NON-ENTERIC COATED TABS : PROBLEM & SOLUTION!

Bones, joints and muscles
1

Hi

I'm new here, so quick background info. I have had ulcerative colitis for 35 yrs and was diagnosed with polymyalgia rheumatica after a haywire blood test last Feb, which had been masked for the previous 6 months by a degenerative spinal condition.

My super GP put me on high dose prednisolone tabs, all enteric coated, and I am now reducing. Thanks to the tablets, the PMR is recovering well and my UC has been brilliantly calm all year. Was down to 10 mg when I had a nasty UC flare up.

The UC was starting to calm down again - as it does - when my GP decided I could reduce the dosage to 9 mg (1 x 5 EC tab and 4 x non-EC tabs per day). Instant relapse of UC!!

As all of us know, steroids don't leave the body for a long time, and neither do their side effects (I wish!).

But it does mean a daily dose of 9 mg can be averaged out over, say, 3 days and taken as 2 x 5 mg EC tabs one day, 2 x 5 mg EC tabs the next, and 1 x 5 mg EC tab + 1 x 2.5 mg EC tab the next = 10 + 10 + 7.5 = 27.5 mgs over the 3 days (or just over 9.1 mg each day). Then repeat the 3-day cycle (I mark off the correct dosage for the day on the calendar.)

Similarly, as my old maths teacher used to say, to make up a daily dose of 8 mg for example, you could take 2 x 5 mg EC tabs the first day, then 1 x 5 mg EC plus 1 x 2.5mg EC tab for each of the following 2 days = 10 + 7.5 + 7.5 = 25 mg over the 3 days (or just over 8.1 mg per day).

With the approval of your GP and a bit of ingenuity you need never take a non-enteric coated tablet again! Even below 2 mg it should be possible to take 1 x 2.5 mg EC tab every other day.

Of course, IT IS IMPORTANT YOU KEEP TRACK OF YOUR DOSAGE EVERY SINGLE DAY.

My GP tells me he is under pressure from our PCT not to prescribe 5 mg EC tablets if the patient can tolerate the non-EC version, so you may have to get him/her to push for you. But, hey, you could always double up on the 2.5 mg EC tabs which apparently are freely prescribable. (And no, we don't understand it either.)

Hope this tip helps someone else. Best of luck out there

from

turnip

2

Hello turnip!

So glad to hear you've found a way of managing the steroids whilst suffering from UC - as if that isn't enough to cope with without PMR!

There is another person who posts here who, I know, has managed her reductions in a similar way due to stomach problems and she may post her experience when she sees your post.

I was unable to tolerate the stomach protection pills prescribed alongside the steroids so have taken a 'live' yoghurt each day before taking the Pred and that seems to have been successful for me.

Good luck on your continuing journey with PMR!

MrsO

3

Hi turnip! That's not a very flattering username!!!!!! But I like turnip and turnips (only Scots will appreciate the difference :lol: )

Your scheme of averaging the dose over a few days is something similar to what a couple of gents suggested for very very slow reductions without cutting tablets - although they were using non-enteric coated tabs as they were not in the UK. You don't get enteric coated anywhere else in Europe or (to my knowledge) in the US. But it is so useful to have people reminded that this can be done with no problems. There has been someone recently just taking 1x2.5 tab a week - then came the problem how she reduced from there!!

Actually some steroids DO leave the body very quickly - and pred is one of them, it is excreted within several hours. It is the antiinflammatoy effect that hangs on anything from 12 to 36 hours and that is what allows some people to use the idea of taking their dose as twice the dose on alternate days and so allowing their body quite a time without the bad effects of the pred. Other corticosteroids stay in the body longer and so cause even worse side-effects and that's why their use is avoided unless necessary.

The reason your GP is under pressure not to prescribe enteric coated pred is because the perceived wisdom was that there was little difference in gastric side-effects between the two and many GPs saw no reason not to adopt the use of ordinary pred tablets together with PPIs as stomach protection. That was until push came to shove and loads of patients came back complaining about problems with the ordinary tabs and the PPIs - and then lots of GPs regretted their decision. It was all basically down to money anyway: enteric coated cost about 17 times what ordinary tabs did and the combo of ordinary plus the cheapest PPI saved money. But the cheapest PPI is the one that causes most problems in its own right anyway :roll: . Now you can add to that the fact that, as soon as the GPs were told to restrict prescribing enteric coated, the drug companies increased the price of the ordinary tabs - and now there is very little difference! You have to get up very early in the morning to make money out of drug companies :wink: The allowance of 2.5's and not 5's may be because there are ordinary 5's but not ordinary 2.5s so they are filling a niche.

