Gastro-Resistant Prednislone vs Uncoated Prednisolone Tablets

[Orangecakes]

Is there any difference between the gastro-resistant Prednisolone tablets and the non-coated Prednisolone tablets as to their efficacy?

I have always been given the un-coated tablets however this time I was prescribed 2.5mg coated tablets.

I am at 2.5mg daily, I have been at this dosage a few times before and each time I've had a flare. I am hoping that I do not flare this time.

I been taking the coated tablets for 5 days now, prior to I was cutting 5mg uncoated in half (2.5) for 12 days.

The previous 12 days felt fine but since taking the gastro-resistant prednisolone tablets have had some neck and shoulder pain.

Today I've gone back to cutting non coated in half and had no pain. Wondering if all in my head or if the the gastro-resistant tabs have a different result?

All the best.

[PMRpro Ambassador]

The non-coated tablets are absorbed quickly in the stomach, within an hour or so, and reach a higher spiky peak briefly and then the level falls over the next few hours.

The coated tablets aren't absorbed immediately, the coating means they resist the stomach acid and pass through the stomach into the more alkaline lower gut before the coating is broken down and the pred absorbed, This introduces a delay of 3 or 4 hours before the tablet breaks down which it also does more slowly so that the pred is released slower too, The level in the blood rises more gently, it tends to reach a lower peak level and then it falls away in much the same way. The same amount altogether is absorbed though. This has 2 effects - it takes longer for the new dose of pred to start working and the peak is a bit lower so may not be quite as effective in some people. Because it takes longer to start working, that means there may be more inflammation to deal with because of the delay. And the lower blood level adds to that.

There are swings and roundabouts with the coated pred and for some people the effect lasts longer - but it sounds as if it isn't as good for you. I know they think giving you 2.5mg tablets is helpful - the UK seems to have a thing against cutting tablets! - but mixing coated and non-coated is also no idea because of the different timings of being absorbed. And one pharmacist told a patient there was no difference - so heaven knows what they thought enteric coating does!!!

[Orangecakes in reply to PMRpro]

Good morning PMpro, Thank you so much for explaining the difference between coated and non coated prednisolone. And for also confirming that possibly the coated tablets are not as good for me. Yes, strange that UK has a problem with cutting tablets, the score on the tablet is there for a reason in my view. Now to approach the surgery in hopes of getting 5mg tabs. Have a good day and a great weekend. Enjoy

[piglette in reply to Orangecakes]

The one possible downside of non enteric coated tablets is that they can affect your stomach. A gastro-resistant tablet is designed to temporarily withstand attack by stomach acid. Gastro-resistant tablets can resist the fluid in the stomach and release their active ingredient in the intestine as PMRPro mentioned. To combat the affect on the stomach that can be caused by non enteric coated tablets some people are prescribed stomach tablets to combat the problem. There is quite an interesting article comparing coated and uncoated tablets at pmc.ncbi.nlm.nih.gov/articl...

[Orangecakes in reply to piglette]

Hi Piglette, Thank you very much for the link, will take a look. All the best.

[darkred in reply to piglette]

I place non-coated tablets into enteric "acid resistant" capsules. (I buy the empty capsules online.) I don't wish to take PPI's like lansoprazole, which I would otherwise have to take to prevent stomach pain.

[Orangecakes in reply to darkred]

Interesting.

[piglette in reply to darkred]

Very sensible.

[tangocharlie in reply to darkred]

Me too

[AtopicGuy in reply to piglette]

That's a really interesting paper. It confirms what we'd expect about enteric coatings, even though the patients involved were all kidney-transplant recipients, and one had had part of their stomach removed.

[Bcol in reply to Orangecakes]

You can get 2.5mg uncoated tablets as well. They are more expensive than the 1.0mg and 5.0mg ones though.

[Orangecakes in reply to Bcol]

Thank you for letting me know. Take care.

