Dexamethasone sucks; why don't they prescribe Prednisolone?

Can any of the Doper Docs explain why Prednisolone is no longer prescribed for anterior uveitis?

The last two times I had uveitis I was prescribed Prednisolone which worked very nicely. This time they’ve prescribed me Dexamethasone which is fixing the problem but I’m suffering side effects - odd dreams (not nightmares) and occasional insomnia. Like last night. I raised this with the optician and he would not change my prescription - I’m almost finished tapering off anyway, thank goodness - but he said that Prednisolone is not allowed. Why is that?

Can opticians even prescribe drugs?

Technically, they advise a doctor to prescribe the drug, but that’s a rubber-stamp process. Note that I’m in the UK.

Whoops. Sorry.

Is cost a consideration? I know someone using dexamethasone ophthalmic drops instead of prednisisolone ophthalmic drops because it saves him $60 a bottle.

But you likely don’t have to consider cost, living in a rational country.

As for side effects, long ago laboratory error led to my being on an immunosuppressive dose of prednisilone, and along with peeing every 45 minutes, I suffered horrible depression/anger issues.

“odd dreams (not nightmares) and occasional insomnia”

Just be glad yours is caused by a medication that you’re tapering off of. For me that’s just bedtime.

Opticians can’t; optometrists can as long as it is within the scope of their practice.

IME, both dexamethasone and predisolone are equally well (or not so well) tolerated. Both are effective for the treatment of anterior uveitis.

I’d suspect prednisolone is ‘not allowed’ for cost reasons. I’ve been helping manage our system’s formulary, and with drug prices fluctuating wildly where one day a drug that was 10 cents a dose is now jacked up to $47.34 per pill while a very similar drug is still 20 cents a dose, we often end up yanking the former off the formulary and substituting the latter.

I’ve got my follow-up appointment in the morning and I’ve just weighed myself. I’ve gone from heading down towards 18 stone to nearly 20 stone.

I’m looking at my UHC cost and GoodRX and they both quote about $15 for a Methylprednisolone dospack (21 pills @ 4mg each). I’m having a really hard time finding (regular) prednisolone (pills, I’m just finding injectable vials) but I’ve been used both, semi-regularly and don’t recall one being more expensive than the other.

Having said that, if you don’t like this one, either straight up request the one you do like** or, when they say ‘I’d like to put you on [other one]’ just say ‘that one gives me some side effects* I don’t like could I use the other one’. Some doctors are weird about one drug over another, but in general, I’ve never had a problem saying ‘nope, don’t like it, want this instead’. I’ve even done it with (not shceulded) muscle relaxants since I HATE flexeril, but Soma works great and I’ve never had a problem getting ADD meds switching around with little more than a simple email saying ‘this isn’t working, can we try that’ or ‘this is working great, but it wears off, can we double it so I can redose at lunch’. Keep in mind, ADD meds are, more or less pharmaceutical speed. A good doc will listen to you and work with you, either believing you or, at least explaining to you why they feel the med they prescribed is better than the one they gave you. For example, assuming you’re on steroids for a short periods of time, the doc might tell you ‘well, I’ve had much better luck with this one’ or ‘in the long run…’, something, but if they just have a stick up their butt about it (and I’ve had that happen to), it might be time to see someone else if the side effects are really that bad.

TL;DR, just ask, most docs will oblige unless they have a good reason not to.

*A nurse that I know very well, as well as a a few drug reps (of which I know, like, 300) have suggested that instead of trying to explain why you don’t want what they’re offering (and remember, they probably just write it because that’s their drug of choice) a good phase is ‘I don’t tolerate that med well’. ‘Tolerate’ or better yet ‘doesn’t tolerate’ seems to be regular medical lingo so they just type it in, often without thinking much of it. If they ask for specifics, then you can tell them what’s going on and you can mention the bad dreams and maybe that it makes you really stressed out when you have to take it.

**Maybe it’s because I have good, long term (often on first name basis (sometimes with the PA)) relationships with the doctors, but I find it’s easier to not beat around the bush and when they ask me why I’m here, just say ‘I’m having another issue with [problem] and I was looking for script for [script]’. It’s just easier than beating around the bush and hoping for the best. If you don’t want to go that route, see if you can email your doctor (if they have Epic/MyChart, it’s very easy), a day or two after you get the script, don’t even have to fill it, send them and email and say ‘I’m having bad dreams with this, it always seems to happen, could I get a script for that instead’. I’ll be willing to bet any of the suggestions in this post work just fine, unless the doc has that stick up their butt syndrome.

One last thing, I don’t (at least quickly) see bad dreams/nightmares on the side effects list, but I do see sleeplessness/trouble sleeping. It may be easier to mention that instead. I hate to advocate lying and I’d still prefer you’d just come out and say ‘Could I just get prednisolone instead’, but if you need a reason, you might be better off picking something off the established side effects list.