However - it could also have something to do with a problem I have had this year but they aren't letting on. I have always taken my pred as enteric coated and have had absolutely no problem. I spent a lot of time out of the country and stocked up when home - and in August got a batch of 5's and 2.5s. I didn't need them until the beginning of October and within 2 and a bit weeks went from fine to almost as bad as at the outset - on the same dose apparently. Except it was the new batch of 5mg enteric coated pills. Swapping to the 2.5mg pills at 12.5mg/day got me back to almost normal - still not quite as good as on the previous stuff at 10mg though. I'm now on Medrol, uncoated methylprednisolone at 8mg/day (the same as 10mg prednisolone) and seem OK - I hope. The weather is about to change and I can feel it - I hope it is just the weather! But was that a very dodgy batch of 5mg pills the NHS bought in???? They will never tell us.

Interesting that you absorb the enteric coated stuff OK with UC as in some gastrointestinal diseases there is impaired absorption - although is the main reason for having enteric coated for UC that it reaches the colon before being absorbed? I did read something about that recently in a set of medical publications about enteric coated vs not ec pills but was looking at the graphs more closely than the text :oops:

Nice to \"meet\" you! Do keep in touch,

Eileen

4

To MrsO

Thanks for the info about 'live' yogurt. I already take a daily Actimel yogurt drink to help with the UC, as recommended years ago by my consultant. My sister also has UC and her consultant was very sceptical at first, saying the stomach acid would destroy the 'live' bit before it reached the colon, but now he has come round as there is so much evidence to show enough of it gets through to help. Didn't realise it might help with the absorption of steroids though - that's a useful tip. Thanks and good health to you.

To EileenH

England 1 : Rest of World 0! Well that's an unusual winning score for the NHS!! I didn't realise we were so favoured to get ANY EC prednisolone at all.

Sorry to hear you had such a rough time with a rogue batch of 5 mg EC tablets, especially when you went to all that trouble to stock up. I do hope it was a one-off situation for all our sakes, but have made a note of Medrol just in case.

Maybe I am just lucky that I can get enough absorption from the EC tablets even with UC, but of course UC occurs in different places: my sister has it in the transverse colon (higher up) and mine is in the descending colon, so maybe that is the reason. She hasn't needed oral steroids - yet! - just the retention enemas.

Best of luck with your recovery on Medrol - it's good to know there is an alternative out there.

Kind regards to you both

turnip

5

Just noticed - where in North Yorks are you? There is a pretty active support group in Middlesborough and several people around the York area now involved with the other forum linked to the northeast pmr/gca support group. Just thought you might be interested! My daughter is a paramedic in Whitby.

Wonderful stuff yoghurt - whatever sceptical NHS consultants might think :wink: The whole of the rest of Europe uses stuff the NHS goes pooh-pooh at - but it seems to work quite well! I and my husband used to work in the NHS and all the next generation do too so we do know a lot about it and its workings!

Eileen

6

To Eileen H

No, nowhere near Middlesbrough or Whitby, but thanks for the suggestion. Best of luck with your ongoing (I hope) recovery.

Regards

turnip

7

Hi Turnip

Why are you called that??!!

I think I am the one Mrs O refers to when she talks about someone who has to manage on just EC tablets.

I have managed my reduction using just 5mg and 2,5 mg tablets as I had a bad stomach reaction when I took the 1mg NEC ones for a few days months ago. I tried to reduce so that I had less than a 10% reduction each time and kept to that for at least 2 weeks before reducing again.

When i was going from 5mg to 2.5mg, I would eg do 2 weeks of 5,5,5,5,5,5,2.5 then 2 weeks of 5,5,5,5,5,2.5 then 5,5,5,5,2.5 etc.

It got more difficult below 2.5 but did 2.5,2.5,2.5,2.5,2.5, 2.5, 0 then as above adding in 0 days. It worked perfectly well.

All was well till a few weeks ago (had been on 2.5 every 5th day for 2 months) when I started getting sore upper arms and shoulders. Just had my ESR re-tested and got the result today. It has gone up to the level it was at when I started PMR 2 years ago so i reckon I need to get back up to 2.5mg every day for a while and see how that goes. i will ask my GP but I doubt she will know! I prefer to ask people on here - they know a lot more.

I have started a new thread to ask them what to do.

Good luck with it all

Beev

8

Hi Beev

That's s good way of tackling 'our' problem. If it's worked for you all the way down the scale I'm sure you'll work out a way of continuing on down - just sorry you're having such a nasty hiccup after all this time. GPs and consultants try hard but no-one knows us like us, do they?

Best of luck healthwise, and with your new thread.

turnip

(It's turnip cos that was part of an email address once suggested by Yahoo - try as I might that one stuck when the others were all forgotten!)

9

Hello Beev and yes it was you I had in mind in my post to Turnip. Didn't want to quote your name on here but I guessed you would be 'popping in' some time. Thank you.

MrsO