Prednisolone - enteric coated or not?

hi and welcome there is a constant debate re enteric coated versus uncoated and yes the price is the main issue but it has also been difficult to get enteric coated for some people . My gp prefers uncoated because she says they are absorbed more quickly, I take omeprazole to protect my stomach and have no problem taking steroids .However with your wifes past history you may have a case for enteric coated steroids it will depend on your gps perscribing budget because they do have to justify use of higher priced meds ,I wish you well but what ever you use, i presume your wife is on meds to protect her stomach lining due to her medical history .carolk

hi - thanks for this. i'm not really concerned about getting the enteric coated - i'm pretty sure the GP will cooperate. (even though she seems to have changed the script without discussing it with us first.) i'm just interested to know what others on here have found.

yes, Tamar takes omeprazole too, in any case. i'm not convinced the possible rapid absorption is an issue - as long as you take them regularly, every 24 hrs at more or less the same time. maybe it's more critical in that emergency period when the PMR first arrives, or returns, and you need rapid relief.

another question for anyone reading this - her pills are made by Actavis - as far as i can see they don't make an enteric coated 1 mg pill (only the bigger dosage pills) - does anyone know of any firm that does? Tamar has gone down from 60 mg (suspected GCA) 15 months ago to 6 and two-thirds gm at the moment (i.e. 5mg enteric coated and the rest uncoated) - but i'm thinking of if and when she gets down to below 5 mg and is taking 4 x 1mg pills - it might be good to be taking coated 1 mg pills then.

I had to go to a Pharmacy in Spain last year while on holiday. I was able to buy 100 Prednisolone (coated) 5mg tabs for less than 8euro,s with no problem at all. i have Crohns and had left my meds at home.

Arty - Hi!

The price justification was made on the basis of figures last year or the year before - I am told by a pharmacist that it is less of an issue now as the pharma companies immediately increased the price of ordinary pred and much of the differential disappeared. In addition, although many GPs thought there were no gastric issues and agreed to it, they were horrified when within a few weeks they had loads of patients turning up with similar problems to your wife and wished they'd not agreed so lightly. The guidelines do say that patients who need them should be allowed to have them - the only thing that is required is that it is stipulated on the prescription by the doctor that enteric coated are dispensed - and do check the pharmacy noticed.

Noone makes 1mg enteric coated - they would be far too expensive to produce as all the tests for absorption and so on still have to be done and for 1mg the price would then be totally disproportionate. You do get 2.5mg enteric coated and once Tamar gets below 5mg taking 5mg on some days and 2.5mg on others can achieve an adequately small dose reduction over a period of 10 days or so - see Ragnar's reduction schedule somewhere on here or on the other forum/northeast support site. However - since it sounds as if she copes with small amounts of ordinary, you can cut 1mg plain tablets to give 1/2mg: 2.5 + 1 +1/2 = 4 and that makes 1/2mg reductions quite easy. I'm sure you know enough not to cut enteric coated - because then you lose the point of the coating as the pred is exposed.

And whilst I'm sure it is easy to get them in Spain - I suspect a private prescription in the south of England is cheaper than a special trip to fetch some, even with everyone's favourite airline Rymafian

OTOH - my husband has just been provided with tailormade warfarin tabs here: he needs 2mg a day for almost perfect control. Here in Italy warfarin comes as 5mg and have to be cut and 2.5 needs quite a complicated scedule not to end up with a soaring INR level - so a load of 5's have been ground and reloaded into capsules as 2mgs. Hmmmm - could this be the answer to my problems with 16mg Medrol which is all they have here. ???

Eileen

hello again eileen - as usual you've been very helpful - just about covered everything there is to say possibly! many thanks.

(btw, i find this forum somewhat more user friendly than the dedicated PMR forum, hence posted here.)

I have been taking non enteric coated tablets for some time now with no problem I always have them after breakfast ( normally Porridge ) and the pro biotic yoghurt with them but my Dr did say if I had a problem to come back and she would give me the coated ones

It does seem wrong on the Drs part to give your wife the uncoated ones if she already had a history of gastric problems and Im sure with all the extra stomach protectors and problems it cant me any saving at all !!