Prednisolone - Disappearance of Enteric Coated

Hi again

I have put a reply to this on the other website

I was given non enteric coated tablets earlier last year and have had no problems with them at all

It does say on the reasons given that one of the reasons is the problem some people have with the coatings and cost

My Doctor said it was cost she actually showed me on the computer that enteric coated ones costed at least 10 times as much She did say that if I had a problem I could go back on the enteric coated ones I havent had to take any stomach protection either

The only problem I had was one day I took 4x5 instead of 4x1 and I was straighr on here in a panic !! I had got the tablets from a differnt chemists and the 1s and 5s were very similar unlike the other ones where the 5s were bigger and squared off Not a mistake I will make again !!!!

As far as I am concerned if it can save the Health service money for other things thats fine

Best wishes

Mrs G

I have never been offered enteric coated tabs and have never had stomach problems with the ordinary variety. Other problems, yes but I'd have probably had those whatever.

Hello, Mrs G & Mrs K. I have been taking uncoated Preds tabs, prescribed to me at the University hospital, together with 15mg Lansoprazole Gastro-resistant capsules. I take them with my cereals at breakfast, and so far I seem to be OK with the stomach.....Thank you Mrs G for your post. I am much better now, and I will retire to bed soon...Tomorrow I have a friend for lunch, and hope I shall awake without the beastly pains ! so that I can enjoy the first social visit since I was hit by PMR last July ! Take care of yourselves. At soon. Granny Moss.

That's the first I've heard of this Mrs k and thank you for passing it on to us.

I have always taken Prednisolone enteric-coated 5 and 2.5mg tablets (commencing on 40mgs) and uncoated 1mg tablets when needing to take a dose not available in enteric coated.

I have never had any allergy problem with the coatings.

I did have problems with the intial prescriptions of both Omaprozole and Lansoprazole by my GP - one caused bowel problems and the other stomach pain so abandoned these at the suggestion of my rheumatologist and resorted to live yoghurt and crossed fingers! At the time, I felt very grateful that at least I was being prescribed enteric-coated tablets.

Being down to a 1mg dose at present means I have now been taking only 1mg non-enteric coated tablets for some considerable time (well over a year). Unusually, in the last few weeks I have experienced a few episodes of indigestion which is most unusual for me, so I'm beginning to wonder whether the long-term uncoated tablets are to blame and now have everything crossed!

The coated tablets have suited me, especially as I'm unable to tolerate the gastro protective pills, so I, for one, would be most unhappy to see them disappear - this can only be a cost-cutting decision especially in view of the current climate.

MrsO

[b:0e4d2ccd08]Hi Mrs O.[/b:0e4d2ccd08] I can see that phasing out the enteric Prednisolone would be a real problem for you and anyone else who can't take Omeprazole or the like. I rarely have a problem with taking tablets but found very early on that I couldn't tolerate non enteric Prednisolone. Until very recently my Doctor has always prescribed the enteric 5mgs and 2.5mgs Pred when required but on my last two visits (whilst I was still on 5mgs) she's given me non enteric along with Omeprazole. I've never had a problem with Omeprazole. I tried the yogurt route but it didn't seem to help. I'm on 4mgs at the moment and find I really need the Omeprazole. The doctor said its cheaper to combine the two than prescribe enteric. I know that enteric Prednisolone isn't available at all in Spain, in fact our local Spanish chemist was very interested when I told her what I was taking and I had to take it in to show her, just to satisfy her curiosity. I have a couple of packets of enteric 2.5mgs stashed away from my 12.5mg days and as I'm thinking of going from 4mgs to 3.5mgs as my next drop (I figure that a 25% drop in the depths of winter when I always ache anyway might be a % too far!) I think I'll be able to do without the Omeprazole just for the 1mg tablet.

