Enteric coated Prednisolone

[Nuts25]

Due to my chronic gastritis, I wish to use enteric coated Prednisolone but GP says it makes no difference. I question that that comment applies to someone who already has a very problematic chronic gastritis. I believe that the coating allows the drug to pass through the stomach into the next stage which seems to me what is needed. Does anyone know if any trials have been carried out under these conditions? I would love to be able to prove my thought with some hard scientific research. Many thanks

[PMRpro Ambassador]

What research I know of probably wouldn't help your case - it's a bit biased against it I fear! There may be other stuff I don't know of.

However, SnazzyD had gastritis problems that necessitated both enteric coated pred AND medication but that did work for her. And we have loads of anecdotal evidence that people with gastritis do better with e/c pred.

There is nothing to stop a sensible GP agreeing to let either hypothesis be tested by letting you have a couple of months of e/c pred to do an N of 1 trial. After all - you are the one concerned and it is whether it works for YOU that matters. You have a baseline of what it is like with plain pred already. Personalised medicine ...

pmc.ncbi.nlm.nih.gov/articl...

[Nuts25 in reply to PMRpro]

Thank you PMRPro. I do intend to fight for it, especially when the GP said that I can thank steroids for my chronic gastritis! I am now 76 after 17 years of treatment and annual attempts to get away from the medication. I am currently on 15mg daily after yet another flare up. I'm ready to admit defeat and stay on 5mg enteric coated ad infinitum, I understand that this is not generally thought to be a high dose and I can live an active life at that level. Thanks again

[Hopingsail in reply to Nuts25]

Hi Nuts. I was sad to read of your tummy woes and unhelpful doc….

I was also concerned that you have been stuck with PMR for such a long time- you write of annual attempts to get off pred and numerous flares , currently bringing you back to 15mg. It prompts me to ask if you use one of the gentle reduction plans recommended on this Forum?

Dorset Lady’s plans have worked well for me - currently on her 7-week plan reducing from .5 to zero! 🤞

Some reduction plans - even those from NHS - are clunky in comparison . As for many GP’s advice …!! Best of luck!

[Nuts25 in reply to Hopingsail]

That's kind of you Hopingsail. Over the years I have reduced so very slowly and in fact, before the current flare up, had got down to a 3 day cycle of 2, 2, 3 which had taken a long time to get down to. You're absolutely right, the gentle reduction plans have been very popular with the members of our local Support Group. Thanks for your reply.

[SheffieldJane]

It definitely makes a positive effect on me. After I mild tussle - cost? I have been on them for years, successfully.

[piglette]

If you have the coated pred you do not need to be prescribed for stomach tablets, if you have the non coated ones it is suggested you be prescribed for both pred and stomach tablets, so your GP would be saving money on not prescribing a second drug? I don’t know if that argument would work???

[Nuts25 in reply to piglette]

Hi piglets, thanks for your reply. Unfortunately I also have GERD so have to take Omeprazole twice daily anyway - so no saving for them there!

[Nuts25 in reply to Nuts25]

Sorry, predictive text- Piglette

[piglette in reply to Nuts25]

Oh well.

[Kendrew]

Hi Nuts25

I have taken enteric coated pred since my PMR diagnosis almost 6yrs ago.

I'm sure this has contributed to helping prevent the need for a PPI..... which is one less medication to have to take!

I may just have been lucky, but anything that potentially might help reduce the need for supplementary medications, is a good thing in my book.

As individuals though, we each have to consider our own personal circumstances before making any such decisions.

[Nuts25 in reply to Kendrew]

Great news Kendrew, long may it last, I'm happy for you.

[Sharitone]

I have both EC pred and Omeprazole. Attempts to give up Omeprazole have failed. Do you think the cost is the issue?

[Nuts25 in reply to Sharitone]

I'm afraid I think that's a reasonable guess Sharitone. It's been suggested that e c are twice the price of uncoated, multiplied over goodness knows how many and it would be a lot.

[Sharitone in reply to Nuts25]

Somebody will correct me, I'm sure, but I seem to remember someone saying that the 2.5mg ec tablets were actually cheaper than the plain. If this is correct, that might be a way forward.

Failing that, you could always move here, where the surgery is prepared to prescribe both!

[PMRpro Ambassador in reply to Sharitone]

They are - anyone on e/c is likely to need them to taper so there is a demand. It is easy to cut a 5mg plain tablet, no demand so it costs relatively more.

[Nextoneplease]

Don’t know whether this may help - I’ve seen people recommend empty capsules into which you can put your pred. Apparently this has an e c effect? I think you can get them on Amazon? Not what you want I know but might be of temporary use??