[tangocharlie in reply to PMRpro]

Great explanation

[SnazzyD]

In addition to PMRPro’s reply a personal one - In the few things about coated v non that I read in the beginning of GCA the curve of blood level with uncoated it was more of a spike and with enteric it looked more like a rolling hill. Due to gastric issues I was cornered into taking the coated as stomach protecting meds had bad side effects and ended up not working eventually anyway. My personal experience of them are:

1) Yes, the wobblies I got from normal Pred when it was at its peak each day was about1-2 hours and lasted for 1-2 hours. With coated I felt it at about 3-4 hours and it lasted also about 2 hours which supports what PMRPro said.

2) Normal Pred didn’t give me 24 hours of symptom control but coated did very obviously.

3) Normal Pred I had to take with a meal not a snack or I would feel sick etc. If I did the same with coated I clearly wasn’t absorbing it as well because I had a rebound of symptoms until the penny dropped and I realised it was the food. I found proteins and fats were particularly influential. So I took coated 2 hours away from food from then on. Once I did that it was plain sailing.

4) Coated had a remarkable effect on my stomach issues but I still needed Gaviscon at night when my stomach was empty for more hours.

My GP was great and believed my problems with PPI’s were real and intractable, enough to go against the theory that for GCA coated is not ideal. She prescribed coated and I did a deal that I would buy my own Gaviscon and she’d save on not prescribing Omeprazole or Famotidine. At that time coated Pred was more expensive than Omeprazole but I think that changed.

Luckily the Rheumy Dept completely failed to give me a follow-up for 6 months after my first 6 week check on 40mg. This suited me fine as I was confident that my own reduction plan was best for me and all was under control. Just as well because when I did come back on the radar 7 months later the registrar was very not happy I was on coated. However, he couldn’t argue with the fact that I had had excellent symptom control, no relapse and a relatively happy stomach. I’m not saying research is wrong at all but I think people are different and it isn’t black and white. When you’ve got raging early GCA it takes nerves of steel and perhaps stupidity to tinker about with experimentation. In my case my hand was forced and circumstances played out conveniently.

[Orangecakes in reply to SnazzyD]

Hi SnazzyD, Thank you for sharing your own personal experiences with prednisolone. tablets. There seems that we are all different and really need to listen to what our bodies are telling us. You are lucky to have a sympathetic GP and surgery, I've had to battle with mine they not understanding PMR and not wanting to. Getting the care we need it seems a bit of a mine field. Take care. All the best.

[SnazzyD in reply to Orangecakes]

It really doesn’t help having to do battle. In my case the Rhemy’s were awful and every appointment was distressing but the GP was good because she knew me well. It really shouldn’t be that way. Good luck.

I forgot to say that when I got to small doses where cutting was involved, my stomach was better enough. I mixed non with coated and staggered the dosing and eating according to which I was taking. It was a right faff. By then my GCA was quiet so any ‘dry’ periods where my blood level was not optimal wasn’t a problem.

[Orangecakes in reply to SnazzyD]

Yes, the lower the dosage the better the tummy. I also take my medication with food. This forum and the members have been so helpful and I so appreciate all. Without the forum I would have been so lost as how to manage my PMR. I have been feeling good for months now and live in hopes that my PMR journey will soon go into remission and I can get off the dreadful Prednisolone. Thank you so much for responding to my question. Enjoy your weekend.

[PMRnewbie2017]

I'm also in the 2.5mg club. I'm on failure no 5 at the moment. It really is my nemesis dose and since I've been on this journey for seven years now, I think I'm possibly going to be one of the long-termers. I tried enteric coated 5mg Pred years ago when I was given it in error. I didn't get on with it and found 5mg of uncoated and 5mg E/C weren't bio-equivalent for me.

[Orangecakes]

Sorry to hear that you are flaring. This illness is so disheartening, just when you think it soon will go into remission, it rears it's ugly head again. I have gone back to uncoated pred. I am doing better on it than the coated tabs. Knock on wood for both of us. We just have to keep as positive as possible and remember not to overdo. You rest and take care. 🙂

[PMRpro Ambassador in reply to Orangecakes]

"just when you think it soon will go into remission"

You have to remember there are 2 versions of remission. One is medication induced and to maintain that you just need to take enough pred or pred+ if you need anything else like MTX to deal with the daily dose of inflammation. . You use this form of remission to have a decent quality of life until the underlying autoimmune disorder that created the inflammation burns out - which it does eventually for some 95% of patients.

