Prednisolone 2.5mg Gastro-resistant tablets

[Purplegloss]

Just picked up my prescription for my pred and for the first time in six years my GP has prescribed Prednisolone Gastro-resistant 2.5mg tablets instead of my normal Prednisolone 2.5mg. I presume these are the coated ones I have heard people mention in the past, but as I already take Lansoprazole 15mg I wouldn't have thought I needed a Gastro-resistant one.

[PMRpro Ambassador]

It is probably because 2.5mg e/c tablets cost less than 2,5mg plain pred! No logic I know!

I wish they would understand that when you are making up funny doses for tapering slowly. mixing the 2 types of tablet isn't good. The e/c tablets take 4 or 5 hours to get into the system, plain pred is in there after an hour. So the peak level you achieve in the blood is lower because it is far more spread out. And it is even cheaper to CUT the 5mg tablets ...

[Purplegloss in reply to PMRpro]

I feel pretty annoyed that this is what has happened, and it is hard enough as it is trying to reduce. Hope it doesn't screw (technical term) everything up for me, as I go down from 4mg to 3.5mg. I had been taking 2mg in the morning and 2mg in the evening, which works very well, and for the 3.5mg 2.5 in the morning and 1mg in the evening. I have probably got enough left of the original version to finish off this reduction, but may have to think about changing when I have to use the Gastro-resistant ones later.

[PMRpro Ambassador in reply to Purplegloss]

Take the gastro ones before bed - working nicely by morning. They work better for some people - just have to mess about a bit.

[Purplegloss in reply to PMRpro]

OK, thanks I will try that when I finish the old version, as all my 1mg ones are the ordinary sort of Prednisolone.

[Orange_2022 in reply to PMRpro]

I hadn't thought of that! Also given 2.5 coated as I was tapering below 5mg. Now having a mild flare so back on 9mg all uncoated. Will bear that point in mind when I'm able to reduce again. Thanks!

[PMRpro Ambassador in reply to Orange_2022]

Did the flare appear while taking coated and uncoated at the same time?

[Orange_2022 in reply to PMRpro]

Yes! I asked for 2.5mg tablets so I had fewer to take on 4.5mg. I did a couple of uphill hikes carrying a day pack so assumed I'd overdone things...but I'd been doing quite a lot of exercise in the build up. Really bad pain hetween shoulders but general mild aching elsewhere too.

[PMRpro Ambassador in reply to Orange_2022]

Unless you take the tablets at different times, the peak in the blood is going to be lower than just taking plain pred. Combine that with doing a bit more than usual and I'm not entirely surprised at your problems - carrying a back pack is usually better than an ordinary one-sided load in a bag. But it depends how much is in it and for how long. Without a good low back support, there is a lot of weight on the shoulders.

[Orange_2022 in reply to PMRpro]

Thank you! That's so useful.

[Purplegloss in reply to Orange_2022]

On that basis I have just emailed my GP to ask him to prescribe uncoated ones and I will take the coated ones back to the chemist. Fingers crossed.

[PMRpro Ambassador in reply to Purplegloss]

No point taking them back - they will just be thrown away. Keep them - they may come in handy when you are at 2.5mg.

[Rugger in reply to Purplegloss]

Pharmacies can't accept tablets back once they've been dispensed. Hang onto them for when you reach 2.5mg and take them at bedtime, as PMRpro suggested - if they have a long enough date!

(2.5mg plain are 10x the price of half a 5mg tablet!)

[Jbobby in reply to PMRpro]

Thank you for this PMRpro. It’s v helpful for me as I’ve had similar experience. Was down to 9mg but that was made up of mixture 7.5mg e/c ( which is what I’m used to) and 1.5 ordinary pred coz rheumy claims 1mg e/c don’t work! So result is my recent blood tests showed raised CRP and ESR ( somewhere in 30-40 range) and return of vague symptoms , aches, back pain, jaw, head etc and so GP advised going back up to 12.5 which I’ve - reluctantly - done today ( e/c coated). Question is could I return to , say, 10mg e/c in a couple of days assuming this hitch is a result of mixing pills? and then just stick to e/c ( which suit me better) as I go down and ignore the rheumy and assume the 1mg e/c are perfectly good?

[PMRpro Ambassador in reply to Jbobby]

Don't think anyone on here has found 1mg any different from any others! There is only one way to find out and you were OK on 10mg before I assume? Try it see what happens.

[Jbobby in reply to PMRpro]

Many thanks PMR pro. Will try....are 32 CRP and 33 ESR worrying results? Or should I really be going by symptoms...? Last time I went up to higher than this in December (CRP around 59) and they immediately tried to up my dose and I resisted coz I suspected it was I had a slight virus/cold. Went back 2 weeks later and markers had come down to around 19/20 level....

[PMRpro Ambassador in reply to Jbobby]

If your normal is 19/20, then over 30 for either is concerning. A single raised value shouldn't result in a kneejerk increase in the dose, you were absolutely correct, You repeat the test to see if there is a rising trend or have things normalised. The lowest you got to on pred is what you aim for.

[Jbobby in reply to PMRpro]

Ah. OK . thank you PMRpro. For now I'll try doing as you suggest and see how I go with all e/c press. Maybe stick to 12.5 for a few days before going down to 10mg....

[PMRpro Ambassador in reply to Jbobby]

I don't think he is right about them not working as well but somewhere you have gone below the dose you need, Of course, the flare could also be partly because you had been ill. How long were you at 10mg - and OK all the time?

