I had a phone appointment with a GP today (just finished my first month of 15mg pred) and I asked him about enteric coated pred. He said that it's no longer prescribed; apparently research has shown that it offers no further protection to the stomach and it was a 'ruse' by the drug companies to charge more for the drug. Perhaps it's only in Scotland that it's no longer prescribed? Has anyone heard of this?
I feel a bit confused after today's appointment! In a previous phone appointment with the same GP he tried to push the alendronic acid, omeprazole and something else (can't remember!) but I was reluctant to take any of them without looking into it further. Today he didn't try to push any of these. Why the change of heart?! (I'm pleased, but confused!)
The good news is my pred is now down from 15mg to 12.5mg! Heading in the right direction...
I too take omeprazole for Crohns disease. It's essentially for acid in your digestive symptoms.
Btw....good to hear you're down to 12.5mg! I also started at 15mg. but am only down to 14.5mg after bouncing around a bit! Waiting to hear if I may possibly have GCA as opposed to pmr😖🙏! Had blood work done yesterday.
That is totally incorrect, enteric coated pred is still prescribed throughout U.K. 5mg, 2.5mg and 1mg. Ask your pharmacist to back me up. Well done on the reduction.
Dumfries & Galloway did issue instructions to stop the prescribing of enteric coated pred in 2010 - largely based on cost I think and possibly other NHS regions have done the same. It may be that the cost differential is no longer so great. Re your recollection of the doctor offering 'something else' - he should have included a Calcium/Vit. D supplement which is definitely something which is prescribed whilst on prednisolone long term.
Fingers crossed that you don't have GCA. I hope you find out soon - at least then you know what you're dealing with.
Some years ago, according to posts regarding this in the past on this forum, enteric coated pred was more expensive. But no more than regular pred plus a PPI like omeprazole (which, by the way, was not developed as a med to be taken long term and contributes to developing osteoporosis). After the price of regular pred was raised in response to this, the difference is far less.
You're right - Calcium/Vit D was the 'something else' - thank you! I was already taking a Calc/Vit D supplement, so that's how I managed to avoid that prescription.
It's interesting re the enteric coated pred. You'd think if one health board stopped using a drug because of the cost, they all would. After all, none of them are awash with money!
Believe me the enteric coated pred certainly helps my stomach. I take 4 enteric pred at night and (at the moment - after a recent flare) one normal pred in the morning. My stomach usually objects.😏
Great news! Just got call from Rheumy. My "markers" are down in blood results which signifies prednisone is working. Wfewww! 1st time in past 7 weeks I've felt optimistic!
I live in Scotland and I discussed enteric coated Pred with my GP about 2 year ago. He scoffed at the difference in price and said there was very little difference in the cost. He did the maths for me but I'm sorry I can't remember the figures. Perhaps this has changed but the particular GP has now retired.
That's interesting, thank you.
He's lying. OK, maybe he is just misled... It is however possible it isn't allowed in Scotland but only a pharmacist can confirm that - or maybe the Scottish charity.
There was a discussion some years ago which quoted research that showed it was not as reliably absorbed as plain pred - but the research was done in patients with Crohns (or possibly ulcerative colitis, not sure) - where they thought it might be beneficial. It wasn't. But we don't have dodgy guts.
At the time there was a big price difference between plain and enteric coated pred, they claimed 17-fold. GPs agreed they would cut back the enteric coated stuff and prescribe plain plus omeprazole - and promptly had a queue of patients who had developed stomach discomfort with plain pred and a PPI. I have a cast iron gut, it felt like a rodent gnawing away! The GPs weren't amused - and regretted agreeing to give up enteric coated. It was finally admitted that patients who needed it could have it - not entirely unconnected with the fact that the suppliers had in the meantime increased the price of plain pred to a level where there is very little difference - especially when the cost of the PPI is added AND the now 2 dispensing fees that must be paid.
A couple of years ago the manufacturers also added 1mg enteric coated pred - to make reducig in small steps possible, by careful adding up you can reduce 0.5mg at a time down to 2mg before it gets difficult!
A typical costing 3 years ago was:
30 tablets plain pred £1.31
30 tablets enteric coated pred £1.86
30 tablets PPI £1.86
Dispensing fee for each, IRO £1 but it can be higher
The overall cost difference is small - and it saves another level of side effects as PPIs can have unpleasant gut effects as well as not working for about one third of patients.They also contribute to developing osteoporosis in the long term.
Speak to a local, preferably private, pharmacist. In case they haven't heard of g/r 1mg:
https://www.medicines.org.uk/emc/product/2077/pil
Not everyone needs coated Pred. It was never suggested to me but I was lucky and found that taking it with a tablespoon of organic natural unsweetened yoghurt did the trick The yoghurt had been recommended to me by a hospital nurse following an endoscopy long before PMR which showed no specific stomach problem. I have never had a recurrence. I wish I had shares in Yeo Valley! I've eaten quarts of it over the years. Worth a try. Cannot do any harm which is more than can be said for some of the stuff Big Pharma tries to push.
It's possible that it has changed in Scotland but I was certainly being prescribed it for 2.5mgs, though not recently, but I haven't requested it. Some medications have been stopped recently, one in particular, was found not to be effective for an eye condition but there is certainly cost cutting so whether it's the case with enteric coated Pred I don't know.
You're not too far behind me MhairiP. I did one month on 15mg in May, going into June. My silly GP then put me down to 10mg - I stuck with it for 3 wks before accepting that it wasn't doing the job so I more or less insisted that I go up to 12.5mg. That was fine so hopefully it will also be for you - best of luck. I'm just tapering from 12.5 to 10mg using DSNS, think it's going to be ok this time. I wasn't as sensible as you and accepted the alendronic acid and omeprazole.
The big advantage is that you do not have to pay for the cost of the PPIs too.
One advantage of living in Scotland is that prescriptions are free for all. As I'm over 60 they would have been free anyway.
I was really talking about the NHS having to pay for the PPIs as well, but you are right in England under 60s would have to have two prescriptions.