[b:0e4d2ccd08]Hi Granny Moss.[/b:0e4d2ccd08] I do hope you enjoy your lunch with your friend today. Its so important to spend time with friends and family. We had my late husband's brother and his wife here for the day yesterday and really enjoyed their company. I do a simple meal, let my partner do the 'extra' housework that always seems necessary when you have people visiting and relax rather than fuss as far as I can.

Best wishes to everyone.

Lizzie Ellen

Lizzie Ellen,

I was initially put on Pred in Nov-08 by a Spanish rheumy (as I wrote earlier, my husband and I spend all Winters here since lots of years) and both 5mg and 2,5mg tablets were uncoated. As you also pointed out, they don't have coated ones here.

So when I told the doctor that I was worried about my stomach, he said: oh, no problems at all, pred won't upset your stomach unless you take Ibuprofen, Voltaren or other non-steroid medication in the same time. I was of course not so sure that he was right, but took my tablets and gave it a try. Luckily, in my case it really works, as I have now been on pred in more than 2 years and still can't notice any stomach problems.

But everyone is different, so what a pity if the coated ones would disappear in your country.

Best wishes to all of you and a nice weekend,

Judit :wink:

Hi Judit,

Give my love to Spain 8) (I will be there in February!). I hope you find the Spanish chemists as helpful to you as they have been to me. I'm pleased you've managed with the non-enteric steroids.

Lizzie (missing the sun!)

Hello Judit

I can agree with the Chemist re the Ibuprofen causing stomach problems I took max dose of Ibuprofen with Paracetamol before I was prescribed steroids and have never felt so bad I would never take Ibuprofen again I gfelt sick dizzy all the time

I have been taking the non enteric coated steroids for some time now and have had no problems

best wishes

Mrs G

Hi all

Interesting discussion about the tablets. You might be interested to hear this.

Admittedly I was on Omeprazole for a few months before the PMR kicked off so I already had a stomach problem - inflamed oesophagus. (I have often wondered and asked if the 2 problems could have been related as they both started so suddenly within months of each other).

Anyway, I had not had problems with the coated pred tablets (5mg and 2.5mg), but within a few days of taking the 1mg (uncoated) I had dramatic oesophagitis symptoms again - and for me this includes a very tight chest, wheezing, coughing etc.. My GP agreed that it was very likely due to the uncoated tablets as this was the only thing that had changed. So I am doing a reduction regime which avoids the 1mg tablets.

My surgery recently were instructed by (I think) their PCT to supply only uncoated tablets as they were 10 times cheaper. I discovered this when I went to pick up my repeats but I refused to take them and rang and spoke to my GP and he agreed that I could have the coated ones.

Interestingly, since then, he has told me that he wishes they had never agreed to go down the uncoated route as they have had so many patients coming to them with stomach problems as a result. So they have decided to defy their PCT and supply coated tablets.

Beev

Hello Beev

That's interesting to hear your GP's views on this subject. I spoke to my usual pharmacist today who said she hadn't heard anything about this.....yet! I told her of my concern should I have to increase back up the dose again and my intolerance to Omaprozole etc, and her view was that they would probably still supply the coated tablets to people who needed them. She added that in the case of Co-proxamol which was apparently withdrawn because of a risk of heart problems, there were some people who were still having them prescribed because other similar drugs didn't work for them.

Hope you're continuing to do well, Beev.

MrsO

Hi beev and Mrs O,

There seems to be some confusion over this whole thing as far as I can see. The original dispute was because some patients with gastrointestinal problems due to things like Crohn's disease and other similar diseases do not absorb the enteric coated pills as well because they do not stay in the gut for long enough for the coating to dissolve (in some cases the pills were leaving the body in the same state they entered it!) and, as a result, the patients were effectively getting a much reduced dose of steroid. These patients were to be prescribed the white tablets which dissolve in the stomach so this problem is avoided.