[Orangecakes in reply to PMRpro]

Okay, my understanding from your above explanation is:

That at this moment my daily dosage of Pred at 2.5mg is at present dealing with my daily inflammation or taking whatever dosage needed to control inflammation? So this would be version 1 of a remission?

Then version 2 of remission is getting to zero pred with no daily inflammation and the autoimmune disorder has burnt out?

I am correct in what I have written?

[PMRpro Ambassador in reply to Orangecakes]

Yes, sums it up well.

[Orangecakes in reply to PMRpro]

Thank you for explaining. Take care.🙂

[tangocharlie]

Prob not of any use to you but info might be useful for others - I tried gastro-resistant tablets and found I got an allergic reaction (the red outer coating) so now put my Pred in gastro-resistant capsules from Capsuline UK.

[PMRpro Ambassador in reply to tangocharlie]

You can just wash the red colouring off the outside of the g/r tablet - it doesn't affect the g/r coating.

[Rugger in reply to PMRpro]

That's exactly what I did when I had 5mg tablets. The red colouring made me breathless. Now on 3.5 / 3mg and I'm OK with the colours on the 2.5 and 1mg tablets.

[PMRpro Ambassador in reply to Rugger]

I remember when the forums first got going, we used to mention it a LOT. Beats me why they insist on using these controversial colours on medication.

[Rugger in reply to PMRpro]

My local pharmacy dispensed vitamin D capsules for me - they were a vivid purple! I looked up the name of the colouring and it's banned for use in food! I returned the capsules to them with a print out of information about the offending E number. This was several years ago, so I can't remember what it was called. Since then, they dispense me plain white vitamin D tablets and there's a note on my records that says "Doesn't want colecaps"! 😉 🤨

[PMRpro Ambassador in reply to Rugger]

Lot of things banned here in EU land that are used elsewhere. Why do things have to be bright any colour?

[tangocharlie in reply to PMRpro]

I tried that at first putting the tablets in a sieve and rinsing them but thought s*d this for a game of soldiers ... and around about then you told me about the capsules that I think HeronNS had found

[PMRpro Ambassador in reply to tangocharlie]

So you use plain pred instead?

[tangocharlie in reply to PMRpro]

Yes plain Pred in gastro-resistant gel capsules. Which is probably being a bit over-cautious as the Cimetidine is a stomach protector but anyway I've got about a 1000 capsules in stock need using up😆

[tangocharlie in reply to PMRpro]

And I can only tolerate certain brands of Pred, not others so my GP specifies certain brands onlyon the prescription. Northstar was the main culprit. They all have slightly different coatings and fillers. Why on earth do they need to put colourings like E172 in meds? Many meds have a wax in the coating to stop them going mouldy presumably and I seem to react to that too as it's high histamine

[PMRpro Ambassador in reply to tangocharlie]

I know - and lactose. I remember someone have a dispute with her GP of all people "but it's only a LITTLE bit of lactose"! And there are pills with WHEAT in ...

[tangocharlie in reply to PMRpro]

These days you have to take what you're given with prescriptions and unless your GP checks for these things and puts a note on the prescription it's pot luck. Somebody reviewed my prescriptions recently and without ven talking to me removed all the notes on the repeat prescription. I had to go and get them re-instated. Sometimes I feel like doing a Blackadder - is this a piece of your brain Baldrick?

[PMRpro Ambassador in reply to tangocharlie]

I hope you made a complaint to the practice manager?

[tangocharlie in reply to PMRpro]

No I didn't think of that I just sent emails for the prescription team and the pharmacy when I was sent a brand I don't tolerate. The pharmacy said they can only do exactly as they're told and there was no note on file, een though I argued there had been one for years. Yet another case of "Not my circus not my monkey". The Practice must have learned from it somehow because only a few months ago I got a phone call to do a meds review. I've never done a complaint to the GPs before but but I'm currently putting one together re the back and how it's (not) been handled. They will blame staff shortages for lack of appointments but that's their problem not mine