preds in empty capsules

[Nanatoo]

I’ve seen posts from people who put their preds into empty capsules which then avoids the use of ppi’s. My question is, does the prednisolone then work in the same way?

[ChrissieHW]

Hello ! I’ve just read some back posts and advice from others on this forum - a Company called Capsuline ( they have a U K website) are recommended, amongst others. I have deliberately stopped taking Omeprazole after 20 months of use - if I can take one less drug I will ! So, I have just ordered size 0 from Capsuline, with postage about £37 for 1000 acid resistant capsules which will keep me going for a bit . I understand that it will delay absorption of pred by a couple of hours but worth it . Isn’t this forum wonderful!

[SnazzyD in reply to ChrissieHW]

I took coated Pred and found that I had to allow 3-4 hours (if taken on an empty stomach) to make its presence known. I still had to take Gaviscon at night but see how you go.

If you have stopped Omperazole abruptly you might find there is rebound acid reflux for a while.

[ChrissieHW in reply to SnazzyD]

Thanks Snazzy, it’s about a week now since I stopped Omeprazole, I have had a couple of, thankfully, minor gastric issues but with Gaviscon to hand it goes away very quickly. Thanks again 🙏

[Kendrew]

Just to say that gastro-resistant prednisolone tablets are available. I've taken them for the past 5½yrs and not required a PPI....so far!

[tangocharlie]

Studies are pretty scant and everybody is different but normal Pred is generally absorbed in around 15 mins to 1hr and enteric Pred 1-4 hours. I use enteric capsules and guess roughly going by my blood sugar readings comparing neat Pred and the Pred in capsules that for me there is about a 2-3 hour difference between the two. This is all very rough and vague and not definitive and this is only looking at when each raises my blood sugar I have no way of knowing when the Pred kicks in and starts to work on inflammation. I'm sure somebody more technical can give a better answer

[Nanatoo in reply to tangocharlie]

Thank you tangocharlie. That’s useful advice. I’m going to try using the empty capsules with my dose of pred inside and note any pain increase,if any. I find the side effects of the ppi’s unpleasant so if I can wean myself off them I’ll be happy.

[tangocharlie in reply to Nanatoo]

I doubt you'll notice any change in pain but you could always do the first capsule dose a few hours earlier than you would normally just in case. Then take them roughly the same time every day which according to studies is probably best in one go early in the morning. Another alternative is to take somethng like Cimetidine or Famotidine as a stomach protector which you can get from your GP. PPIs really shouldn't be used long term if they're just for stomach protection unless they're sorting out sme other gastric problem. I listened to the talk by Dr Christian SElinger at the online PMRGCAuk AGM and he said probably below about 10mg you don't need a PPI and also that the danger of stomach bleed which you are trying to protect against is cumulative ie won't happen from taking Pred neat if need be, so long as you don't do it every day. Some people just take the Pred with food. So plenty of options. I've now got about 3 years worth of Capsuline capsules in the cupboard so might as well use them.

[dmart7]

I've been doing it for about a year, using capsuline. The enteric properties help me both to avoid PPIs and to take the dose at 2-4am without food. The effect of the Pred seems to be the same. Which seems to contradict numerous (albeit dated) studies which tested enterics and concluded that the absorption is unreliable!

[Nanatoo in reply to dmart7]

Thank you dmart7 for such an informative reply. I’m going to definitely give it a try as omeprazole has bad side effects for me.

[PMRpro Ambassador in reply to Nanatoo]

There are other PPIs besides omeprazole - the best is said to be pantoprozole but there are several. There are also H2 inhibitors - different mechanism so different effects. Always worth being firm with your GP.

[Hugh_Marc in reply to PMRpro]

I had to come off omeprazole after it gave me severe diarrhoea. I was prescribed one 20mg a day. Dr said my symptoms were very common. I’m now on an alternate at 15mg every other day.

I’m eating so much natural Greek yoghurt for my stomach I’m now making my own.

[PMRpro Ambassador in reply to Hugh_Marc]

They are common - and GPs are beginning to realise that cheap is not always cheerful!

[PMRpro Ambassador in reply to dmart7]

Using the capsules may let you take the pred before bed rather than during the night - it won't release until about 2-3am which is the ideal time to take pred for management of PMR morning symptoms.