Prednisolone enquiry

[HamishPMR]

Presently as well as PMR I am being treated for Vasculitis. The regimen was high doses of prednisolone with mecophenolate and rituzimab infusions. My consultant on reducing the pred is suggesting 5mg on alternate days instead of 2.5mg daily. Any ideas of the reasoning behind that?

[Rugger]

There is probably no rhyme or reason! 🤣 Do they not know that 2.5mg tablets are available (in the UK)? You could use a pill cutter to halve 5mg tablets!

I have LVV and my Rheumatologist has never advised alternate day dosing and she's a leading expert in the field.

Best wishes.

[HamishPMR in reply to Rugger]

My consultant did think that 2.5mg tablets were unavailable but I corrected him. I think that I will go for a daily dosage.

[Rugger in reply to HamishPMR]

Plain 2.5mg tablets are quite expensive, relative to half a 5mg tablet (14p each compared with 1p for half a 5mg tablet!) 2.5mg gastro-resistant tablets are around 4p each and the 5mg g-r tablets are 5p - but of course, they can't be cut.

So if you take plain tablets and feel like saving the NHS a few pence, then cut your 5mg tablets.

Good luck!

[DorsetLady PMRGCAuk volunteer]

Not sure really - some Rheumies seem to like the alternate day approach - and it is mentioned in some guidelines.

But as I’ve said many a time, some of us think it is harder on the body….and not sure how it really helps the patient. You are up one day, down the next -whereas with a slower taper the lower dose is introduced more gradually -and was originally designed because smaller doses weren’t readily available… or people hadn’t thought about cutting tablets

At least when you are reducing using a slower taper that we advocate when you start at day 1 you are on higher dose and end the period [say day 28] you are on the lower dose… with the alternate day you are in the same position on days 27&28 than you were on days 1&2.

To me that doesn’t seem like progress… but perhaps I’m missing something!

[HamishPMR in reply to DorsetLady]

Thank you Dorset Lady. I will go for daily dosage.

[piglette]

Alternate days is used for some illnesses such as Myasthenia Gravis for which it works well. I would not have thought it was a good idea for PMR however. Perhaps your doctor is not very au fait with PMR. 5mg tablets can always be cut in half provided it is not the coated version.

[PMRpro Ambassador]

Some doctors consider that ADD (alternate day dosing) encourages the return of adrenal function because of the stimulus of the day without pred. If it is started from the outset it is supposed to affect the adrenals less. WE think that swinging the dose like that from day to day is confusing for your body and it often protests.

And as Rugger says - depends on whether it is plain or enteric coated pred. Plain 2.5s are relatively expensive. Cutting a 5mg is the economical option.

[HamishPMR in reply to PMRpro]

Thank you. As a pharmacist (OK, retired) I do understand about the availability of different strengths. Hell, I remember when the only enteric coated tablet was Deltacortril by Pfizer. But thanks.