[Jbobby in reply to PMRpro]

WEll I think Id been at 10mg for about a month and things were a bit up and down but I had no major symptoms and nothing that cd be called a flare.. So actually 12.5 was where things seemed more stable which is why GP recommended going back up to that meantime, whatever the cause for the spike in markers....

[PMRpro Ambassador in reply to Jbobby]

"things were a bit up and down"

Which suggest to me that 10mg was already too low, another step down was the cherry on top. Nothing to do with the type of pred ...

[DorsetLady PMRGCAuk volunteer in reply to Jbobby]

and assume the 1mg e/c are perfectly good ? As PMRpro has said, others haven’t said, but only way is to try… But they are a lot more expensive than other doses, so maybe that clouded Rheumy’s judgement 🤨…

[Jbobby in reply to DorsetLady]

Thanks DL. Thats possible re his attitude...however e/c suits me best as I dot want to be on long term PPi's...

[Lclmlbls in reply to PMRpro]

I am having to mix 5mg and 2.5mg EC tablets with uncoated 1mg tablets as my GP surgery aren’t supplying 1mg EC. I do try to remember to take the coated ones early and have the uncoated after breakfast. Currently I’m tapering 8 to 7.5 so it’s it’s only 1/2mg of uncoated. But, when I’m tapering to 7, that will mean I’m having 2mg uncoated and 5mg EC. Should I not be doing this?

[PMRpro Ambassador in reply to Lclmlbls]

It isn't a case of "not", it may work well for you and you can take the e/c before bed and the plain pred early in the morning to get them closer together, You just have to work out how best to do it for YOU.

[DorsetLady PMRGCAuk volunteer]

Ahh.. but they don't think logically.. and as PMRpro probably down to cost..so an edict from the penny pinchers,

[piglette in reply to DorsetLady]

Remember we are paying for everyone’s pills!

[DorsetLady PMRGCAuk volunteer in reply to piglette]

Having worked in various government finance departments for more years than I care to recall, I’m well aware of that... just wish others would spend more wisely at times..😊

[piglette in reply to DorsetLady]

It is the people who stop taking antibiotics half way through the course because they feel better that annoy me.

[DorsetLady PMRGCAuk volunteer in reply to piglette]

Very true!

[PMRnewbie2017]

It is possible that the person working behind the scenes pressed the wrong button. The repeat prescription process in the UK isn't done by Drs. It's done by a member of the reception team. Drs don't even sign the scripts anymore. It's all done electronically and the paper prescription is printed off in the pharmacy. For non-repeat special items the system is different. Sadly despite being able to counter-prescribe all manner of things these days, Pharmacists are not allowed to change what's written on the script. For example if you take 40mg of Drug X and it's not available, they cannot give you twice the quantity of 20mg so you take two at a time rather than one. So I suggest you speak to the Pharmacy and find out what was written on the script. If it was EC then speak to the person at the surgery who does the repeats and ask why you have been switched. They won't have any idea that a change in formulation will affect how you have to take it and the effect this may have on your PMR control. To be honest the GP won't have a clue either.

[Purplegloss in reply to PMRnewbie2017]

I checked my online medical records, and it was prescribed by my GP, I do like to get my facts right first. I had been on 4mg for a while, so only using 1mg Pred, and he took the 2.5mg uncoated off the list, so it wasn't a repeat prescription as such. I asked him to put the 2.5mg back as I am reducing to 3.5mg, but didn't notice he had put 2.5mg Gastro resistant ones on instead when I ordered them online.

[Rugger]

Years ago, the same thing happened to me, so since then I've taken all gastro-resistant tablets and I hope they've protected my stomach for the last 7+ years, without a PPI. If you want plain tablets, ask for 5mg and cut them.

The g-r 2.5mg are about 5p each, compared with 2.5mg plain at 14p each. Half a 5mg tablet is about 1.5p! 😉

[DBE46]

My Prednisolone as now come off my repeat prescription to enable discussion around dose prep. I prefer enteric coated as I am back on Naproxine 3 times a day for my osteoarthritis. Since increasing my naproxine from once daily to tds I have managed my collection of pains very well. Down to 5mg reducing 0.5mg every 4 weeks.

Also regarding Discoballs feet 1 have one leg 1/2 inch shorter have several pairs of Sketchers with separately purchased double insole in left foot and love them.

I suppose I am saying different horses for courses.

[PMRnewbie2017]

OK so there's your answer. Ask the surgery to change it to plain Pred 2.5mg and if they resist explain that you need uncoated ones so you can split them for a 1.25mg dose which you may want to later down the line. The problem with surgery and pharmacy computers is when you input "Pred..." a long list of items will appear including plain tablets, EC tablets, soluble tablets, eye drops, suppositories etc. It is very easy to pick the wrong one. I may be wrong but my gut feel based on years of experience in Pharmacy is that the switch is a simple clerical error.

[PMRpro Ambassador in reply to PMRnewbie2017]

"It is very easy to pick the wrong one."

Or the apparently cheapest ...

[Purplegloss in reply to PMRnewbie2017]

No, not a clerical error, just my GP putting Gastro-resistant ones onto my medication record when he put the tablets back on there for me to select and order as I usually do. He had previously removed the 2.5mg uncoated ones I was on 4mg for a while and not using 2.5mg. so not a repeat prescription. I sent an email to him a few hours ago asking for my original non coated ones to be put back on there for me to order, and explained why, as I did not want to mix the two different types, and I would not be able to cut them either. I have just checked the medication section, and he has changed it already, and sent the new changed prescription through to the chemist for me to pick up tomorrow.