adverse effects.

[Rugger]

I have taken enteric coated prednisolone in all three strengths - 5mg, 2.5mg and 1mg. I wash off the coloured coating and it doesn't affect the tablet underneath! I found I was breathless with the red colouring on the 5mg tablets but once I washed it off, the breathlessness went away. I use a sieve and run it under the tap - sieve to prevent losses down the drain! Good luck!

[Ladyhillingdon in reply to Rugger]

Thank you your reassurance and advice has really helped.

The 2.5 mg tablets Accord brand contain ponceau4R E124

5 mg contain sunset yellow ( E110) Azores dyes.

A banned substance in USA Norway and other countries !

[Rugger]

I don't have any 5mg tablets, as I'm on 2.5 / 2mg these days, but my brand of bright red 5mg tablets had Ponceau4R, which is known to cause shortness of breath.

Incidentally, my pharmacy offered me bright purple vitamin D capsules and when I looked up the colouring agent, it is a banned food colouring in the UK, but obviously not banned by the pharmaceutical industry..... They now dispense me plain white vitamin D tablets. I'm probably one of their 'heart-sink' patients! (But over the years, I will have brought them some considerable income. 🤣)

PMR: 2016

GCA-LVV: 2019

[Ladyhillingdon in reply to Rugger]

I have only taken the 2.5 mg e.c . For 10 days but apart from feeling unwell I was having a sore scratchy throat too which had gone later in day.

I am so angry that the pharmaceutical industry in this country(UK) is allowed to use colourings that our banned in USA because they are carcinogenic .

[PMRpro Ambassador]

Apart from anything else - I do wish they would accept that the e/c pred is not absorbed at the same rate and that affects the peak amount in the blood which may be critical for some patients.

If it were me, I would cut a 5mg plain tablet to get the 2.5mg which would clearly show if it is the e/c tablet.

[Gimme]

You aren't wheat/gluten intolerant are you? Some brands of pred contain wheat starch. I got caught out like that and had a similar reaction. The leaflet listed maize starch, which is fine for me, and some other unspecified starch, which turned out to be wheat starch when I checked with the pharmacist.

[Ladyhillingdon in reply to Gimme]

No not wheat intolerant but I do avoid . I think today will give me the answer, I have not taken the enteric coated 2.5 mg but halved an uncoated 5mg this morning to make my 12.5 mg dose. Hoping this is the solution I will know in a couple of hours?

[Gimme in reply to Ladyhillingdon]

Hope that goes well for you. The tablets that caused me the problem were made by Stride.

[Jbobby]

I’m sorry you’re having such trouble and feeling so unwell. That’s horrible. And I’m v interested by what you say re EC Pred. Im also on 12.5 , have been for a month since Christmas diagnosis of PMR and GCA and was on 70mg a week and then 60 etc. . I switched half way through last month to EC Pred from plain ones mainly coz I found PPI’s very uncomfortable - bloating , diarrhoea etc. Now Take 10mg EC morning, 2.5mg EC at night before bed. No ppi.. Im feeling very faint intermittent jaw stiffness so carrying on with 12.5 but not raising. Last CRP was 6 and ESR around 2. Have felt sone breathlessness so wondering if this is the E Numbers on ec Pred. Also does anyone think/know that Ec Pred is LESS effective than plain, or is it that they just take longer to work? My rheumy said his teacher thought plain worked more effectively than EC. I’m wondering as I feel these symptoms slightly more than when on 12.5 plain…. Re your situ I’d go with what DL and PMR suggest and cut a plain 5mg in half and see how/if that affects you.

[PMRpro Ambassador in reply to Jbobby]

I found e/c just as effective as plain. Yes they take longer, the peak level in the blood may be a bit lower but it is present for much longer which can have advantages better taking the antiinflammatory effect up to 24 hours.

There was a study where they though e/c pred might be better for use in gastric conditions such as Crohns disease because it is released lower down the gut and it might exert a local effect that was beneficial. There was no improvement and for some it worked less well. That result seems to have transferred itself to the general opinion. For PMR, it depends on the patient as so much with PMR, and I think a lot of doctors just don't appreciate just how wide the individual response can be.

And you can always wash off the colouring on e/c tablets - unlike normal tablets where the colouring is right through the tablet! I wish I knew why they use these horrible substances. And then there lactose and wheat used in tablets that patients with intolerances my need. I even heard of a GP who got quite iffy at a patient who can't tolerate lactose "it is only a very SMALL amount" - not the point is it?

[Jbobby in reply to PMRpro]

Thank you PMR. Totally agree - wish docs cd appreciate individual responses. And also agree about colouring in EC pills. What’s wrong with using turmeric, beetroot etc. Surely there’s a solution to be found there…?

[PMRpro Ambassador in reply to Jbobby]

Some are - still get an e-no. But they can also be problematic ... White for everything I say!!!!

[Jbobby in reply to PMRpro]

🤣!

[Ladyhillingdon in reply to Jbobby]

I am actually stunned at how different I have felt today,I did cut a 5mg in half. Having the mixture of e.c and plain was down to my GP’s prescription and not an error on the part of the pharmacist, I have spoken to both.

I have no doubt in my mind that feeling unwell and having at scratchy sore throat was down to the enteric coating on Accord brand Prednisolone e.c 2.5 mg. I am going to fill in a yellow card about the side effect.

[Jbobby in reply to Ladyhillingdon]

That’s extraordinary. And very interesting anbd helpful information. How wonderful that you feel so different/better today. I hope things continue that way.

[Katkin1]

I'm really interested in your post Ladyhillingdon. I have been on enteric coated Prednisolone for 3 years, both 5mg and 1mg. I have tried several times to get the 2.5mg ec Pred to no avail! I have asked my doctor and different ones in the surgery on various occasions to be told they are 'black listed'. I also asked the Rheumatological nurse that I saw this week and told her that they would help me reduce down. She said she would check and then emailed me to also say they are black listed! Why? Some while ago, while seeing a private Rheumy, he had no hesitation in giving me a private prescription for the 2.5mg ones, which cost me £7. Perhaps it's because they are expensive? I don't think that's the case judging from what I read on this site. It's unbelievable how some doctors think they are ok and some ban them!

[DorsetLady PMRGCAuk volunteer in reply to Katkin1]

Actually it’s the Health Authorities rather than individual doctors that are doing the black-listing .. and in most doses the EC cost is higher than the equivalent plain ones

But in this case it doesn’t make sense, because the 2.5mg EC are about the same price as 5mg whereas it’s the 1mgs that are more expensive.

You can check prices on BNF/NICE website -but as the ruling has been made it’s not likely to be overturned.

[Katkin1 in reply to DorsetLady]

Thank you Dorset Lady. It's all very odd because when I ask why they are black listed, no one seems to know!

[DorsetLady PMRGCAuk volunteer in reply to Katkin1]

Some health authorities have black -listed all EC Pred for GCA/PMR because they don’t consider they are cost effective or better for patients😳.. did look it up a couple of months ago when someone else queried it…

You might find something on your local HA website if you can be bothered….

[Katkin1 in reply to DorsetLady]

Thanks Dorset Lady. Might just do that!

[Katkin1 in reply to Katkin1]

Found this: 'Prescribe standard tablets only, enteric-coated tablets are black-listed due to lack of evidence of cost-efficacy.' I'd better shut up and just accept the 1mg and 5mg I think!

[PMRpro Ambassador in reply to Katkin1]

Piece of nonsense for us. It is probably perfectly true for most use but you need the 2,5s for tapering.

[Katkin1 in reply to PMRpro]

Indeed PMRpro!