Owing to a sensitive stomach, advice needed on on... - PMRGCAuk
Owing to a sensitive stomach, advice needed on on a reduction programme from 5mg using either only coated pred or a minimum of uncoated?
Hi Pat
You'll probably be ok whilst using a mixture of coated 2.5 and uncoated 1s, although having said that they do go to different parts of the stomach to be absorbed.
I relied on 'live' yoghurt with breakfast each day before taking the steroids - the yoghurt contains live bacteria which help to keep the stomach lined with good bacteria to protect against the steroids.
I never took any of the stomach protection pills prescribed alongside the steroids as they caused adverse side effects on my bowel so I relied on the live yoghurt for protection. It served me well for the 5+ years I was on steroids even though I started on a very high dose of 40mgs (GCA and PMR). Perhaps this will help you when you reach 1mg pills only.
Thanks Celtic,
I'll give that a try when I am ready to drop from 5mg, fortunately I like yoghourt.
Having started at 15mg, I got to 10mg when I was switched to uncoated pred owing to the local PCT policy and my stomach played up big time even though I am taking Omeprazole to protect my stomach. Since then I have taken only coated pred but it is more difficult at the lower doses.
My GP is fairly flexible about reductions as long as I take it slowly, make an effort to reduce and have blood tests regularly. She would prefer me to drop by 0.5mg at a time and has prescribed a selection of 5 coated, 2.5 coated and 1mg which does not come in coated form. It is quite possible that my stomach will cope with a 2.5 and two ones even though it could not cope with 10 uncoated. I will try alternating 5 and 4.5 for a week to see how my stomach copes.
Hi Pat,
Consider this. Why did they bother to make coated tablets in the first place? Answer, to protect the stomach as much as possible. They are more expensive because they are designed to break down more slowly.
I, like Celtic, found that Omeprazole caused probs. in my intestines. l always take meds and suppliments with small amounts of food. I rely on one or two slices of toast spread with olive oil margarine. This works for me. If you do not like my choice of food, then use something that you have found not to upset your stomach and take the steroids with that.
Stick to the coated as much as you can. Buffer your stomach with any food you eat which you have found not to upset it. Bingo! By the way the one thing guarenteed to protect your stomach are antacids like Rennies. Unfortunately, they stop you absorbing Pred. Wait at least 2 hours before taking any antacids. Theyre a brilliant source of calcium. Two a day will give you all the extra calcium you need to protect you from bone loss.
Pats
Hello Pat,
As I already had a severe reflux problem which gave me constant laryngitis, I have been taking Omeprazole, Ranitidine (aka Zantak) and Gaviscon Advance (all prescribed by ENT consultant) for longer than I've had the pred. And I always have bio yoghurt for breakfast. So far, so good. But I realise that this isn't the solution for everyone. All you can do is work out what suits you and stick to it. What does your GP say?
Thanks for your reply.
My GP has been very good working out a reduction programme from 10mg to 5mg which I reached last week. Her advice is "If in doubt DO NOT DROP". She suggested going to 5mg alternating with 4 but I was worried about taking 4 1mg pills in one go. Off the top of my head I suggested alternating 5mg with 3.5 which she agreed to. She said I must try the 1mg and not to assume that there will problems. Previously she had said to avoid alcohol, spicy food and all painkillers apart from paracetemol. I am doing this plus I have mostly coped without painkillers. I always take the steroids immediately after breakfast.
I had a few really bad days straight after the last drop although I am better now thank goodness. Coupled with the advice on this website I thought that smaller drops of 0.5mg would be preferable if I could cope. It was also my GPs preferred way forward. Looks like I should add some yoghourt or toast to my breakfast of mueslil or porridge and give 4.5 a go.
Why don't the manufacturers make coated 1mg pred?
Hope everyone's dose reductions go well.
Pat
Hi Pat,
I'm not sure, but it's prob due to the cost. Our National Health system will always look for the cheapest option for obvious reasons. When I was first diagnosed with PMR my GP would not prescribe 2.5mg tabs coated for me. He said he was not allowed to. However, my Rheumy did prescribe them along with 5mg and 1mg tabs uncoated. I do not have any probs with meds as I always take pred, ibuprofen and suppliments with food. I am lucky I know. Many people have trouble with their stomachs and have to have extra help.
I am going on line to find out if coated pred is made elsewhere and prescribed in other places.
What I do know is that uncoated pred is as cheap as chips.
Pats
Thanks Pats for offering to search on line. Thats very good of you. It will be interesting to see what you turn up.
On past experience I am dropping the dose about once every four to five weeks so if all goes well I am about three weeks away from the next drop. Two weeks after a drop I give myself a big pat on the back if I am no worse than on the higher dose.
All painfully slow but at least I am moving in the right direction.
Pat
Hi Pat,
I have been on line and put in "what doses of prednisolone have enteric coating" and up came lots of information. If you do the same, you will see for yourself. I still think that cost is the main reason. They are much more expensive.
I am dropping each dose by half a mg at a time and using 2.5mg tabs to help. They are the coated ones and very easy to distinguish from the 5 and 1mg tabs. Luckilly for me I have no probs with my stomach, but I can see that some folks might make a mistake in dosage when they have three different doses of tabs to take which look very similar.
Pats
Thanks Pats.
I've looked at the web and I think that you are right that cost is the driving factor. Sadly there is no sign of enteric coated 1mg pred tabs.
Following all of the advice given I will wait until I feel ready to drop the dose - probably after 4-5 weeks on 5mg on past experience and then go for 4.5mg(2.5coated + 1 +1) alternating with 5mg for a week. Whilst I always have eaten breakfast I will try to eat a bit more, adding yoghourt or toast to my daily muesli to give my stomach more protection. If that works then I will drop to 4.5mg daily. Still got a couple of weeks at least to go before dropping but at least 5mg seems okay. Will blog as to how I get on then.
Pat
Hi -- a lot of us with PMR find drops every 3-4 weeks are too fast and have been advised by rheumatologists to stay as long as is needed at one level. As a doctor friend who had PMR himself said, do not be in a hurry to drop especially below 10mg -- he said think of PMR as a smouldering fire and you must be sure it is 'out' at each level of pred or it is likely to re-ignite. I stayed at 5 mg for a couple of months and many specialists seem to advise doing so at around 10mg then again at around 5. You can also alternate at .5mg differences for a week or two weeks or longer. I've had success since a long stay at 5mg by dropping .5 about every 3 weeks with a week of alternating between the old dose and new dose. You can take it even slower by doing a week or more of alternating days, eg 4mg,3mg,4mg,3mg... then the next week(s) do 4mg, 3.5mg, 3.5mg, 4mg, 3.5mg,3.5mg. then go to 4mg, 3.5mg 3.5mg,3.5mg,4mg,3.5mg,3.5mg,3.5mg etc. before going to 3.5 alone for a few weeks.
You can also cut the 2.5 tablets with a pill cutter. But I don;t think it likely you'd have problems with only taking a couple of 1mg when you get to those levels - - not the same at all of taking 8mg of uncoated at a time.
As others note, taking preds with food/milk is the best approach and I also use yoghurt though kefir or those probiotic drinks would do the same thing.
It is much better to take it slow with drops, and not incur a flare which could make you have to start over at a much higher dose.
