DSNS: Reducing from 2 to 1.5 mg Prednisolone when using Enteric Coated Tablets

[Rostom]

Hello

I have always been very grateful to this site for all the tips and knowledge I have gleaned over my 3.5 years PMR journey.

I am possibly nearing the end of having PMR (not 'THE END'!!) and would be very grateful for what hopefully could be a last piece of advice. I have reduced from an initial 15mg (then quickly up to 20 mg) of Prednisolone using the wonderful DSNS method with only one flare and am now ready to reduce from 2 to 1.5mg Prednisolone.

I have acid reflux and my GP has been able to prescribe enteric coated prednisolone which I take at night (I take other medications throughout the day and the enteric coated Prednisolone has worked wonderfully well for me).

I am now about to begin reducing from 2 to 1.5mg and of course, there are no enteric coated 1.5 mg tablets and a 1 mg enteric coated Prednisolone can't be cut in half.

I was thinking that perhaps I would use a different method to manage this drop, taking a higher dose one day but nothing the next, which would negate needing any .5 tablets etc.

However, I have just read though the FAQ section where it is suggested that it is better not to miss a dose then take a slightly higher one later etc.

Actually, I have two questions:

What is the best method of dropping from 2 to 1.5 mg Prednisolone when using enteric coated Prednisolone.

and

As I do have some 1mg 'ordinary' Prednisolone and could cut these in half, are these likely to upset my reflux as such a low level? I understand that these would need to be taken with food but presume that at a low-level, I would not need to take Lansoprazole which was originally prescribed for me before I was switched to the enteric coated pred.

Apologies if I have trundled on a bit - just trying to give all information etc. I would be very appreciative for any informative responses as I just don't know what my next move should be.

Many thanks in advance for any replies.

[piglette]

You could be OK at such a low dose to use the non coated tablets. You could always give it a go.

[DorsetLady PMRGCAuk volunteer]

What is the best method of dropping from 2 to 1.5 mg Prednisolone when using enteric coated Prednisolone.

In my mind, only one way.really - and that’s it use a plain 1mg cut in half… not a great fan of the alternate day way of tapering.

Just make sure you take the uncoated half tablet with yogurt or similar to aid digestion.. and be aware it will be absorbed into your system more quickly that the EC version…about an hour compared to 3 or 4…

Good luck

[PMRpro Ambassador]

I was able to tolerate small doses of plain pred but not more than 3mg in 1mg tablets without feeling it. So the only way to find out if YOU can manage 1/2mg is to try,

Originally, DSNS was developed partly so that patients on e/c pred could still taper slowly even without using plain pred by repeating each step of a 2,5mg drop several times - at that time you couldn't get 1mg e/c pred. It did still work at higher doses and most people could manage tiny doses of plain pred.

[Rostom]

Many thanks to Piglette, Dorset Lady and PMR Pro (what would this site do without your knowledge and help?) for your whizzy responses.

I will try the 1.5 mg Prednisolone on the DSNS taper, using 1mg of enteric coated and a split 1mg of plain Pred. As you say, I won't know until I try!

I dislike yogurt but take Kefir (I know, I know, go figure!) and will ensure I take the .5 plain Pred with a swig or two of Kefir but it's such a small dose, I don't think my reflux will throw a wobbly.

I will remember the time difference between this and the enteric coated 1mg- thanks for that tip.

Thank you all once again.

[Sophiestree in reply to Rostom]

you could always get capsules to put the 0.5 pred in if you're concerned.

[PMRpro Ambassador in reply to Rostom]

Kefir and yoghurt do taste VERY different so I don;t think it is surprising - what about Greek yog? I think it tastes more like cream than yoghurt.

[readingbooks in reply to Rostom]

How about a piece of hard cheese instead of yogurt ? Works well for me.

[Lclmlbls]

It is a good feeling to be reducing to a very low dose but we must be cautious about celebrating too soon! I have a similar situation to you. I find mixing the two types of tablets to achieve the correct dose doesn’t have any effect on my acid reflux, but always take the uncoated ones after food. Good luck on (hopefully) the final stretch of your journey.

[PMRnewbie2017]

I have another suggestion.As you are on such a low dose it's unlikely the Pred will trigger gastritis but of course it is possible. Thinking about your adrenal function, it would be good if you took your dose in the morning after the natural 8am cortisol peak. So I'm thinking, switch to plain Pred, take your dose with breakfast. You won't have any postural issues either to cause reflux as you won't be lying down.

The only other thing to be aware of is the % drop in dose. If you struggle you may need to consider 0.25mg reductions which are easily achieved using 1mg and 2.5mg uncoated tablets.