Prednisolone uncoated tablets

The Mid Mersey Medicines Management Board (4MB) The Mid Mersey Medicines Management Board (4MB) recommends the prescribing of uncoated prednisolone tablets in patients newly initiated on prednisolone tablets The Mid Mersey Medicines Management Board (4MB) recommends the switching of patients currently prescribed prednisolone enteric coated tablets to There is currently no evidence to indicate that enteric coated prednisolone is less likely than uncoated prednisolone to cause peptic ulceration.1,2,3 The evidence that enteric coating is less likely to cause dyspepsia is unsatisfactory.3 There is no robust evidence to suggest that enteric coating of prednisolone confers gastro-intestinal protection.1 Note: Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. If appropriate, an exceptional funding request will be required following the usual locally defined process. Review Date: July 2012 (or earlier if there is significant new evidence relating to this recommendation) It is currently accepted that the peptic ulcer risk from taking steroids is a systemic rather than a direct irritant effect.2 Corticosteroid therapy is only weakly linked with peptic ulceration and is mainly in those people who have had a previous peptic ulcer or a disease which is linked to peptic ulceration, e.g. rheu-matoid arthritis and hepatic cirrhosis.2 There is currently no evidence to indicate that enteric coated prednisolone is less likely than un-coated prednisolone to cause peptic ulceration.1,2,3 The enteric coated prednisolone has a similar bioavailability to uncoated, but it has a lower and slower time to peak plasma concentration.1,4 There have been case reports that in some disease states the enteric coated prednisolone can pass through into the small intestine unabsorbed leading to lower plasma cortisol levels.5 Several case reports have demonstrated a lack of disease control in those taking the enteric coated as opposed to uncoated prednisolone and also when a person is switched from uncoated to enteric coated prednisolone1 It is suggested that due to the lower and slower time to peak plasma concentrations and unpre-dictable absorption for some people taking prednisolone enteric coated tablets that for those dis-eases which need stable and predictable steroid levels it is more effective and safer to prescribe uncoated prednisolone.1 On switching, it is recommended the person is monitored closely for disease control. Due to the potential for lower doses of prednisolone being required when patients are switched from the enteric coated to the uncoated form, it is suggested that people are monitored closely after switching for adrenocorticol suppression e.g. blood pressure, electrolytes imbalances, etc (see BNF). Their dose should be reviewed regularly to maintain them on the lowest effective dose to minimise any potential side effects. As with any person on steroids, it is recommended they are monitored for signs of gastrointestinal irritation. A graph showing the quantity and cost of uncoated and enteric coated (e/c) predisolone 5 mg tablets supplied accross the Mid Mersey Health Economy during 2009/10 and the potential cost saving if all e/c had been supplied as uncoated 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 London and South East Regional UKMI Q&A. Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets? January 2010. Anon. Do corticosteroids cause peptic ulcers? Drug Ther Bull 1987; 25: 41-3. Anon. What use is enteric-coated prednisolone? Drug & Therapeutics Bulletin, October 1977; 15 (21): 83-4. Adair C. G, McCallion O, McElnay J. C, et al. A Pharmacokinetic and pharmacodynamic comparison of plain and enteric-coated prednisolone tablets. BJCP 1992; 33: 495-499. Fernando O. N, Moorhead J. Absorption of enteric-coated prednisolone. BMJ 1979; 1795. Review Date: July 2012 (or earlier if there is significant new evidence relating to this recommendation)

Source: http://midmerseymmb.nhs.uk/recommendations/documents/10_10_prednisolone_uncoated_201007.pdf