PK/PD properties Formulation Flashcards
Patient example - formulation
A 65-year-old male patient presented with a IE COPD, he is prescribed oral prednisolone 30mg for 5 days. He has concerns about the risk of gastric irritation and ulcers due to his long-term use of NSAIDs. He requests a prescription for enteric-coated prednisolone, thinking that it may be better for his stomach.
I would explain that while enteric-coated (EC) prednisolone is marketed as gentler on the stomach, there is no evidence it offers any advantage over regular prednisolone. The goal of treatment is to rapidly reduce airway inflammation during an exacerbation and EC prednisolone has delayed and variable absorption. The time to reach peak blood levels is significantly longer, taking up to 4 hours, which may delay the therapeutic effect required for acute exacerbations. Given the patients NSAID use, which already increases the risk of gastrointestinal issues, the issue is not the prednisolone formulation but the combination of NSAIDs and steroids. Standard prednisolone, taken first thing in the morning, offers quicker and more reliable absorption, making it the better choice. I’d also recommend monitoring for gastric discomfort and considering a proton pump inhibitor (PPI) if necessary.