In the meantime, in order to cut costs, it has been put into their prescribing guidelines by many PCTs that if prednisolone is prescribed the default is to be the white tablets. They are not being \"phased out\" as such and if there is \"clinical need\" then the enteric coated pills may be prescribed but this must appear clearly written on the prescription. Alongside it, there are also instructions in some PCTs that the cheapest available PPI (the stomach protection medicines) must also be used, unless there is a clinical need. Which suggests that there is a notable number of patients who can't manage with the cheap and cheerful (or not!) versions. I'm not sure how the costs correlate in terms of cheap steroid plus cheap PPI versus cheap steroid plus expensive PPI or just enteric coated steroid.

I found a few stories on an asthma forum where patients on long term steroids were having problems with the white tablets - one developed gastric bleeding within a few weeks which resulted in her needing treatment and to be referred to another consultant so there wasn't a lot of cost-saving there!

I have had both - personally I have had problems in the past as soon as I try to use the white tablets for more than the odd few mgs and a few months ago tried to use up some 5mg tabs rather than waste them only to have awful indigestion within hours. Whether that is associated with having totake 3x 5mg tabs I don't know. However - I shall be reluctant to give up the enteric coated ones and shall fight my corner!

It seems to me that if any of us is faced with this choice we should insist on a prescription for the white tabs for a short time as a trial and not be given a large supply which may then be wasted - once you have taken the tablets away from the pharmacy they have to be chucked away. If you have no problems - fine, money saved as per instructions. On the other hand - PMR is bad enough without ending up with another pain and other drugs. It's one thing taking steroids for a few weeks but taking them over months is another ball game altogether.

Basically, what I'm saying is that we don't have to be forced into a change-over if we have problems - and obviously beev's doc has met with quite a few now they are trying the theory out.

At present I have a good stock - I only wish I thought I would never need any more :roll:

best wishes from a very sunny but very cold and windy northern Italy!

EileenH

Thanks for clearing up the confusion, Eileen - now that you have explained that it is sufferers of diseases such as Crohn's who are the ones who can have problems absorbing the enteric coated tablets, that puts a different slant on things and, knowing that the coated ones are not \"disappearing\", I can relax as I only have PMR/GCA! :roll: If necessary, I will follow your example and \"fight my corner\" too! :D

MrsO

Mrs O

Sorry to say, but it is not only Crohn's that are having difficulty with the enteric coated. And it is not only Prednisolone that are enteric coated.

I was worried once I reached 4mg as Mam had incurred a peptic ulcer.

I was offered and took the PPI but found they did not suit everyday.

I gambled and after one year on non-enteric no problems and when I took the drop from 4mg to 1 mg noticed no difference at all.

The edict has gone out and some patients are fighting their corner, but some are finding that they can do with lower dose. It is all to do with absorption.

I guess it is either non ec and ppi's or fight your corner.

Mind one drug I won't take is Alendronic Acid. They can keep that one forever.

MrsK - the absorption bit is quite interesting. The rate at which it reaches the peak is slower for the EC tablets as they take longer to get to the bit of the gut where they are broken down. There is also a question as to the even-ness of absorption. That's fair enough.

However - I wondered whether the fact I couldn't reduce my dose was because I took my pills on alternate days so tried to change back to a daily dose. At the equivalent daily dose I had real problems with pain - I really got the impression that the double dose on alternate days is squashing the inflammation and the effect lasts well over 48 hours as on the morning I need the next dose I feel great. What a bizarre disease! :lol:

I'll second that. If my own experience was not enough, the literature ( just google it ) makes you wonder for whose benefit this stuff was manufactured and marketed.

If you read the financial press you will soon hear the smacking of big pharma's lips as they contemplate the\"reforms\" of the NHS.

I was 15 in 1947 as the NHS was born.I'd have liked it to be still available when I have gone but I fear not. Sorry; I'm feeling despair at the current ethos. Not sure if that's the right word. Most of my life there was progress. No longer. There is a mean spirit abroad in this country and I no longer see where the power to combat it will come from.