[Nuts25 in reply to Nextoneplease]

Thank you very much, what a novel idea, I'll bear it in mind. Kind of you to mention it

[SnazzyD]

It made a huge difference to me. I couldn’t tolerate Omeprazole or Famotidine. I still needed Gaviscon at night. Why won’t the GP just try it? It’s not as expensive as it used to be.

[Nuts25 in reply to SnazzyD]

Hi SnazzyD, thanks again. I actually managed to get an E C prescription today by standing my ground. I was only hoping that there might be some recognised research out there to avoid having to argue my case on a regular basis, which I'm quite prepared to do if necessary!

[PMRpro Ambassador in reply to Nuts25]

If you have your own trial evidence, that should be enough. Always supposing the doc believes you!

[Nuts25 in reply to PMRpro]

I found an article written years ago that said, ec not needed unless the patient has a condition which puts them more at risk of ulcers, so that definitely nods to the fact that we should be assessed on our individual situation. Plus, if you check side effects of pred it clearly says can increase acid production which can damage stomach lining so why keep putting the damaging meds into the already damaged area? I also found that uncoated are being absorbed after 15 minutes, whilst coated is delayed to around 4 hours. I assume that the gut copes better?

[PMRpro Ambassador in reply to Nuts25]

Being on pred could be said to do that! The main difference is that the EC pred has a coating that resists the acid environment in the stomach so it reaches the duodenum which is much less acid before breaking down. It is the presence of the acid in the stomach that causes the problem - it will take advantage of any irritation and attack it and can erode the stomach lining enough to bleed or even form ulcers. There is some evidence that it isn't just the mechanical effect but the pred also does something to the prostaglandins that can lead to damage too so in some people EC alone isn't enough, a PPI or H2 antagonist might still be needed as well. So some people are OK with nothing, some with EC and some might need both. But in the lower gut, the environment isn't as acid.

[Nuts25 in reply to PMRpro]

Thank you PMRPro, very informative. I'm currently taking Omeprazole 20mg/twice daily to calm the GERD. I'm also making huge changes to my diet to try to calm the tum so am hoping that I might at least get rid of one Omeprazole/day. Having said everything about pred, I am soo grateful that it exists, I've had 17 active years which I wouldn't have had without it. I guess the bill has landed 😉

[PMRpro Ambassador in reply to Nuts25]

I haven't received a bill yet - but yes, 16 years and counting for me. Definitely NOT the devil drug as far as I'm concerned.

[Nightingales]

I dont have any study evidence but I add myself to those who said they make a big difference. I am diagnosed with GERD. My GP didn’t believe they would make a difference either but was willing to try. I get all three doses so I can taper.

[Nuts25 in reply to Nightingales]

I, too have GERD, and increased stomach acid will surely not help that. Thanks for your reply

[Zebedee44]

I was found to have gastritis and intestinal metaplasia last year so I take lansoprazole as well as 2.5mg ec coated. I’m tapering very slowly from 3mg and my doctor has denied me the 1mg coated tablets. If I ever get below 2.5mg I guess I will have to use uncoated 1mg tablets, or have the same discussion as you have had.

The gastroenterologist told me recently that the biopsies had come back showing improvement and I have put that down to the green tea I now drink in the morning.

[Nuts25 in reply to Zebedee44]

You must be very pleased with the improvement. It's interesting that you think green tea has helped, I have read that that plus 1 tsp of good Manuka honey is very good. I have resisted trying it because of the taste of green tea and the cost of good Manuka honey. I am definitely going to rethink that as I understand that 1 cup in the morning is enough to make a difference. Thank you

[PMRpro Ambassador in reply to Nuts25]

It is also said that a good, locally produced honey has almost the same benefits as Manuka - particularly since a very high percentage of so-called Manuka can't possibly BE Manuka, they can't make that much!

[Nuts25 in reply to PMRpro]

Thank you for the tip - check out the local health shop

[PMRpro Ambassador in reply to Nuts25]

Or your local beekeeper's association.

[Nuts25 in reply to PMRpro]

Oh good idea, I'll look into that, thanks again

[Zebedee44 in reply to Nuts25]

Try a local farm shop or farmers market.

[Nuts25 in reply to Zebedee44]

Thanks Zebedee44, added to list 😀

[pammy_hyland]

What a load of tosh....They have made so much difference to me and my stomach problems but they are hard to get hold of ..finerly I've found a chemist's that get me them every month even though they struggle ...after the pharmacy in my doctors practice refusing to try even ...

[Nuts25 in reply to pammy_hyland]

Well done for persistence